Hip replacement is one of medicine's most successful operations. What to expect week by week, the exercises that matter, and how physio helps you recover.
A total hip replacement has been called "the operation of the century" — the title of a 2007 review in The Lancet — because of how reliably it relieves pain and restores mobility for people with advanced hip arthritis. Many people are walking without aids within weeks and wonder why they waited so long.
Recovery still takes work, though. The muscles around the hip need rebuilding, walking needs retraining, and there are practical questions about sleeping, sitting, driving and getting back to the things you enjoy. This guide explains the stages of recovery, the exercises that matter most, what the research says about hip precautions, and how physiotherapy helps. Your surgeon's instructions always come first.
At a glance
- Hospital stay: usually a few days, walking the day of or after surgery
- Walking aids: commonly for 2–6 weeks
- Hip precautions: depend on your surgeon and surgical approach — many now use fewer restrictions
- Driving: often around 4–6 weeks
- Most improvement: in the first 3 months, continuing for up to a year
- Key to recovery: strengthening the hip and thigh muscles, especially the gluteals
What is a total hip replacement?
The hip is a ball-and-socket joint. In a total hip replacement, the worn ball at the top of the thigh bone is replaced with a metal or ceramic ball on a stem fixed into the thigh bone, and the socket is lined with a new cup. The aim is a smooth, pain-free, stable joint.
Surgeons reach the hip through different approaches — commonly from the back (posterior), the side (lateral) or the front (anterior). The approach affects which muscles are disturbed and which movements may be restricted early on. Ask your surgeon which approach they used, as it shapes your rehab.
When is it time?
A hip replacement is usually considered when arthritis causes significant pain and limitation despite non-surgical care. Our hip arthritis guide covers non-surgical options and the signs it may be time to talk to a surgeon.
Before surgery: prehab
- Strengthen the hip, thigh and core muscles, and keep walking as comfortably as you can
- Practise walking with crutches or a frame, and getting in and out of a chair and bed
- Prepare your home: firm, higher chairs with arms, a raised toilet seat if advised, rugs removed, items at waist height
- Arrange help for the first few weeks, especially with driving and shopping
- Stop smoking, and manage diabetes and weight, to help healing
Questions to ask your surgeon
- Which approach will you use, and what precautions will I have?
- How long do the precautions apply?
- Can I put full weight through the leg straight away?
- When can I drive, return to work, swim and cycle?
- Who do I contact if I am worried after I go home?
Hip precautions: what does the evidence say?
For many years, people were given strict "hip precautions" after surgery to reduce the risk of dislocation — for example not bending the hip past 90 degrees, not crossing the legs, and not twisting — along with equipment like raised toilet seats and long-handled reachers.
A Cochrane review looked at the evidence for these precautions and equipment and found it was insufficient to show whether they reduce dislocation, while they can make daily life harder. As surgical techniques have improved, many surgeons now give fewer or shorter-term restrictions, particularly after an anterior approach.
The practical message: follow your own surgeon's precautions, and ask how long they apply. They differ between surgeons and approaches, and your physio will work within them.
The stages of recovery
In hospital (days 1–3)
- Up and walking with a frame or crutches, usually on the day of or after surgery
- Gentle exercises: ankle pumps, buttock squeezes, thigh tightening, heel slides
- Learning stairs, getting in and out of bed, the car and the toilet within any precautions
Weeks 1–6: walking and early strength
- Walking: several short walks a day, gradually increasing; progress from frame to crutches to a stick to no aid as your limp improves.
- Exercises: standing hip movements to the side, back and front within precautions; bridges; mini squats holding a bench; sit-to-stands.
- Swelling and bruising down the thigh are common; elevation and ice help.
- Sleep: most people sleep on their back at first, sometimes with a pillow between the knees when on the side, as advised.
Weeks 6–12: strength and normal walking
- Progressive strengthening, especially the gluteal muscles on the side of the hip, which control a limp
- Balance training
- Longer walks, stationary cycling and water exercise once wounds have healed and your surgeon agrees
- Return to driving, work and most daily activities
Months 3–12: keep building
Strength, walking speed and endurance continue to improve. Some people notice a slight limp or tiredness on long walks for months, which usually improves with continued strengthening.
“The single biggest factor in walking without a limp after a hip replacement is strength in the muscles on the side of the hip. That work continues long after the wound has healed.”
— UpPlus Physiotherapy team
A milestone checklist
| When | Common milestones |
|---|---|
| Week 1 | Walking around home with an aid; managing stairs and getting in and out of bed and chairs. |
| Weeks 2–3 | Wound healing; walking short distances outside; exercises becoming easier. |
| Weeks 4–6 | Often down to one crutch or a stick, then no aid; limp improving; stationary bike if allowed. |
| Weeks 6–12 | Driving, shopping and light work; longer walks; precautions often eased by your surgeon. |
| 3–12 months | Strength, walking speed and endurance continue to improve; the limp usually resolves. |
Managing pain, swelling and sleep
- Take pain relief as prescribed, especially before exercise and walking in the first weeks.
- Swelling and bruising often spread down the thigh to the knee and even the ankle. Lying down with the leg raised, and short walks, help it settle.
- Ice wrapped in a cloth for 15–20 minutes after exercise can ease soreness.
- Sleep on your back at first, or on your side with a pillow between the knees if your surgeon allows. Most people find sleep settles after a few weeks.
- Pace yourself: several short walks a day are better than one long one.
Preventing falls at home
A fall in the first weeks is one of the biggest risks to a new hip. Simple changes help:
- Remove loose rugs, cords and clutter from walkways.
- Use night lights between the bedroom and the bathroom.
- Wear supportive, closed-in shoes or slippers with a firm sole.
- Use a shower chair and grab rails if you have them, and a non-slip mat.
- Take your time standing up, especially at night, and keep your walking aid within reach.
- Ask for help with pets, which can get under your feet.
What does the research say about rehab?
- An Australian systematic review in the Journal of Physiotherapy found that physiotherapist-directed exercise in the outpatient or home setting improved strength, walking speed and walking pattern after hip replacement.
- Another systematic review of exercise after hip replacement found benefits from progressive strengthening and walking training, especially in the weeks and months after hospital.
Key exercises
- Buttock squeezes: squeeze and hold 5 seconds, 10 times, several times a day.
- Heel slides: lying down, slide the heel towards you and back, within your precautions.
- Standing hip abduction: holding a bench, lift the leg out to the side and lower slowly. 10–15 times.
- Standing hip extension: holding a bench, take the leg straight back without leaning forward. 10–15 times.
- Bridges: lying on your back, lift the hips. 10–15 times, as allowed.
- Sit to stand from a firm, higher chair, progressing to lower chairs.
- Step-ups onto a low step as strength improves.
Everyday questions
When can I drive?
Often around 4–6 weeks, once you are off crutches, can get in and out of the car comfortably within any precautions, and can brake firmly. Check with your surgeon and your insurer.
Getting in and out of the car
Push the passenger seat right back and recline it slightly. Back up to the seat, sit down first, then swing both legs in together, keeping within any precautions. A plastic bag on the seat makes turning easier. Reverse the steps to get out. Plan short trips at first, with breaks to stand and walk on longer journeys.
When can I go back to work?
Desk work is often possible at 4–6 weeks; physical work may take three months or more.
What about sport and activity?
Walking, cycling, swimming, golf, bowls, tennis doubles, dancing and gym work are commonly enjoyed after a hip replacement. High-impact running and jumping sports are generally discouraged. Ask your surgeon about your specific situation.
Can I sit in low chairs and on the floor?
In the early weeks, higher, firm chairs with arms are easier and may be part of your precautions. Low couches, deep armchairs and sitting on the floor usually come later, once your surgeon is happy and your strength allows. Practising sit-to-stand from progressively lower chairs is a useful exercise in itself, and getting down to the floor and back up safely is a goal worth working towards with your physio.
Will one leg feel longer?
Some people feel a difference in leg length early on, often due to muscle tightness and the pelvis tilting, which commonly settles over weeks to months. If it persists, discuss it with your surgeon and physio.
Realistic expectations
Most people are very satisfied after a hip replacement. A systematic review in BMJ Open found that a minority of people still report unfavourable pain long-term — fewer than after knee replacement, but enough that persistent pain should be assessed rather than accepted.
Warning signs
Contact your surgeon or GP promptly, or seek urgent care, if you have:
- Fever, or increasing redness, heat, swelling or discharge from the wound
- Calf pain and swelling, chest pain or shortness of breath (call 000)
- Sudden severe pain, a clunk, the leg looking shorter or turned, or being unable to stand — possible dislocation
How UpPlus Physiotherapy helps after hip replacement
- Prehab before surgery and home set-up advice
- Rehab in the clinic, and home-visit physiotherapy in the early weeks if needed
- A staged walking and strengthening programme within your surgeon's precautions
- Hydrotherapy and gym-based rehab as you progress
- Support for DVA clients and liaison with your surgeon
Read more about our hip replacement rehab, and our knee replacement guide.
Finding a physio near me after hip replacement
When searching for the best physio after a hip replacement, look for someone who works within your surgeon's precautions, focuses on walking and gluteal strength, and keeps progressing you well beyond the first few weeks.
Our clinic is at 177 Trimmer Parade, Seaton, a short drive from Woodville, Findon, West Lakes, Grange and Semaphore Park. No referral is needed, and you can claim on the spot with private health cover.
Physio take-home message
- Hip replacement is highly successful for advanced hip arthritis.
- Follow your own surgeon's precautions — they vary with the surgical approach.
- Walk little and often early on, and build up gradually.
- Strengthen the gluteal muscles to walk without a limp.
- Report warning signs such as fever, wound changes, calf swelling or sudden severe pain.
If you are preparing for or recovering from a hip replacement, our physiotherapists can guide you at every stage. Book online or call 0403 907 587.
This article is general information, not a diagnosis or a substitute for an individual assessment or your surgeon's instructions. If you are unsure about your recovery, contact your surgeon or a health professional.
