Exercises After Hip Replacement: Safe Recovery Guide

You've had a hip replacement. The surgery is done, and now the real work begins—rebuilding strength, mobility, and confidence in your new hip.

Exercise after hip replacement is essential for recovery. But it must be done safely, progressively, and with awareness of precautions. Here's your guide.

The Goals of Post-Hip Replacement Exercise

Short-Term (0-6 weeks)

• Reduce swelling
• Prevent blood clots
• Maintain hip mobility
• Begin gentle strengthening
• Walk safely with assistive device

Medium-Term (6-12 weeks)

• Restore normal walking pattern
• Build strength for daily activities
• Increase range of motion
• Reduce need for assistive devices

Long-Term (3-12 months)

• Return to normal activities
• Build strength for active lifestyle
• Maintain hip function
• Prevent future problems

Critical Precautions: Protect Your New Hip

Most hip replacements today have specific movement precautions to prevent dislocation, especially in the early weeks.

Posterior Approach Precautions (Most Common)

If your surgeon used a posterior approach, typically avoid:

• Flexing hip past 90 degrees (don't bend too far forward)
• Crossing operated leg over midline (don't cross legs)
• Internal rotation (don't turn foot/knee inward)

For how long: Usually 6-12 weeks, but follow your surgeon's specific instructions.

Anterior Approach Precautions

Anterior approach may have different or fewer restrictions:

• Avoid extreme hip extension (leg too far back)
• Avoid external rotation (in some cases)

Important: Follow YOUR surgeon's specific instructions. Approaches and precautions vary.

General Safety Rules

• Use prescribed walker or cane as instructed
• Don't sit in low chairs (hip flexes too much)
• Use raised toilet seat
• Don't pivot on operated leg
• Sleep with pillow between legs

Phase 1: Early Recovery (Days 1-14)

You'll start exercises in the hospital, usually the day of or after surgery.

Ankle Pumps

Purpose: Prevent blood clots, promote circulation

How to do it:

1. Lying in bed
2. Pump feet up and down (like pressing gas pedal)
3. 10-20 reps, every hour while awake

Quad Sets

Purpose: Activate thigh muscles

How to do it:

1. Lying with legs straight
2. Tighten thigh muscle, pressing back of knee into bed
3. Hold 5 seconds
4. Relax
5. 10 reps, 3-4 times daily

Glute Squeezes

Purpose: Activate buttock muscles

How to do it:

1. Lying on back
2. Squeeze buttocks together
3. Hold 5 seconds
4. Relax
5. 10 reps, 3-4 times daily

Heel Slides

Purpose: Gently mobilize hip

How to do it:

1. Lying on back
2. Slide heel toward buttock, bending knee
3. Don't go past 90 degrees hip flexion
4. Slide back out
5. 10 reps, 3 times daily

Straight Leg Raise (Assisted)

Purpose: Begin hip flexor strengthening

How to do it:

1. Lying on back, non-operated knee bent
2. Tighten thigh of operated leg
3. Lift leg 6-12 inches, keeping knee straight
4. May need assistance initially
5. 10 reps, 2-3 times daily

Walking

Purpose: Essential for recovery

How to do it:

• Use walker or crutches as instructed
• Follow weight-bearing guidelines (may be partial or full)
• Start with short distances
• Gradually increase
• Walk multiple times daily

Phase 2: Building Strength (Weeks 2-6)

Continue Phase 1 exercises and add:

Standing Hip Abduction

Purpose: Strengthen outer hip

How to do it:

1. Stand holding support (counter, walker)
2. Move operated leg out to side
3. Keep knee straight, toe pointing forward
4. Lower slowly
5. 10 reps, 2 sets

Standing Hip Extension

Purpose: Strengthen glutes and hip extensors

How to do it:

1. Stand holding support
2. Move operated leg straight back
3. Keep knee straight, don't arch lower back
4. Lower slowly
5. 10 reps, 2 sets

Note: If you had anterior approach, ask your PT about this exercise.

Standing Knee Raise

Purpose: Hip flexor strengthening

How to do it:

1. Stand holding support
2. Raise knee toward chest
3. Don't go past 90 degrees (or your prescribed limit)
4. Lower slowly
5. 10 reps, 2 sets

Seated Knee Extension

Purpose: Quadriceps strengthening

How to do it:

1. Sit in chair (proper height to avoid excessive hip flexion)
2. Straighten knee, raising foot
3. Hold 3 seconds
4. Lower slowly
5. 10 reps, 2 sets each leg

Glute Bridges

Purpose: Hip extensor and glute strengthening

How to do it:

1. Lie on back, knees bent, feet flat
2. Squeeze glutes and lift hips
3. Don't overarch lower back
4. Lower slowly
5. 10 reps, 2 sets

Walking Progression

• Gradually increase distance
• Work toward walking without limp
• May transition from walker to cane
• Follow PT and surgeon guidance

Phase 3: Functional Progression (Weeks 6-12)

As precautions are lifted (confirm with your surgeon):

Side-Lying Hip Abduction

Purpose: Outer hip strengthening with gravity

How to do it:

1. Lie on non-operated side
2. Keep operated leg straight
3. Lift leg toward ceiling
4. Lower slowly
5. 15 reps, 2 sets

Mini Squats

Purpose: Functional leg strengthening

How to do it:

1. Stand with feet shoulder-width apart
2. Hold support if needed
3. Bend knees slightly (30-45 degrees)
4. Don't go deeper than comfortable
5. 12 reps, 2 sets

Step-Ups

Purpose: Functional strength for stairs

How to do it:

1. Use low step (4-6 inches initially)
2. Step up with operated leg
3. Bring other foot up
4. Step down with non-operated leg first
5. 10 reps each leg

Heel Raises

Purpose: Calf strength and balance

How to do it:

1. Stand holding support
2. Rise up on toes
3. Lower slowly
4. 15 reps, 2 sets

Stationary Cycling

Purpose: Cardiovascular fitness, hip mobility

How to do it:

• Seat high enough that hip stays under 90 degrees
• Low resistance
• Start with 5-10 minutes
• Progress to 20-30 minutes

Balance Exercises

Purpose: Stability and fall prevention

How to do it:

• Single leg stand (with support nearby)
• Weight shifts
• Tandem standing
• Progress as balance improves

Phase 4: Return to Activity (3-12 Months)

Strengthening Progression

• Increase resistance in exercises
• Add exercises like lunges (when cleared)
• Progress to gym equipment if desired
• Continue hip-specific exercises

Cardiovascular Options

Usually safe:

• Walking
• Swimming (after incision heals)
• Cycling
• Elliptical
• Water aerobics

Check with surgeon:

• Golf
• Doubles tennis
• Dancing
• Hiking

Often not recommended:

• Running (high impact)
• High-impact aerobics
• Contact sports
• Singles tennis

Long-Term Maintenance

• Continue hip strengthening 2-3x/week
• Maintain cardiovascular fitness
• Keep a healthy weight (reduces hip stress)
• Stay active within recommended activities

Sample Weekly Schedule

Weeks 1-2

Daily:

• Ankle pumps: Every hour
• Quad sets: 10 reps, 4x/day
• Glute squeezes: 10 reps, 4x/day
• Heel slides: 10 reps, 3x/day
• Straight leg raises: 10 reps, 3x/day
• Walking: Multiple short sessions

Weeks 3-6

Daily:

• Walking: Increasing distance
• Phase 1 exercises: Continue

3x/week:

• Standing hip abduction: 10 reps, 2 sets
• Standing hip extension: 10 reps, 2 sets
• Standing knee raise: 10 reps, 2 sets
• Glute bridges: 10 reps, 2 sets
• Seated knee extension: 10 reps, 2 sets

Weeks 7-12

Daily:

• Walking: 20-30+ minutes

3-4x/week:

• Side-lying abduction: 15 reps, 2 sets
• Mini squats: 12 reps, 2 sets
• Step-ups: 10 reps each leg
• Heel raises: 15 reps, 2 sets
• Glute bridges: 15 reps, 2 sets
• Stationary cycling: 15-20 minutes
• Balance exercises: 5 minutes

Warning Signs: When to Contact Your Doctor

Call your surgeon if you experience:

• Increased pain that doesn't respond to medication
• Significant swelling or redness at incision
• Fever over 101°F
• Drainage from incision
• Sudden increase in pain after improvement
• Leg feels unstable or gives way
• Signs of blood clot (calf pain, swelling, warmth)

Tips for Success

Follow Precautions

Dislocation is a real risk. Follow movement precautions exactly as instructed until cleared.

Attend Physical Therapy

Outpatient PT is crucial. Attend all sessions and do home exercises as prescribed.

Be Patient

Recovery takes months, not weeks. Progress can feel slow, but it's happening.

Pain Management

Some discomfort during exercise is normal. Sharp pain or significantly increased pain after exercise means you did too much.

Ice After Exercise

If swelling increases after exercise, ice for 15-20 minutes.

Stay Consistent

Daily exercise, even when you don't feel like it, drives recovery.

The Bottom Line

Hip replacement recovery requires consistent, progressive exercise within safe guidelines.

The essentials:

1. Follow precautions exactly as prescribed
2. Start immediately with simple exercises
3. Progress gradually through phases
4. Attend physical therapy (essential for best outcomes)
5. Be patient (full recovery takes 6-12 months)
6. Stay active for life (protect your investment)

Your new hip is designed to last for years and return you to an active life. The work you put into recovery determines how well and how quickly you get there.

Start with the basics. Progress safely. Trust the process. Your new hip will thank you.