Hip Replacement Exercises: Complete Recovery Guide

A hip replacement can give you your life back—freedom from pain, ability to walk without a limp, and return to activities you love. But surgery is just the first step. The exercises you do during recovery determine your outcome. This guide takes you from day one through full recovery.

Understanding Your Recovery

Surgical Approach Matters

Your exercise precautions depend on your surgical approach:

Posterior approach (most common):

• Avoid hip flexion beyond 90 degrees
• Avoid internal rotation (turning knee inward)
• Avoid crossing legs
• Precautions typically for 6-12 weeks

Anterior approach:

• Fewer precautions often
• Avoid hip extension combined with external rotation
• Precautions typically for 2-6 weeks

Always follow YOUR surgeon's specific guidelines.

Recovery Timeline

• Week 1-2: Basic mobility, reduce swelling
• Week 3-6: Progress range of motion, begin strengthening
• Week 6-12: Build strength and endurance
• Month 3-6: Return to most activities
• Month 6-12: Full recovery and optimization

Goals

1. Walk with a normal gait pattern
2. Regain hip range of motion
3. Restore muscle strength
4. Return to desired activities
5. Protect the new hip while it heals

Hip Precautions (Know Yours!)

Posterior Approach Precautions

Do NOT:

• Bend hip past 90 degrees
• Cross your legs
• Turn knee/foot inward
• Twist at the hip

Use:

• Raised toilet seat
• Reacher/grabber
• Long-handled shoe horn
• Chair with arms

How to Follow Precautions

Sitting: Keep knees below hips; avoid low chairs Sleeping: Sleep on back or non-surgical side with pillow between legs Bending: Use hip hinge, don't round forward Getting dressed: Use assistive devices; surgical leg last into pants, first out

Phase 1: Days 1-14 (Immediate Post-Op)

Start these exercises in the hospital and continue at home.

Ankle Pumps

Prevents blood clots:

1. Pump feet up and down
2. 20-30 repetitions
3. Every hour while awake

Quad Sets

1. Lie with leg extended
2. Tighten thigh muscle, pushing knee down
3. Hold 5-10 seconds
4. 10-20 repetitions, 4 times daily

Glute Sets

1. Squeeze buttock muscles together
2. Hold 5 seconds
3. Relax
4. 10-20 repetitions, 4 times daily

Heel Slides (Within Precautions)

1. Lie on back
2. Slide heel toward buttock, bending hip and knee
3. Only go as far as your precautions allow (90 degrees max for posterior)
4. Slide back out
5. 10-20 repetitions, 3-4 times daily

Straight Leg Raise (Hip Flexion)

1. Lie on back
2. Tighten quad
3. Lift entire leg 6-12 inches
4. Hold 5 seconds
5. Lower slowly
6. 10 repetitions, 3 times daily

Abduction (Leg Out to Side)

1. Lie on back
2. Slide surgical leg out to the side
3. Keep toes pointing up
4. Slide back to center
5. 10-20 repetitions, 3 times daily

Standing Hip Extension

1. Stand holding walker or support
2. Move surgical leg straight backward
3. Keep body upright
4. Return to standing
5. 10 repetitions, 3 times daily

Standing Hip Abduction

1. Stand holding support
2. Move surgical leg out to the side
3. Keep toes forward
4. Return to standing
5. 10 repetitions, 3 times daily

Walking

• Use walker as prescribed
• Short, frequent walks
• Focus on normal gait pattern
• Weight bear as allowed

Phase 2: Weeks 2-6 (Progress Mobility and Strength)

Continue Phase 1 exercises and add these.

Supine Hip Flexion (Marching)

1. Lie on back
2. Lift knee toward ceiling (within precautions)
3. Lower with control
4. Alternate legs
5. 10-15 each leg, 2-3 times daily

Bridging

Excellent for glutes:

1. Lie on back, knees bent, feet flat
2. Squeeze glutes and lift hips
3. Hold 5 seconds
4. Lower slowly
5. 2-3 sets of 15

Side-Lying Hip Abduction

1. Lie on non-surgical side
2. Keep surgical leg straight
3. Lift toward ceiling
4. Lower with control
5. 2-3 sets of 15

Standing Marching

1. Stand holding support
2. March in place, lifting knees alternately
3. Within hip flexion limits
4. 2-3 sets of 20

Sit-to-Stand

From a raised surface initially:

1. Scoot to edge of chair
2. Feet shoulder-width apart
3. Lean forward
4. Push through legs to stand
5. 10 repetitions

Step-Ups (Low Step)

1. Use a 4-inch step
2. Step up with surgical leg
3. Step down with non-surgical leg first
4. 2 sets of 10

Stationary Bike

When cleared (usually week 2-4):

1. Set seat high enough to maintain hip angle <90 degrees (if posterior)
2. Start with no resistance
3. 10-15 minutes
4. Progress resistance and duration

Pool Walking (When Incision Healed)

• Excellent for early strengthening
• Water reduces joint stress
• Walk forward, backward, sideways
• 15-20 minutes

Phase 3: Weeks 6-12 (Build Strength and Function)

Hip precautions are often lifted around week 6-12. Confirm with your surgeon.

Increased Heel Slides/Hip Flexion

Once precautions are lifted:

1. Work toward full hip flexion
2. Pull knee toward chest
3. Hold 30 seconds
4. 3-5 repetitions

Clamshells

1. Lie on non-surgical side
2. Knees bent, feet together
3. Lift top knee, keeping feet touching
4. 3 sets of 15

Monster Walks

1. Band around ankles
2. Quarter squat position
3. Walk sideways
4. Maintain tension throughout
5. 2 sets of 15 steps each direction

Hip Flexor Stretch

1. Half-kneeling, surgical leg in front
2. Tuck pelvis under
3. Shift weight forward gently
4. Feel stretch in front of back hip
5. Hold 30 seconds, repeat 3 times

Standing Hip Flexion (Higher)

1. Stand holding support
2. Lift knee toward chest
3. 3 sets of 10

Single-Leg Balance

1. Stand on surgical leg
2. Hold 30-60 seconds
3. Use fingertip support as needed
4. Progress to no support

Squats

1. Start with mini squats
2. Progress depth as comfortable
3. Keep knees over toes
4. 3 sets of 10-15

Walking Program

• Progress from walker to cane to no device
• Increase distance gradually
• Focus on eliminating limp
• Vary terrain as able

Phase 4: Months 3-6 (Return to Activity)

Advanced Strengthening

Single-Leg Romanian Deadlift:

1. Stand on surgical leg
2. Hip hinge, reaching back leg behind
3. Maintain balance
4. 2-3 sets of 8-10 each leg

Lateral Lunges:

1. Step to the side
2. Bend stepping leg, keep other straight
3. Push back to start
4. 2-3 sets of 10 each side

Step-Ups (Higher):

1. Progress to 6-8 inch step
2. 3 sets of 10-12

Bulgarian Split Squat:

1. Rear foot elevated on bench
2. Lower into lunge
3. 2-3 sets of 8-10 each leg

Cardiovascular Training

• Cycling (outdoor when ready)
• Swimming
• Elliptical
• Walking on varied terrain
• Low-impact aerobics

Activities You Can Return To

Most people can return to:

• Golf
• Swimming
• Cycling
• Doubles tennis
• Dancing
• Hiking
• Bowling

Discuss with your surgeon: Singles tennis, skiing, running

Generally not recommended: High-impact activities, contact sports

Sample Schedule

Weeks 1-2

3-4 times daily:

• Ankle pumps: 30 reps
• Quad sets: 20 reps
• Glute sets: 20 reps
• Heel slides: 20 reps
• Straight leg raise: 10 reps
• Standing hip extension: 10 reps
• Standing hip abduction: 10 reps

Walking: Every 1-2 hours, short distances

Weeks 2-6

Daily:

• All Phase 1 exercises
• Bridging: 2 × 15
• Side-lying hip abduction: 2 × 15
• Standing marching: 2 × 20
• Sit-to-stand: 10 reps
• Step-ups: 2 × 10

3-4 times per week:

• Stationary bike: 15-20 minutes

Walking: Progress distance, work on gait quality

Weeks 6-12

3-4 times per week:

• Clamshells: 3 × 15
• Monster walks: 2 × 15 each way
• Squats: 3 × 12
• Single-leg balance: 3 × 30 seconds
• Hip flexor stretch: 3 × 30 seconds
• Bike: 20-30 minutes

Daily:

• Walking: 20-30 minutes
• Key strengthening exercises

Months 3-6

3-4 times per week:

• Full strength training routine
• Cardiovascular: 30-45 minutes
• Sport-specific activities as cleared

Gait Training Tips

Avoiding a Limp

Common causes of limping after hip replacement:

• Weak hip abductors (gluteus medius)
• Fear of weight bearing
• Habit from pre-surgery limp

Fix it:

• Focus on equal time on each leg
• Push through heel of surgical leg
• Stand tall—don't lean away from surgical side
• Practice in front of a mirror

Weaning Off Assistive Devices

• Walker → Cane → No device
• Use cane on OPPOSITE side from surgery
• Don't rush—use support until gait is smooth

Red Flags

Contact your surgeon immediately if:

• Fever over 101°F
• Increasing redness, warmth, or drainage from incision
• Sudden severe pain
• Calf pain or swelling (possible blood clot)
• Hip feels like it "pops out"
• Unable to bear weight when you should be able to
• Significant increase in swelling

Tips for Success

Protect Your Hip

• Follow precautions exactly for recommended duration
• Don't push too fast—your tissues need time to heal
• Use recommended equipment (raised seat, grabber)

Manage Swelling

• Ice after exercises: 15-20 minutes
• Elevate leg when resting
• Compression stockings if prescribed

Stay Consistent

• Do exercises multiple times daily in early weeks
• Keep a log of your progress
• Attend all physical therapy appointments

Be Patient

• Full recovery takes 6-12 months
• Progress isn't always linear
• Most significant gains happen in first 3 months

Key Takeaways

1. Know your precautions—they protect your new hip
2. Start exercises immediately—early motion aids healing
3. Hip abductor strengthening is critical for normal walking
4. Progress gradually—don't skip steps
5. Gait quality matters—work on eliminating the limp
6. Full recovery takes time—most people feel "normal" by 6-12 months
7. Stay active for life—your new hip will thank you

Your hip replacement is designed to last 20+ years with proper care. The work you put into rehabilitation in the first few months sets the foundation for decades of improved quality of life. Stay committed to your exercises, respect the healing process, and enjoy your new hip!