After a total hip replacement, how soon should patients start walking?

Early Mobilization After Total Hip Replacement

Patients should begin walking within 24-48 hours after total hip replacement surgery to optimize recovery outcomes, with initial mobilization starting as early as sitting out of bed for 30 minutes on the day of surgery (day 0). 1

Recommended Mobilization Timeline

• Day 0 (Surgery day):

  • Sit out of bed for approximately 30 minutes 1
  • Begin basic bed mobility exercises

• Day 1 (First postoperative day):

  • Progress to standing and short walking with appropriate assistive devices 1
  • Aim for 6 hours per day out of bed 1
  • Use walker or crutches as needed for stability

• Days 2-7:

  • Gradually increase walking distance as tolerated
  • Continue using appropriate walking aids
  • Early ambulation leads to improved functional outcomes by day 7 post-surgery 2

Benefits of Early Mobilization

Early mobilization after total hip replacement provides several important benefits:

• Reduces hospital length of stay by approximately 1.8 days 3
• Improves functional recovery and walking capacity 2
• Increases likelihood of discharge directly home rather than to high-level care facilities 2
• Reduces risk of postoperative complications such as pneumonia and delirium 4
• Improves range of motion and muscle strength 5

Walking Progression Protocol

1. Initial walks: Short, supervised walks with appropriate assistive devices
2. Progressive increase: Gradually extend walking distance and duration based on tolerance
3. Gait training: Focus on proper weight-bearing technique according to surgeon's specifications
4. Walking efficiency: Pay attention to lateral trunk displacement, which can increase energy expenditure 6

Important Considerations

• Ensure adequate pain control before mobilization attempts
• Remove urinary catheters within 24 hours to facilitate mobility 1
• Monitor for contraindications to early mobilization:
  • Hemodynamic instability
  • Uncontrolled pain
  • Surgical complications requiring bed rest 1

Cautions

• Patients with cardiovascular instability may not tolerate early ambulation well and may require a modified approach 2
• Proper gait training is essential to prevent compensatory movements that increase energy expenditure 6
• Always use appropriate assistive devices as prescribed to ensure safety and proper weight-bearing

Early mobilization represents a key component of enhanced recovery protocols after total hip replacement and should be implemented as standard practice unless specifically contraindicated.