What exercises are recommended after hip replacement surgery?

Recommended Exercises After Hip Replacement Surgery

Exercise-based rehabilitation is strongly recommended for patients after hip replacement surgery and should be maintained for at least 3 months to optimize recovery of function, pain reduction, and quality of life. 1

Early Phase Exercises (0-4 weeks post-surgery)

• Begin with immediate weight-bearing as tolerated, ensuring correct gait pattern (with assistive devices if necessary) and monitoring for pain, effusion, or increased temperature 1
• Start with isometric quadriceps exercises in the first week to reactivate muscles when they provoke no pain 1
• Incorporate gentle hip, trunk, and functional strengthening components that avoid positions that could compromise the surgical site 1
• Focus on regaining basic mobility skills including transfers, walking with appropriate assistive devices, and basic activities of daily living 2
• Gradually increase daily steps, with research showing patients typically achieve around 1100 steps in week 1 and 2500 steps by week 2 2

Mid-Phase Exercises (4-8 weeks post-surgery)

• Progress to more dynamic strengthening exercises for hip and trunk muscles, particularly the gluteus medius 3
• Incorporate balance and proprioceptive training to address deficits in dynamic balance and single-leg stability 1
• Begin low-impact aerobic activities such as stationary cycling or aquatic exercises to improve cardiovascular fitness without excessive joint loading 3
• Gradually increase walking distance and duration, with research showing patients typically achieve around 4100-4800 steps per day during this phase 2
• Monitor quality of movement during exercises, focusing on proper alignment during functional tasks like sit-to-stand and gait 1

Advanced Phase Exercises (8-12 weeks and beyond)

• Progress to more functional strengthening exercises that mimic daily activities and desired recreational pursuits 1
• Continue with progressive resistance training for hip and lower extremity muscles to address strength deficits 3
• Incorporate more challenging balance activities and functional task training 1
• Gradually introduce more demanding activities based on individual goals and surgeon clearance 4
• Continue monitoring response to exercise with appropriate outcome measures such as the HAGOS or IHOT questionnaires 1

Exercise Precautions and Considerations

• Avoid the "leg-shaving" position (combined hip flexion, adduction, and internal rotation) which puts the hip at risk for dislocation 2
• Monitor for signs of exercise intolerance including increased pain, joint effusion, or limping 3
• Adjust exercise intensity and duration based on individual response, avoiding pushing through significant pain 3
• Consider using objective measures like step counts from wearable devices to monitor activity progression, as increased steps correlate with improved functional outcomes 2
• Be aware that complete recovery may take 6 months or longer, with continued improvements in strength and function possible with ongoing exercise 5, 6

Common Pitfalls to Avoid

• Avoiding all activity due to fear of pain can lead to muscle weakness and joint stiffness 3
• Progressing too quickly with high-impact activities can compromise surgical outcomes 4
• Failing to address specific impairments such as hip muscle weakness, altered gait mechanics, or balance deficits 1
• Discontinuing exercise program too early (before 3 months), as longer duration programs show better outcomes 1
• Not monitoring response to treatment with appropriate outcome measures can lead to suboptimal management 1

Long-Term Exercise Recommendations

• Maintain regular physical activity for general health and bone quality, which improves prosthesis fixation 4
• Focus on low-impact endurance activities like swimming and cycling for fitness maintenance 4
• Higher-impact activities may be performed recreationally at lower intensities if approved by surgeon 4
• Continue with periodic strengthening exercises to maintain hip and core muscle strength 3
• Physical activity should be encouraged as part of long-term management to optimize quality of life 1, 3