How Exercises After Hip Replacement Surgery Can Speed Your Recovery

Your recovery from a hip replacement doesn’t end when you leave the hospital. Every movement you make in the initial hours, days, and weeks after you get out of the hospital bed plays a role in your recovery from a hip replacement. Your prescribed exercises will improve balance, restore strength in the muscles that support your hip, and extend the range of motion in your new hip.

“Don’t get discouraged if you find that the first few weeks of recovery are slow-going,” says Jennifer Hankenson, MD, a Yale Medicine physiatrist (a physical medicine and rehabilitation physician). “You may be on a walker for up to four weeks, but your pain should improve significantly after about two weeks.”

We spoke more with Dr. Hankenson about the kinds of exercises patients should do after hip replacement surgery and how it can benefit their recovery.

Hip replacement surgery is a medical procedure that involves replacing a damaged or worn hip joint with an artificial one, usually made of metal, ceramic, or plastic. The goal of this surgery is to alleviate pain, improve mobility, and enhance the quality of life for those suffering from hip joint disorders, injuries, and/or arthritis.

You’ll get moving pretty shortly after you wake up from surgery, says Dr. Hankenson. “Patients may meet with a physical therapy team the same day as surgery or, at the very least, be walked by nursing staff,” she says.

You’re going to use some type of assistive device, adds Dr. Hankenson. “You’ll likely start with a walker and progress from there, either to a cane or walking independently,” she says.

You’ll have regular sessions with your therapist throughout your hospital stay, and you’ll continue with PT for at least a few weeks to a couple of months or more after discharge.

The setting for your post-discharge physical therapy depends on a few different factors. The most important one is whether you’re mobile and stable enough to go home on your own or with a family member.

Before discharge, you’ll decide with your care team which type of physical therapy is best for you. Your options, depending on insurance coverage, may include:

• An in-patient rehabilitation facility, where you’ll have physical therapy every day to help accelerate your recovery and get you ready to move on your own at home.

• Physical therapy at home with a therapist who comes to you.

• Physical therapy at an outpatient center that you go to for each session.

All of these methods will help get you where you need to be physically, Dr. Hankenson notes, but if you have a choice, she reminds patients that they’ll have access to the best equipment at an outpatient facility, not in their home.

Whether you have PT at home or at a physical therapy center, expect about three sessions a week that last a half-hour to an hour. On your “off days,” you’ll do exercises on your own or with a caregiver at home.

“Depending on how your recovery is going,” Dr. Hankenson says, “you’ll probably continue at that intensity for at least a few weeks.”

After those initial intense weeks, your physical therapist may tell you that you can drop down to fewer sessions per week, or you may even be cleared to stop formal sessions and simply continue the exercises on your own at home.

After a hip replacement, every exercise you do in your PT sessions will target one or more of the following objectives:

• Regaining your balance on your new hip

• Strengthening your glutes

• Reaching the full range of motion in your new hip

Regaining balance

You might be unsteady after surgery. Balance is critical to getting you back home and resuming your life. So balance will be the first order of business with your physical therapist.

When you’re ready, your therapist might have you stand on one leg (usually starting with 20 to 30 seconds to a minute and progressing to longer periods) near a counter so that you can grab it if you need support.

You may also try what’s called a three-way stance: You hold onto a counter or your walker, then extend the leg behind you, to the side, and then to the front. With your therapist’s supervision, you might march in place or do mini-squats.

“It’s important to do the squats with your therapist to make sure you aren’t bending too deeply at the hips,” Dr. Hankenson says. “You’ll have restrictions around range of motion at first.”

Strengthening your glutes

Your glutes—the group of muscles that form your buttocks—are the main muscles that support your hips and the movements that come from them. You’ll need to strengthen them in order to be stable on your new hip and use it to its fullest potential.

“Strengthening the glutes may help with pain reduction and potentially reduce future injury as they redistribute forces across the joint,” Dr. Hankenson says.

Your physical therapist will provide specific glute-strengthening exercises that are safe and appropriate for you. One option may be to lie on the floor and squeeze, hold, and release your glutes several times.

Increasing range of motion

Range of motion refers to the full movement potential of a joint; it’s the distance and direction a joint can move between flexed and extended positions. After a hip replacement, the range of motion you use will increase gradually over the first few weeks. It’s important to do only the prescribed range-of-motion exercises while your hip is still healing to reduce the risk of dislocation.

“Your doctor’s range-of-motion precautions may include not over-flexing at the hip, not crossing your legs, and using a pillow between your legs when sleeping on your side,” Dr. Hankenson says.

Make sure you understand what you should and should not do as part of your at-home exercises and day-to-day activities. Also check with your physical therapist to make sure you have the proper form when you do your exercises.

"You will have to take extra care, following your therapist’s or surgeon’s instructions, to reduce the risk of hip dislocation,” says Dr. Hankenson. "This can happen when doing high-impact activities [before you're cleared to do so] or not following range-of-motion precautions given by your doctor."

In time, you will get the green light to move on from PT and go about your life as usual.

You should expect it to be at least six weeks before your surgeon clears you to return to higher-impact activities, like sports that involve running and jumping. And, if you did those activities before surgery, you’ll most likely get approved to go back to them.

“It may be as early as six weeks, but most return within three months,” Dr. Hankenson says. “It’s important to talk to your surgeon regarding restrictions, but with improvements in surgical technique and joint prosthetics, returning to higher-impact sports is entirely possible and good for your overall health and well-being.”