Essential Guide to Hip Replacement Rehabilitation: Prehab, Recovery Phases, and Long-Term Success

Introduction

Hip replacement surgery (total or partial) is one of the most common and successful orthopaedic procedures, helping people return to an active, pain-free lifestyle. But as with knee replacement, rehabilitation determines the long-term outcome.

This guide covers:

• Pre-surgery preparation (prehab)

• Recovery phases and exercises for total and partial hip replacement

• Red flags to watch out for

• Long-term strategies to protect your new hip

Total vs Partial Hip Replacement

• Total Hip Replacement (THR): Both the ball and socket of the hip joint are replaced. This usually means a longer rehab process but excellent long-term outcomes.

• Partial Hip Replacement (Hemiarthroplasty): Only the ball of the hip is replaced. This is often done after fractures, with a potentially faster initial recovery but similar rehab goals.

Phase 0: Pre-Surgery Preparation (Prehabilitation)

Goals:

• Strengthen hip, glute, and core muscles

• Improve mobility within safe limits

• Build upper body strength (to help with crutches/walker)

• Optimise overall health (weight, nutrition, cardiovascular fitness)

Exercises:

• Glute bridges – 2–3×10–12

• Mini squats to chair – 2×8–10

• Standing hip abductions (band or no band) – 2–3×10–12

• Seated knee extensions – 2×12

• Wall push-ups/seated rows – 2×10

Lifestyle prep:

• Protein, calcium & vitamin D focus

• Stop smoking, reduce alcohol

• Prepare home (remove trip hazards, arrange supportive seating)

Phase 1: Immediate Post-Op (0–2 Weeks)

Goals:

• Control pain and swelling

• Protect new hip joint (observe surgeon’s precautions—especially against dislocation)

• Begin safe mobility with walking aids

• Prevent blood clots

Exercises:

• Ankle pumps – 10–20 reps hourly

• Quad sets – 10 reps, 5–10 sec hold

• Heel slides – 2×10 reps (within surgeon’s range restrictions)

• Standing weight shifts (with support) – 2–3×10 each side

• Short walks – 1–5 minutes every few hours

⚠️ Avoid crossing legs, bending hip past 90°, or twisting (depending on surgical approach).

Phase 2: Early Recovery (2–6 Weeks)

Goals:

• Progress range of motion (without breaking precautions)

• Strengthen glutes, quads, and core

• Improve walking pattern with support

Exercises:

• Straight leg raises – 2×8–10

• Mini step-ups (low step) – 2×8–10 each leg

• Standing hip abductions/extensions (with support) – 2–3×10–12

• Stationary bike – start 5 mins, build to 15–20 mins

• Gait practice – heel-to-toe walking, 5–10 mins

Phase 3: Functional Recovery (6–12 Weeks)

Goals:

• Walk without aids

• Regain functional strength

• Improve balance and hip stability

Exercises:

• Sit-to-stands – 2–3×10–12

• Bridges (progress to single-leg as tolerated) – 2–3×8–10

• Side steps with band – 2×10–12 steps each direction

• Supported single-leg balance – hold 20–30 sec, 3 reps per side

• Walking – 20–30 mins, 4–5x/week

Phase 4: Advanced Conditioning (3–6 Months)

Goals:

• Return to recreational activities

• Build hip endurance and power

• Improve mobility and stability

Exercises:

• Leg press (light to moderate load) – 2–3×10–12

• Hip abduction/adduction machines – 2–3×10–12

• Step-ups/step-downs – 2×8–10

• Swimming or cycling – 20–30 mins, 2–3x/week

• Functional drills – floor transfers, carrying loads

Phase 5: Long-Term Maintenance (6+ Months)

Goals:

• Maintain joint health

• Support full independence

• Protect implant (expected lifespan: 15–20 years)

Ongoing strategy:

• Strength training – 2–3x/week (8–12 reps, 2–3 sets)

• Cardio – walking, cycling, swimming, 30 mins, 4–5x/week

• Balance/mobility drills – 5–10 mins per session

• Avoid high-impact loading (running, jumping, twisting sports)

Key Principles for Hip Replacement Rehab

• ✅ Respect hip precautions in early stages

• ✅ Focus on glute and hip stability (not just quads)

• ✅ Progress walking distance gradually

• ✅ Mild muscle ache is normal, sharp pain or swelling flare-up means scale back

Red Flags – When to Seek Help

• Severe pain or swelling

• Redness, heat, or discharge at incision site

• Leg length discrepancy or instability

• Clicking, locking, or hip giving way

• Signs of blood clot (calf pain, swelling, redness)

Conclusion

Whether you’ve had a total or partial hip replacement, your success depends on structured rehabilitation. By preparing before surgery, progressing through recovery phases, and maintaining long-term strength, you’ll protect your new hip and return to a more active, pain-free life.