A total hip replacement can be a major surgery, but for many people it can also be life-changing. Hip pain and stiffness can make everyday activities, exercise, and the things you enjoy increasingly difficult. Hip replacement aims to reduce that pain and help you get back to living your life.
Recovery is a process, and it doesn't always feel linear. Some days you will feel like you're making great progress, while other days may feel slower. Knowing what to expect can help you feel more prepared and understand that recovery takes time.
In this blog, I want to give you a general idea of what to expect before, during, and after a hip replacement and where physiotherapy fits into the process.
What Is a Total Hip Replacement?
A total hip replacement, also called a total hip arthroplasty (THA), is a surgery where the damaged parts of the hip joint are replaced with artificial components.
The hip is a ball-and-socket joint. During surgery, the damaged ball at the top of the thigh bone is replaced, and the damaged surface of the socket is also replaced.
The goal is to reduce pain, improve mobility, and help you return to the activities that have become difficult because of your hip.
Why Do People Have Hip Replacements?
The most common reason for a hip replacement is advanced hip osteoarthritis.
People may experience:
Hip or groin pain
Stiffness
Difficulty walking
Difficulty getting in and out of a chair or car
Difficulty putting on socks or shoes
Difficulty exercising
Reduced ability to participate in recreational activities
Hip replacement is generally considered when hip pain and stiffness are significantly affecting your quality of life and other treatment options are no longer providing enough relief or allowing you to participate in activities meaningful to yourself.
Preparing for Your Hip Replacement
Your recovery actually starts before surgery.
If you know you're going to have a hip replacement, one of the best things you can do is maintain as much strength and mobility as possible.
Depending on your symptoms, your physiotherapist may work with you on:
Hip and leg strength
Walking
Balance
Mobility
General conditioning
Learning exercises you will use after surgery
This is sometimes referred to as prehabilitation.
You don't need to be in perfect shape before surgery. The goal is simply to give yourself the best possible starting point.
If you’re preparing for hip surgery, check out Strong Hip—a program I designed specifically for after hip surgery, that may also help you build strength and prepare beforehand. I do always recommend seeing a physiotherapist before surgery as well.
It's also worth preparing your home. Think about how you will manage stairs, getting in and out of chairs, getting into bed, and other everyday activities during those first few days.
Your healthcare team can help you determine whether you need any temporary equipment or modifications. Some equipment you may need might include a walker, a cane, a reacher/grabber, raised toilet seats, an ice machine, bed rails or even a temporary hospital bed.
What Happens During Surgery?
During a total hip replacement, your surgeon removes the damaged parts of the hip and replaces them with artificial components.
There are different surgical approaches, including anterior, lateral and posterior approaches. Your surgeon will determine which approach is appropriate for you.
You may hear a lot about one surgical approach being better than another, but there are many factors that influence recovery. The surgical approach is only one part of the picture.
Once the surgery is complete, your rehabilitation begins.
What Happens Immediately After Surgery?
The first few hours and days are focused on managing pain, making sure you're medically stable, and getting you moving safely.
You may experience:
Pain around the hip
Swelling and bruising
Muscle weakness
Fatigue
Difficulty getting comfortable
Changes in your walking pattern
Don't be surprised if simple things feel much harder than they did before surgery.
Getting out of bed, standing, and taking a few steps can feel like a big effort initially.
Your body has just undergone a major operation.
How Soon Do You Start Moving?
In many cases, walking begins very soon after surgery, sometimes on the same day.
This doesn't mean you are expected to walk normally right away.
Your first walks will likely be short and may involve a walker or another mobility aid.
Early goals include:
Getting safely in and out of bed
Standing
Walking short distances
Learning to use your mobility aid
Managing stairs if necessary
Completing your initial exercises
Don't rush to get rid of your walker or cane.
The goal isn't to stop using your mobility aid as quickly as possible. The goal is to walk safely and gradually reduce your reliance on the aid as your strength and confidence improve.
Check out this video for exercises that can begin day one after surgery - Total Hip Replacement: Top 3 Safe Exercises to Start Recovery
The Role of Physiotherapy
Physiotherapy plays an important role throughout your recovery and you will see a physiotherapist in the hospital and should see one outside the hospital within the first 7 days after surgery.
Early rehabilitation focuses on getting you moving safely and restoring basic function.
This may include:
Walking
Gentle mobility exercises
Muscle activation
Transfers
Stair practice
Balance
Education around activity and recovery
As you progress, rehabilitation becomes more challenging.
The focus can gradually shift toward:
Hip and leg strength
Glute strength
Balance
Walking mechanics
Endurance
Functional movements
Returning to recreational activities
This is where rehabilitation becomes more than simply recovering from surgery.
The goal becomes building your capacity back up.
What Should You Expect During the First 6 Weeks?
The first six weeks are generally focused on managing symptoms, improving mobility, and gradually becoming more independent.
Weeks 1–2
Pain, swelling, bruising, and fatigue are common.
You will likely still be using a walker or another mobility aid, and your walking may not look normal yet.
Physiotherapy will focus on safe walking, mobility, muscle activation, and gradually increasing your activity.
Don't be discouraged if progress feels slow during this stage.
Weeks 3–6
As your symptoms settle, you should gradually become more independent.
Walking distances will increase, your mobility aid may be reduced when appropriate, and strengthening will become more important.
This is also when we can begin focusing more on your individual goals and rebuilding your overall strength and confidence.
Remember: feeling better doesn't mean you're fully recovered.
Your symptoms may improve before your strength and capacity have fully returned.
Week 6+
By around 6 weeks, many people are feeling more independent, but rehabilitation is far from finished.
This is where the focus shifts toward strength, function, and overall capacity. Strengthening can become more progressive, with exercises designed around your daily activities and the things you want to return to.
The focus may include:
Building hip and leg strength
Improving balance and walking endurance
Progressing stairs and functional movements
Increasing exercise tolerance
Returning to the gym and recreational activities
The goal isn't just to get through your daily activities—it’s to build the strength and confidence to get back to the things you enjoy.
Recovery continues well beyond 6 weeks, so continue to progress gradually and allow your body time to adapt.
Please check out my program Strong Hip for a guided strength and mobility program designed for 12 + weeks after Total Hip Replacement surgery.
What Surprises Most People?
There are a few things I find patients don't always expect after hip replacement.
Recovery isn't perfectly linear.
You may have a great day followed by a more difficult day. This doesn't necessarily mean you've gone backwards.
Strength takes time.
You may be walking fairly well but still have significant weakness around your hip and leg.
Your hip may feel different for a while.
Even when surgery has gone well, the hip and surrounding muscles can feel tight, weak, uncomfortable, or simply different during recovery.
You can feel better before you're fully recovered.
This is an important one. As your pain improves, it can be tempting to do too much too quickly.
Gradually increasing your activity is important.
When Should You Contact Your Healthcare Team?
Some pain, swelling, bruising, and fatigue are expected following surgery.
However, you should follow the specific instructions provided by your surgeon and healthcare team regarding warning signs and when to seek medical attention.
If you have concerns about your incision, increasing redness or drainage, fever, significant swelling, worsening symptoms, or anything that doesn't seem right, contact your healthcare provider.
If you experience emergency symptoms such as sudden chest pain or significant difficulty breathing, seek emergency medical care.
Final Thoughts
A hip replacement is a major surgery, but it can also be the beginning of getting back to the activities that pain and arthritis may have taken away from you.
The first few weeks are about managing symptoms, moving safely, and becoming more independent.
From there, the focus shifts toward rebuilding strength, improving your movement, and eventually returning to the activities that matter to you.
Don't compare your recovery to someone else's.
There is no single timeline that applies perfectly to everyone.
Focus on steady, consistent progress and give your body time to recover.
If you're planning for a hip replacement or are currently recovering from one and aren't sure what your next step should be, send me an email or please reach out. I'd be happy to help you through your recovery.
Liam
Disclaimer
This content is for educational purposes only and does not replace medical advice. Every hip replacement and recovery is different. Always follow the specific instructions provided by your surgeon and healthcare team, including any restrictions or precautions following surgery.
