Rehabilitation in Total Hip Replacement
Overview: Total hip arthroplasty (THA), also known as a total hip replacement is an elective
surgical procedure to treat patients who experience pain and dysfunction from an arthritic hip
joint. THA is an effective option if the patient’s pain does not respond to conservative treatment
and has caused a decline in their health, quality of life, or ability to perform activities of daily
living. This procedure removes the arthritic structures that make up the hip joint and replaces
them with artificial implants. The head of the femur, which makes up the ball of the hip joint, is
removed and replaced by a smooth ball with a stem fixed within the femur. The acetabulum,
which makes up the socket portion of the hip joint, is fitted with a metal socket with a smooth
inner lining. Once in place, the artificial pieces allow improved function of the hip joint.
Total hip replacement (THR) rehabilitation is crucial for a successful recovery, helping patients regain
mobility, strength, and function. The process typically progresses in stages, from immediate post-
surgical care to long-term strengthening and return to normal activities.
Phases of Total Hip Replacement Rehabilitation
1. Immediate Post-Surgery (Days 1-7)
Hospital Stay: Usually 1-3 days
Goals: Prevent complications (blood clots, infections), manage pain, and begin mobility
Activities:
o Walking with assistance (walker, crutches, or cane)
o Ankle pumps and quadriceps contractions to prevent blood clots
o Gentle hip movements (within surgeon’s guidelines)
o Deep breathing exercises to prevent lung issues
o Education on hip precautions (to avoid dislocation)
2. Early Recovery (Weeks 1-4)
Goals: Improve mobility, decrease pain, and regain independence in daily activities
Activities:
o Walking short distances with support, gradually increasing
o Avoid crossing legs, excessive bending (beyond 90 degrees), or twisting
o Seated and standing exercises (leg lifts, gentle stretches)
o Physical therapy (PT) sessions to improve movement and strength
o Ice therapy for swelling and pain management
3. Mid-Term Recovery (Weeks 4-12)
Goals: Strengthening muscles, improving endurance, and reducing reliance on assistive devices
Activities:
o Walking longer distances with minimal support
o Balance exercises
o Light resistance training for hip and leg muscles
o Swimming or stationary cycling (as approved by the surgeon)
o Continued adherence to hip precautions
4. Long-Term Recovery (3-6 Months)
Goals: Return to normal activities, improve flexibility, and regain full strength
Activities:
o Progressing to full weight-bearing activities
o Strength and flexibility exercises for the hip, thigh, and core
o Resuming low-impact activities (walking, swimming, cycling, golf)
o Avoiding high-impact activities (running, jumping) unless approved by a doctor
Key Tips for a Successful Recovery
✔️Follow all hip precautions given by your surgeon
✔️Stay consistent with physical therapy
✔️Use assistive devices as needed but aim to phase them out
✔️Maintain a healthy diet to support healing
✔️Watch for signs of complications (increased pain, redness, swelling, or fever)
Precautions Anterior approach:
(strictly adhered No hip extension past 20 degrees
to for first 6
No hip external rotation past 50
weeks, guarded
progression degrees Posterior approach
thereafter) No hip flexion past 90 degrees
No hip internal rotation or adduction past
neutral General precautions
WBAT, with use of assistive device (AD) as needed (crutches, walker)
No crossing legs (crossing ankles OK)
Use good bending/lifting mechanics (keep back straight and bend at
knees)
Keep hips above knees when sitting, avoid sitting in deep chairs
ROM/Manual Early range of motion (ROM) as tolerated within the restricted range
Therapy Soft tissue mobilization as needed, scar mobilization once incision heals
(>2-3 wks)
Corrective Proper activation and recruitment of all hip and core
Interventions musculature without compensation required prior to initiating
strengthening
Neuromuscular re-education for balance and correction of faulty mechanics
Therapeutic exercise for lower extremity strength (double and single limb)
Outcome Select based on the needs of the patient and practice setting
Testing recommendations
Patient reported outcomes: VAS/NRPS, Lower Extremity Functional Scale,
Hip Osteoarthritis Outcome Score, Hip Outcome Score: ADL (17 items) |
Sports (9 items)
Performance tests: 30-Second Chair Stand Test, Gait Speed, TUG,
Functional Reach Test, 6-min Walk Test
Criteria to High impact activities such as plyometrics and running are generally not advised following
Initiate total joint replacements. First priority following these surgeries is to prevent damage to the
Plyometric new artificial joint. Due to lack of evidence on how high impact activities affect the integrity
Program of artificial joint replacement, patients are advised to participate in low impact
exercise/activities. Patients considering plyometrics with the intent to resume running
should consult with their physician.
Full, functional, pain-free ROM
> 80% quadriceps, hamstring, and hip (using hand-held
dynamometer) strength compared to uninvolved leg
Squat > 150% BW leg press
10 forward and lateral step downs from 8” step with proper mechanics
Criteria to Full, functional, pain-free ROM
Initiate > 80% of uninvolved quadriceps, hamstring, hip strength (hand-held
Running dynamometer)
Program Squat > 150% BW (barbell squat or leg press)
10 forward and lateral step downs from 8” step with proper mechanics
Hop and hold with proper mechanics (uninvolvedinvolved)
Ability to tolerate 200-250 plyometric foot contacts without reactive
pain/effusion
No gross visual asymmetry and rhythmic strike pattern with running
Criteria for Physician clearance at last check-up
Return to Strength: > 90% compared to uninvolved hip (using hand-held
Recreational dynamometer)
Activities/ > 90% BW with SL leg press
Discharge Demonstrate ability to simulate functional sport specific movement
Patient reported outcome measures: Score ≥ 90%
***Criteria for discharge from PT is less rigorous for those not returning to sport. Ensure
the patient is able to perform all ADLs and recreational activities without pain, reactive
effusion, and with appropriate functional mechanics.
Reference:
Chelseana Davis. (2018). TOTAL HIP REPLACEMENT POST-OP CLINICAL PRACTICE GUIDELINE. The Ohio State
University
