Post-Hip Replacement Exercise Guide: Most Important Exercise & Rehabilitation After Surgery

Sales Page Link Ant THR
Sales Page Link Post THR

With over four decades of experience in orthopedic physical therapy, I cannot stress enough the significance of rehabilitation following a total hip replacement (THR). A vital part of your journey back to mobility and strength is a well-structured exercise program.

This guide is designed to shed light on the most crucial exercise to incorporate into your daily routine post-surgery, ensuring a steady and safe recovery. Let’s embark on this essential phase of your healing process together, paving the way for a successful return to your active lifestyle.

Early Post-operative Exercises After Hip Replacement Surgery

Following hip replacement surgery, it’s crucial to begin early post-operative exercises to prevent post-surgical complications, enhance recovery, and promote optimal joint function.

Postoperative exercise regimens that are effective can be divided into five key categories that I believe are essential for achieving both functional and overall recovery. It’s important to remember that, despite differences in emphasis, the overall effect of these four categories promotes the best possible recovery.

These categories, in order of importance in my opinion, are:
1.)   Blood clot prevention.
2).   Strength recovery.
3).   Balance.
4).   Walking endurance.
5).   Range of motion

The most important exercise after total hip replacement is ankle pumps.

The first category, blood clot prevention, is paramount immediately following surgery. Engage in ankle pumps, as these exercises promote venous return and reduce the risk of thromboembolic events.

The patients that I have seen develop blood colts in their calves are patients who were extremely sedentary or chose to fly before their surgeon’s approval.

The importance of these four categories of exercise after such a significant procedure cannot be overstated. As a seasoned orthopedic physical therapist, I’ve seen firsthand the remarkable benefits that targeted exercises after hip surgery can bring to a patient’s rehabilitation.

The second category, strengthening exercises, initially are targeted at reconnecting the brain to the muscles through isometric exercises; and are further enhanced by muscular contractions that move the hip joint through various atice hip motions.

The third category, balance exercise, is concentrated on returning to a normal gait pattern; taking equal-length steps without limping.
Read my article: How Long After Hip Replacement Can You Walk Without a Limp?

In the fourth category, walking endurance, I have my patients follow a specific protocol that has them walking 1,000 feet without any ambulatory assistance, by three weeks post-surgery.
I have followed the same walking protocols I have my total knee patients follow.
Read my article:
Walking After A Total Knee Replacement: (When and How Much?)

In the fifth category, hip range of motion exercises, it depends on whether the surgeon replaced the hip with an anterior or posterior approach technique.
Posterior approach replacements have range of motion restrictions and the focus is on preventing certain range of motions.
Anterior approach replacements have little or no range of motion restrictions, so there are range of motion exercises I use with these patients to gain range of motion.
Read my article:
Total Hip Precautions: Anterior, Posterior & Lateral Approaches

From day one after surgery, gentle movements, and a specialized hip replacement exercise program are pivotal to ensure a smooth transition back to daily activities.

By adhering to a carefully constructed exercise plan, individuals can start to reclaim mobility and improve their quality of life post-surgery. It’s essential to remember that every individual’s recovery timeline is unique, and the exercises after surgery must be tailored to match personal progress and pain levels.

Always consult with your healthcare provider before engaging in any new exercises post-hip surgery, to ensure your safety and the best possible outcomes. With methodical practice and a bit of patience, you’ll see that the effort put into these early exercises after a hip replacement can yield significant dividends in restoring movement and strength.

Essential First Week Hip Replacement Exercises: Ankle Pumps

Following hip replacement surgery, it’s crucial that you begin your rehabilitation with tailored exercises. The exercises after such a significant procedure play a pivotal role not only in recovery but also in ensuring the long-term success of your hip replacement.

In the immediate period after surgery, I often emphasize the importance of starting with simple yet effective exercises. One of the most beneficial and easy-to-perform exercises after hip replacement is the ankle pump. Ankle pumps are an excellent way to stimulate circulation in the lower limbs and prevent blood clots, a common risk post-surgery. They’re a gentle way to start re-engaging with your body’s natural movement patterns without putting undue stress on your new hip.

Ankle pumps mimic the activity of walking, the activity that not only assists in venous blood return, but also is the primary mover of lymphatic fluids to prevent extra-cellular fluid accumulation, known as swelling, and in severe cases, pitting edema.

121213 Stasis blister dorsum of foot 3 cropped watermarked
This huge stasis blister formed when the patient
refused to do ankle pumps on her own, wear
TED hose, or elevate her feet.
She slept in a chair with her feet on the floor.

As walking activities are resumed, ankle pumps become less important and surgeons will consider withdrawal of blood thinning medications and be less insistent on wearing TED compression hose.
Read my article:
How Long to Wear Compression Socks After Surgery: Post-Surgery TED Hose Guide

Crossing Legs Pivot correctly watermarked cropped 200711
Total Hip Patient
wearing TED compression hose.

Advanced Hip Replacement Exercise Regimen Post-Surgery

Once you’ve made it past the early stages of recovery from hip replacement surgery, it’s crucial to focus on more progressive exercises to optimize the function of your new hip. At this juncture, you’re no longer just on the path of healing; you’re actively retraining your body to regain strength, stability, and mobility.

The cornerstone of an advanced hip replacement exercise regimen is a structured walking program. Walking isn’t just a milestone after surgery; it’s a therapeutic exercise that enhances circulation, prevents stiffness, and rehabilitates your gait. As a seasoned physical therapist, I’ve always emphasized that step-by-step, walking can be both the simplest and the most important exercise as you recover from hip surgery once you are past the ankle pump stage to prevent blood clots.

In addition to walking, incorporate exercises that address the muscles surrounding your hip and knee. Bridging and squats, performed with proper form and appropriate resistance, can significantly improve the support around your new joint.

However, quality should never be sacrificed for quantity. Even the smallest movements should be executed with precision to prevent any undue strain on the knee, especially since it plays a pivotal role in your overall leg function post-hip surgery. Specific exercises after hip replacement surgery, such as short arc quads and heel raises, are essential for rebuilding muscle strength without compromising the replacement hip’s integrity.

It’s pivotal to follow a structured sequence of exercises after surgery, all while remembering to respect your body’s new limits. Knee extensions could become a part of your routine, provided they are introduced at the right time and performed correctly. Remember, every exercise should be seen as a stepping stone to regaining the freedom of movement you once enjoyed. With a comprehensive approach to hip replacement exercise, you’re on a promising path to a fully functional hip and a more active lifestyle.

Phase l Exercises:

  1. Heel slides for flexion.
  2. Quadricep isometric exercises.
  3. Gluteal isometric exercises.
  4. Hamstring isometric exercises.
  5. Short Arc Quadricep exercises.
  6. Calf stretches.

Phase ll Exercises:

  1. Bridging exercises.
  2. Long Arc Quadricep exercises.
  3. Heel raises exercises.
  4. Hamstring curl exercises – standing.
  5. Hip extension exercises – standing.
  6. Chair squat exercises.

Integrating Strengthening and Walking into Your Hip Exercise Routine

After your hip replacement, it’s crucial to focus on BOTH strengthening exercises AND a progressive walking program to foster optimal recovery and improve the function of your new joint. In the early stages post-surgery, I’ve highlighted the significance of early post-operative exercises and, particularly in the first week, the central role of ankle pumps. But as you advance in your hip replacement exercise regimen, walking must become a cornerstone of your daily routine.

Why walking, you ask? It’s because walking is a natural motion that helps to lubricate the joint, preventing stiffness, whilst also enhancing circulation, which is key to healing. As you gradually increase your walking intervals, paying heed to your body’s signals, the goal is to build endurance without overtaxing your new hip.

It’s important to incorporate walking into your exercise schedule, aiming for consistency rather than intensity, at least initially.

It is always my Type A personality total hip replacement patients that gets themselves into trouble.
When they are instructed to walk a certain distance, they immediately think “Twice that far would be better”.
About 50% of the time they cause themselves a flare-up that requires a week to 10 days to recover from, setting them back in their rehabilitation by that amount of time.

Parallel to walking, focus on strengthening exercises that target the muscles around your hip joint. Strong muscles will support your joint, providing stability and helping you return to your regular activities with confidence. Nevertheless, you must exercise patience and ensure that you’re neither rushing your progress nor neglecting the importance of rest.

Always remember, the most important exercise is the one that’s done correctly and consistently. Thus, balance your strengthening routine with walking intervals that feel comfortable, gradually extending the duration as you gain strength and confidence in your hip replacement.

At the core of all hip replacement exercises and walking programs is the imperative to listen to your body and communicate with your physical therapy team. Together, we’ll tailor a plan that advances your recovery, protects your new joint, and ultimately, returns you to the activities you love. Complete dedication to your exercise regimen, including an emphasis on regular walking, will ensure the longevity and success of your hip replacement.

Best Types of Exercise After Total Hip Replacement

After hip replacement surgery, it’s vital to engage in the right exercises to ensure a successful recovery and return to optimal fitness.

As stated before, ankle pumps in particular, are an essential first-week exercise, promoting circulation and reducing the risk of blood clots.

As you advance through your recovery, knee exercises will play a significant role in bolstering the muscles that support your hips and knee joints, fostering stability and mobility.

Exercise after a hip replacement also involves gradually enhancing fitness levels through exercises tailored to your unique healing process. In the realm of hip replacements, the objective is to restore your range of motion without overstraining the new joint. Therefore, your post-replacement surgery exercise plan will incorporate exercises that are gentle on your hips yet effective in strengthening the surrounding muscles.

Fitness activities that involve low-impact movements are ideal after hip replacement, so consider incorporating swimming, after your surgical site is completely closed and healed, and cycling into your routine.

As your strength and confidence grow, walking can become a central element of your exercise after hip replacement, fostering endurance and joint health.

Properly paced exercises after replacement surgery aim to build your hips’ and knees’ strength and flexibility. Remember that post-THR, it isn’t just about the quantity of exercise but the quality. Integrating a comprehensive strengthening regimen tailored to your hips and knees is crucial. It’s imperative to balance these activities with periods of rest to allow your body to heal. Therefore, the most important exercise post-hip replacement is the one that aligns with your personalized rehabilitation goals, ensuring steady progress toward regaining your desired level of fitness.

Minimizing Swelling and Maximizing Joint Health After Surgery

After undergoing hip replacement surgery, it’s paramount to focus on rehabilitation to ensure optimal recovery and long-term joint health. The hips are fundamental to mobility, and dedicated post-surgery care is essential. One of the most important aspects of rehabilitation is managing swelling after hip replacement. Swelling is a natural response your body has to surgery, but when controlled, it will aid in healing.

I advocate for gentle movement exercises, such as ankle pumps, which I’ve discussed as an essential early post-operative exercise after hip replacement surgery. These simple movements encourage blood circulation and help minimize swelling.

I find the application of cold therapy, almost continually initially, and intermittently over the following weeks, to be an essential part of pain and swelling control.
The primary cause of pain after total hip replacement is pain.
Read my article: Ice After Total Hip Replacement: A PT’s Complete Guide

As you progress in your recovery, it’s vital to integrate a comprehensive hip replacement exercise regimen. Advanced exercises should focus not just on the hip joint, but also on the surrounding muscles to support and stabilize the hips. Consistent movement and gradual increase in activity are key components in ensuring a swift return to daily activities after surgery. Still, there’s no rush—each joint has its own timeline for healing.

Incorporating strengthening exercises and walking into your routine as soon as it’s advisable post-surgery is crucial. These activities nurture joint health and function, helping you regain not only strength but also confidence in your new joint. Don’t underestimate the importance of these exercises; they are the very foundation of successful long-term outcomes after hip replacement. 

Additionally, remember that strategies to effectively manage swelling are as important as the exercises themselves. Wearing compression stockings and elevating the limb can also be beneficial in the first weeks after surgery. The goal is to balance rest and activity to maximize rehabilitation outcomes.

Remember, every step taken in these early stages of post-replacement surgery is significant. Your dedication to following the prescribed exercise regimen will pay dividends in your joint’s health and longevity. Trust the process, be patient with your body, and know that these important exercises and precautions are the pillars of a successful recovery.

Read my other articles about Total Hip Replacement

Sales Page Link Ant THR
Sales Page Link Post THR

Q: What is the most crucial exercise to start with after a total hip replacement (THR)?
A: Post-surgery, the most crucial and safe exercise to begin with are ankle pumps. This simple movement helps prevent blood clots and maintains blood circulation, which is critical for your recovery. Begin by flexing and extending your ankles gently, as though you’re pressing and releasing a gas pedal, and aim to do ten repetitions several times a day.

Q: When can I start walking after my hip replacement surgery?
A: Walking can often start very soon after surgery, typically as soon as you’re medically cleared to do so, which may even be within the first day or two post-operation. It’s crucial to start with short, manageable distances and gradually increase as recommended by your healthcare provider or physical therapy team.

Q: How can I safely increase my hip strength and mobility after THR?
A: After the initial recovery phase, you can safely increase your hip strength and mobility with targeted exercises like gluteal contractions, hip abductions, and short arc quads to rebuild the muscle strength around the new joint. It’s vital to only progress to these exercises once you have adequate healing, as indicated by your healthcare provider.

Q: How do I manage post-surgical swelling and ensure proper healing following a THR?
A: Managing swelling is key to healing well after hip replacement surgery. In addition to ankle pumps, which help minimize swelling, it’s advisable to wear compression stockings, elevate the operated limb, and balance rest with activity. Following a tailored exercise plan with gentle movements and consistent application of any recommended swelling control measures will assist with your recovery.

Q: What role does walking play in my rehabilitation from a hip replacement?
A: Walking is an integral part of rehabilitation after a hip replacement because it’s a natural movement that helps lubricate the joint and improves circulation. Walking aids in preventing stiffness, reinforces a proper gait, and strengthens the muscles around your new joint. It’s important to follow a progressive walking program, beginning with shorter intervals and increasing duration as your endurance and joint stability improve. Always consult with your physical therapist on the appropriate walking schedule for your specific recovery needs.


Dr. Donaldson is dually licensed; physical therapy in 1975 and doctor of chiropractic in 1995. He held credentials of Orthopedic Clinical Specialist in physical therapy for 20 years, QME in California, and taught at USC. He owns and operates an orthopedic physical therapy practice. See "About Me" page.

Recent Posts