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In this article, I am going to cover how much a total hip replacement recipient should walk at all three stages of the recovery after surgery: the hospital stay, the in-home physical therapy, the outpatient physical therapy, and the independent continuation of the rehabilitation process to complete recovery.
How often should I walk after total hip replacement surgery?
A total hip replacement patient should be up about every 60 to 90 minutes to walk the short distances that are required to complete normal Activities of Daily Living, as well as initiating a “walking rehabilitation” program, from day one after surgery.
The caregiver should not provide valet services that the patient can do for themselves.
The caregiver should encourage the patient to make the trips to the table for meals and other ADLs and not provide valet services more than absolutely necessary.
As a physical therapist who has progressed hundreds of total hip replacement patients through the first 3 weeks of in-home physical therapy after surgery, walking endurance is one of the primary focus areas of the patient’s rehabilitation program.
Out of all the exercises a human being can do, walking is the best overall exercise that will return the greatest benefits for the time and effort invested.
That includes everyone of all ages, including total hip replacement patients.
There is a peer-reviewed research article regarding the increased tolerance of walking after total knee replacement that I find true for my total hip replacement patients as well.
This National Institute of Health (NIH) research paper shows that total knee replacement patients have a significant increase in tolerance for the number of times they are willing to get up and walk short distances after a total knee replacement.
I find this true for my total hip replacement patients as well.
I instruct my total hip replacement patients to always stop ANY activity as soon as it causes the hip to send signals to the brain that say “I’m beginning to feel the effects of this activity; maybe we should take a break”.
This instruction also applies to both the walking and exercise portions of the home physical therapy program that I have designed for them. Pushing too far past this early warning signal from the hip can and does often cause a flare-up that puts their home rehabilitation program on hold for 3 days or longer.
All of my total hip and total knee replacement patients, for the first three weeks after surgery, are instructed to use either Cold Therapy Packs or Cold Therapy Machines (Amazon affiliate links) multiple times daily to help control pain levels.
For more information, see my article: Ice After Total Hip Replacement: A PT’s Complete Guide.
How soon after Total Hip Replacement will I be able to walk?
Before hospital discharge a new total hip replacement recipient will be required to walk with a physical therapist in the hospital the day after the surgery and will be taught stair negotiation if there are stairs in the home.
Most hospital records I read, before seeing the Total hip Replacement patient in their home to initiate home health physical therapy, state the patient has ambulated with a physical therapist, usually about 150 feet, using a front wheeled walker.
That coincides with my years of experience as the Chief of Physical Therapy in a hospital setting, seeing patients bedside the same or the following day after surgery.
Additionally, if the total hip recipient has stairs at home to negotiate, the therapist will train the patient on stair climbing, and the patient will be required to demonstrate going up and down stairs safely.
Stairs cannot be safely negotiated with a walker, in my opinion.
I recommend having two walkers, one upstairs and one downstairs.
A good walker to consider is the Drive Medical 2-Button Folding Walker (Amazon link).
The only time I have my patients ever use a cane is for assistance with the handrail going up and down the stairs.
For more information, see my article Stair After Total Hip Replacement.
How far should I walk immediately after a Hip Replacement?
A total hip replacement patient should be walking about 150 feet with a walker the day after the surgery.
By three weeks after surgery, most patients are able to walk about one-quarter of a mile without any ambulatory aid, such as a walker or cane.
Most surgeons have a post-surgery packet of specific instructions that are issued to the total hip replacement recipient upon their discharge from the hospital.
In this packet of instructions, there is usually a section that discusses how much the surgeon wants the patient to walk during the two to four weeks of home therapy before the patient initiates outpatient physical therapy.
In those instructions, they almost always say “Walk 10 to 15 minutes a day”.
Those instructions are unclear and too general and need further clarification.
First Clarification:
The surgeon is telling the patient to “walk 10 to 15 minutes a day” as part of a home exercise rehabilitation program.
Walking to and from the bathroom is not considered part of the rehabilitation program; it is considered an activity of daily living (ADL).
All walking done as part of ADL does not count as time toward the rehabilitation exercise program.
Secondly Clarification:
The recommended “10 to 15 minutes of walking” is all done at one time.
It is not broken into smaller segments of time that are then added together to achieve 10 to 15 minutes of walking.
Third Clarification:
The surgeon is not taking into consideration the patient’s speed or stride length when recommending “walking 10 to 15 minutes daily”, so there is no clear distance goal for the patient to consider. Distance goals are just as important as time goals.
A high-functioning total hip replacement patient could walk twice as far in 15 minutes as I would allow my patients during the early days of their home physical therapy rehabilitation program.
Fourth Clarification:
The surgeon is not taking into consideration if the patient is a “High Fall Risk” patient or not and is not telling the patient when those “10 to 15 minutes of walking” are to be done without an assistive device.
I do two Fall Assessment Risk tests on the first day of home physical therapy to determine where to start the patient’s walking program; the Tennitti Test and the TUG Test. The Tennitti test tells me when the patient is safe to walk without an assistive device.
The TUG test gives me the most information about how far the patient should be walking.
TUG test (Timed Up and Go):
This test instructs the patient to rise from a seated position, walk 10 feet away from the chair in which they were seated, and then return to that same chair and sit down (20 feet total).
If the patient takes longer than 14 seconds, the test scores rate the patient as High Fall Risk.
If the patient takes longer than 24 seconds, the test is predictive of a fall within 6 months.
If the patient takes longer than 30 seconds, the test is predictive of requiring an assistive device for ambulation.
In the many years I have been performing this test on the first visit with my home health physical therapy hip replacement patients, I would say less than 5% complete the TUG test in 14 seconds or less; they would be a very high functioning total hip patient (and almost 100% of these patients completing the test in less than 14 seconds are younger than 65 years of age).
That being said, if my patient had completed the TUG in 14 seconds and I had allowed them to walk for 10 minutes, they would have walked at least 858 feet; that’s 358 feet further than I allow my patients to walk on the first day.
In 15 minutes, they would have walked at least 1,285 feet! That would be my end goal for them!!
That would almost certainly cause the patient a flare-up of pain and inflation on their first day of treatment and would probably set them back up to a week in recovery!!!
Almost all of my normal-functioning patients initially test at 30 to 90 seconds to complete this 20-foot round trip TUG test on my first home visit, a day or two after surgery.
My fastest normal-functioning patient, requiring 30 seconds to walk 20 feet, would walk at least 400 feet in 10 minutes.
Just using the TUG data, I would not let that patient walk for more than 12.5 minutes, which would be 500 feet.
Allowing them to walk a full 15 minutes would put them over my recommended 500 feet limit on day one by 20%.
If my slowest normal-functioning patient, requiring 90 seconds to complete the 20 foot Tug test, had walked for 10 minutes, they would have walked at least 133 feet.
In 15 minutes, they would have walked at least 200 feet; therefore, based on the TUG data alone, I would have walked this patient the full 15 minutes, if they tolerated that amount of time walking, but I would stop at whatever distance the patient began to experience the first feelings from the hip saying “maybe this is far enough right now”.
The patient scoring 90 seconds on the TUG test usually has a lot of apprehension and some pretty bad gait patterns and habits that need to be addressed. Even so, they usually reach the 1,000 foot minimum walking distance goal and frequently the ¼ mile goal without an assistive device within three weeks.
The TUG test gives me a rough idea of the time and distance I should expect this specific patient to walk on the first visit of home physical therapy.
The “Take Home” message:
The point being that recording the amount of time a patient can ambulate continuously tells me very little about the patient’s functional ability, but the distance a patient can ambulate tells me a lot about that patient’s functional ability.
Taking both time and distance into consideration allows me to optimize the surgeon’s instructions to “walk 10 to 15 minutes daily” into a safe and effective plan for progressing the patient through the home walking program during the first three weeks of home physical therapy.
I always limit all my patient’s walking distance to 500 feet maximum on the first day of home physical therapy. I use a rolling tape measure wheel for accurate distance measurements. My recommended measuring wheel is the Zozen Measuring Wheel (Amazon Link).
How I Progress My Total Hip Patients With Walking Distance:
I always request that my patient not take pain medications at least two hours before my arrival; otherwise, the pain medications mask the pain.
I need unmasked pain responses from my patient during treatment to be sure the treatment is within the patient’s pain tolerance limits.
At the initial evaluation, I walk my patient, usually with a front wheeled walker, to the distance at which they have the first feeling of “That is as far as I should go”.
I stop the walking at that time.
Since I am asking the patient to stop at the first signs of discomfort, I have to pick a walking route that will allow the patient to be seated as soon as any discomfort is felt.
This means I can’t walk the patient in a straight line until discomfort (we would still have that same distance to return), so I pace out a 50-foot lap within the home that we walk until the patient needs to sit down.
Usually, in that first session, the tolerated distance is somewhere between 150 feet and 500 feet.
I always stop the patient at 500 feet on the initial visit, even if they feel they can go further.
Many years of experience have taught me that allowing the patient to walk further than 500 feet on that first visit is a mistake.
Allowing them to go further on the first visit can cause some patients to experience increased pain after walking further. Better safe than sorry.
For the patient’s independent home walking program, I request that the patient walk only 50% of the distance they walked with me on the treatment days, when the patient and I walked together.
I ask them to do this independent home walking program at 50% of the distance we walked together and to repeat this activity 2-3 times a day.
I do not want them to walk as far as they walked with me, only ½ that distance, but to repeat that distance 2-3 times daily.
At each physical therapy session, with me present, I will push the patient for additional distance.
The patient’s independent home walking program will be adjusted to the new 50% of whatever distance they were able to walk with me on the day of treatment.
Within 3-4 sessions I expect the patient to have reached at least the 1,000 feet mark, but the goal is ¼ mile (a ¼ mile is 1,320 feet).
By then, I expect to hear my patient say something like:
“When I’m in the kitchen, I don’t use the walker. I just touch the countertops as support”.
At this point, I am going to retest the patient’s balance without an assistive device using the Tinetti test, and if it is no longer a “high fall risk” result, I will start walking with my patient using no assistive device at all.
We will establish a new baseline of tolerance for walking without any assistive device by walking without an assistive device until the hip begins to feel like “that is far enough”, or we reach 500 feet.
Again, the patient’s independent home program is to walk 50% of the distance they walked with me but to do this 50% program 2-3 times a day.
I increase that distance, as the patient tolerates, at each of the next 3-4 visits with the expectation that they will be able to walk about ¼ mile without any assistive device by the ninth treatment session.
After the initial first home therapy session I request a prescription to see my patients three times a week for three weeks.
On average, my patients reach all our goals for walking and exercises by the seventh session, at which time I discharge them from Home Physical Therapy and request the physician prescribe continuation with physical therapy rehabilitation in an outpatient facility.
After the initial first home therapy session I request a prescription to see my patients three times a week for three weeks.
On average, my patients reach all our goals for walking and exercises by the seventh session, at which time I discharge them from Home Physical Therapy and request the physician prescribe continuation with physical therapy rehabilitation in an outpatient facility.
It has been my experience that transitioning to a cane causes patients to activate that old ambulation motor memory pattern of limping; canes just do that.
On rare occasions, a patient may need additional support when transitioning from a walker to no assistive device, but it is never because of the need to reduce weight-bearing on the new total hip. Weight-bearing should not be painful, even from day one after surgery.
Almost always, if there is an issue transitioning from a walker to no assistive device, it is a confidence or balance issue.
The patient simply needs a third point of reference for balance input. That is best achieved through the use of a single walking stick (Amazon link).
Walkers and walking sticks allow the patient to walk without activating that old “limp” motor memory. A cane will activate that old motor memory limp.
How fast should a total hip patient walk after surgery?
Immediately after total hip replacement surgery, 95% of patients should be walking with a walker at between 0.3mph and 0.9mph.
By the end of three weeks, on average, total hip replacement patients should be walking at least 1.0mph without any device over a distance of 1,320 feet.
This is my personal clinical experience after treating hundreds of total hip replacement patients from 1 day after surgery to completing 7-9 home therapy sessions over a three-week period of time.
This comes from the data that I collected over 10 years of evaluating my patients using the TUG (Timed Up and Go) test, a standardized test nationally recognized as valid for fall risk assessments.
At the initial evaluation, 95% of my patients completed the 20-foot timed test in between 30 and 90 seconds. On rare occasions, I would see a total hip patient who could complete the TUG test in under 30 seconds.
For the patients I saw who initially took 30 seconds to walk the 20 feet doing the TUG test on the first visit a day or two after surgery, that translates into 0.45mph.
For the patients I saw who initially took 90 seconds to complete the 20 feet walking distance doing the TUG test on the first visit a day or two after surgery, that translates into a speed of 0.15mph.
In reality, these 30 to 90-second completion patients are walking at a faster pace than stated above because the TUG test requires the patient to rise from the seated position, turn 180 degrees at the 10-foot mark, then turn and sit down in a chair as part of the timed portion of the TUG test.
In my opinion, these positional maneuvers within the TUG test, if eliminated from the test, would probably increase the patient’s walking speed by 100%, making the true walking speed much more likely to be between 0.3mph and 0.9mph.
I progressed my total hip replacement patients over the following three weeks to walking 1,320 feet (¼ mile) in 15 minutes without any device.
That translates to a 1.0mph walking speed.
An additional goal I have for my patients is to complete the ¼ mile walk without an assistive device in 10 minutes. Many do achieve this goal.
That translates into 1.5mph.
According to an NIH article:
The normal walking speed for people over 65 years of age living independently in the community is 2.01mph to 2.91mph.
It further states a walking speed of less than 1.6mph is predictive of a clinical event, such as falling.
My patients, having achieved the goal of 1.0mph to 1.5mph walking speeds in their home physical therapy program, are now ready to seek further, more aggressive physical therapy in an outpatient physical therapy setting.
Seeing total hip replacement patients in my outpatient physical therapy office over a 40 year span of time, my walking speed goals for them are 2.0mph, but certainly greater than 1.6mph.
The walking for increased speed portion of the outpatient physical therapy program was done on a treadmill.
How many steps per day should a total hip patient take?
The first day after surgery a total hip replacement patient should be taking a total of about 100 steps-per-day and by three weeks be over 1,000 steps-per-day with a long-term goal of a minimum of 4,400 steps-per-day and an optimal goal of 7,500 steps-per-day, a distance of about 2.0 miles and 3.5 miles respectively.
This optimal goal will probably not be met until several weeks after surgery and will require the continuation of a progressive rehabilitation plan.
Walking has become the rage among the human population over the last few years. Many opinions have been expressed about how far the average human being should walk.
The most frequent recommendation from health gurus is 10,000 steps-per-day.
According to a National Institute of Health (NIH) article, the steps per day for the average active U.S. population are between 4,000 and 5,000 steps-per-day while inactive people may get only 2,000 steps-per-day or less.
It references a study of 17,000 women with an average age of 72 that followed them for four years and found a 41% reduction in the risk of death if they increased their steps-per-day from 2,700 to 4,400.
The risk factors for death continued to decrease, up to 7,500 steps-per-day.
There was no benefit seen in that study among people who walked more than 7,500 steps per day.
These same steps-per-day goals are further supported by the article “How many steps/day are enough? For older adults and special populations” as published on the National Institute of Health’s website also.
Healthline recommends the Fitbit Charge 5 Advanced Health & Fitness Tracker to keep track of your daily steps, distances walked, and several other health metrics. (Amazon link).
Final Thoughts:
The walking progression I have described above is what I do and see in 95% of my total hip replacement patients.
The exceptions are frequently patients who have other orthopedic or medical issues that prevent them from achieving the walking goals defined above.
Of all the total hip replacement patients I see, I can classify them into three groups:
- Those who “stay in the lane” of the outlined walking and exercises are instructed to do them as a home program.
- Those who need some encouragement to rise to the level of optimal walking and exercise are also requested to do them as a home program.
- Those who say “If 3 is good, 6 is better”. With these patients, I have to continually pull them back into “the lane.”
Those that I have to continually try to restrain their overactivity are the only patients that have problems meeting the goals (not only in terms of walking but also in terms of pain).
At least 50% of these over-achiever “type A” personalities will set themselves back 3-10 days because of the surgical site’s bad reaction to being over-exerted.
Stay in “the lane”, and you too can walk out of this post-surgical debilitation in about 3 weeks.
I hope this information is helpful to you in setting your own goals for your walking rehabilitation program.
Read my other articles about Total Hip Replacement
Happy Non-Limping Painless Walking.
Paying It Forward
Perhaps you are approaching or already retired and wondering how you could earn extra money in retirement.
One option would be to do as I am doing.
Read my article How To Generate Retirement Income: Cash In On Your Knowledge.
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