If you've had total hip replacement surgery, which is when damaged bone and cartilage are replaced by artificial implants, recovery can seem daunting. Adding in movement soon after surgery can help you recover better, faster. In fact, experts recommend exercise immediately after a hip replacement.
"One of the keys to recovery from hip replacement surgery is getting up, walking and being active. Since your hip can be sore and sometimes even painful, you rely more on your core and upper body to help you get around," Michael P. Ast, MD, orthopedic surgeon and chief medical innovation officer at the Hospital of Special Surgery (HSS) in New York, tells LIVESTRONG.com.
"Exercise in one form or another starts right away. Usually these are very simple exercises meant to get your hip moving and begin your recovery. The most important exercise to do during that time is simply walking," he says.
As far as early exercises post-op, recommendations focus on walking. During the first six weeks after hip replacement surgery, people are encouraged to do a daily walk as a form of exercise, Dr. Ast says. The goal is to gradually increase your physical activity post-surgery.
"We generally recommend that patients walk about 1,000 steps per day and slowly increase that by 1,000 steps per day per week. This would mean that by the end of the second week, a patient would be walking 2,000 steps per day, by the end of the third week, they would be walking 3,000 steps, etc." Dr. Ast says.
In addition to walking, Dr. Ast recommends doing hip replacement post-op exercises that target your glute muscles that surround and stabilize your hips. These exercises work to restore joint mobility and stability.
"The gluteal exercises I recommend are lifting the leg lateral (out to the side) and posterior (behind you) in a standing position while holding on to something for balance," he says.
Whether you're four weeks or two months out of surgery, here are the best exercises after hip replacement. (Before incorporating these recommendations, make sure you talk to your doctor and/or physical therapist about the best hip replacement exercises for you.)
These exercises after hip replacement are recommended for people who have had total hip replacement surgery versus partial hip replacement surgery. Unlike total hip replacement surgery, partial hip replacement surgery replaces only one side of your hip joint — the femoral head — instead of both sides, according to the HSS.
"Since partial hip replacements are usually done on a different patient population following a broken hip, their exercise recommendations are usually different and not generally standardized, as they often need to account for the patient's ability to stand and walk, and any other injuries that may have been suffered at the time of the broken hip," Dr. Ast says.
Exercises After Hip Replacement Surgery: 4 Weeks
In addition to walking regularly, most hip replacement post-op exercises strengthen your glutes to help stabilize your hips and restore joint mobility.
During the first four weeks post-surgery, Erica Fritz Eannucci, PT, DPT, physical therapist and HSS physical therapy manager, recommends these exercises for strengthening your glutes and improving hip flexibility. Do 3 sets of 10 reps per exercise three times a day for the first four weeks post-op.
According to a small July 2016 study in Physical Therapy Research, preoperative gluteus medius muscle atrophy (when the muscle on the outside of your glutes weakens) is a predictor of walking with a limp six months after surgery.
So by strengthening your glutes — particularly your gluteus medius, which is responsible for moving your leg away from your midline (or the center of your body) — you'll be able to walk and do other activities more comfortably.
You want to avoid exercises that target your hip flexors, the group of muscles near the front of your hips, which can irritate the muscles. "For most patients, it's not necessary to do a large amount of hip flexor strengthening after a hip replacement; however, if patients desire to strengthen their hip flexors, I recommend they wait at least six weeks and preferably even longer," Dr. Ast says.
1. Sit to Stand
This move is one of the most functional exercises because it mimics the act of getting into and out of a chair, which can be difficult for those with hip arthritis, Eannucci says. "This exercise builds strength to do this activity while strengthening your thigh and buttock muscles."
- Sit on a chair with your back and chest upright, knees bent to 90 degrees and feet firmly on the ground. Keep your arms straight by your sides.
- Shift your body weight forward by slightly leaning your chest forward.
- Press your feet into the ground and squeeze your glutes to stand up.
- Hinge your hips back and bend your knees to lower your butt down to the chair.
- Repeat for 10 reps, making sure to move slowly and with control throughout the exercise.
2. Bent Knee Fall Out
This exercise works hip abduction (moving your leg away from the middle of your body) and external hip rotation, and activates your core.
"Hip rotation is a motion that typically is lost due to hip arthritis. People find they can't put their shoes on and off, for example, as a result," Eannucci says. "This exercise is recommended to help improve hip rotation flexibility."
- Lie face-up with your knees bent and feet flat on the ground. Place your arms by your sides, palms down on the ground.
- Engage your core by slightly tucking your pelvis under so your lower back is pressing into the ground.
- Slowly let your left leg fall to the side as far as possible while keeping your back and pelvis stable.
- Bring your leg back to the starting position. This is 1 rep.
- Do 10 reps, then switch sides.
3. Standing Hip Abduction
Hip abduction exercises after hip replacement surgery are important because your hip abductor muscles, including your gluteus medius and minimus and tensor fasciae latae (front hip muscles), tend to be the weakest before and after surgery, Eannuci says.
Your hip abductor muscles are responsible for many daily movements, including walking, balancing and climbing up stairs. This exercise aims to strengthen these muscles and increase hip flexibility, she says.
- Stand with your feet hip-width apart next to a chair and hold onto it for support as needed.
- Keeping your hips square and your legs straight, shift your weight onto your left leg and slowly lift your right leg to the side.
- Bring your right leg back to the center and repeat.
- Repeat for 10 reps, then switch legs.
4. Glute Bridge
Your glutes are primary movers for many daily activities, like walking, picking things off the floor and standing up from sitting. The basic bridge exercise builds glute strength while teaching people how to fully extend their hips, Eannucci says.
- Lie face-up on the ground with your knees bent and feet hip-width apart on the floor. Place your hands on top of your hips or by your sides on the ground.
- Engaging your core and squeezing your glutes, press your feet into the ground and drive your hips up toward the ceiling. Your body should form a diagonal line from your knees to your hips to your shoulders. Avoid arching your lower back.
- Pause for a few seconds, then slowly lower your hips back down to the ground.
- Repeat for 10 reps.
How Long Does It Take to Walk Normally After a Hip Replacement?
How long you'll limp after a hip replacement surgery is related to how much you limped before the operation.
"Most patients will walk more normally around three months after the operation, but for some patients who have had bad arthritis and a really bad limp for a long time, it can take up to a year or even longer for the limp to go away," Dr. Ast says.
Find walking with a cane easier post-op? Check out our picks for the best canes to use after hip replacement surgery.
Exercises After Hip Replacement Surgery: 6 Weeks
At six weeks post-op, you're going to build upon the glute and hip flexibility exercises you were doing at four weeks and start incorporating balance exercises, which are essential for preventing injury. You can also reduce the number of times you do these exercises to just once a day instead of three, Eannucci says.
"After six weeks, I generally tell patients to start increasing their exercise routines and also to start adding hip stretching exercises, but this depends on the individual," Dr. Ast says.
Specifically, he recommends doing hip rotational stretches and exercises because people with severe hip arthritis tend to lose their rotational flexibility, which is necessary for doing daily tasks, like putting on your socks and shoes.
"One of the most important stretches is to try to regain the ability to sit cross-legged with your ankle of the operated leg on the knee of the other leg. This is a useful position for putting on shoes and socks and caring for feet, but this flexibility is often lost as the hip becomes stiff from arthritis," Dr. Ast says.
Make sure you keep up with your walking routine and aim to clock in two to three miles a day. This is also a good time to incorporate some core exercises into your routine, he adds.
1. Single-Leg Balance
- Stand in front of a stable surface with your feet hip-width apart. Hold onto it for support as needed.
- Shift your weight to your left leg and lift your right foot off the ground, bending your knee. If you feel stable enough, lift your hands from the supporting surface and balance on your left leg as long as possible.
- Place your right foot back down on the ground and repeat.
- Hold for 10 seconds, then repeat six times before switching legs.
When lifting your leg off the ground, you can choose any direction you're most comfortable with, whether it's in front of you or behind, Eannucci says.
You can gradually increase the amount of time you hold the single-leg balance, working your way to holding it for one full minute. For instance, start with 10 seconds for 6 reps on each side and then 30 seconds for 2 reps on each side.
By targeting your hip's external rotators, aka your glutes, the clamshell move gives you strength to fully rotate through the hip, Eannucci says.
- Lie on your right side, stacking your legs and hips on top of one another and bending your hips and knees to form 90-degree angles. Your knees should be slightly in front of you.
- Keeping your hips square, press your heels together and activate your outer glutes to rotate your left knee toward the ceiling. Avoid letting your pelvis rock forward or backward by bracing your core.
- Slowly bring your left knee back down to the starting position.
- Repeat for 10 reps, then switch legs.
After surgery, it may feel uncomfortable to lie on the operated side. It isn't dangerous to the surgical site, but only begin lying on the operated side to do this exercise when you feel comfortable, Eannucci says.
3. Side-Lying Hip Abduction
This exercise is a progression of the standing hip abduction. It strengthens your hip abductors — your glutes and tensor fasciae latae — which are often the weakest before and after surgery, Eannucci says. "They contribute to balance and the ability to walk normally."
- Lie on your right side, resting your head on your right arm and stacking your legs and hips on top of one another. Bend your right knee to 90 degrees and straighten your left leg.
- Slowly lift your left leg up toward the ceiling as high as you can without rocking your pelvis forward and back.
- With control, lower your leg back down to the starting position.
- Repeat for 10 reps, then switch sides.
4. Forward Step Up
Before hip replacement surgery, many people will have pain doing weight-bearing exercises, such as climbing stairs, and develop muscle weakness and compensatory movements, Eannucci says. The step-up exercise helps strengthen your glutes and quad muscles, improving your ability and balance to climb stairs.
- Stand with your feet hip-width apart in front of a step. Place your entire right foot on the step, not just your forefoot.
- Press your right foot into the step to straighten your leg and lift yourself up onto the step. Place your left foot onto the step once your right leg is straight and it is aligned with your right foot.
- With control, slowly lower your left foot back down to the ground. Make sure to keep your hips level throughout the exercise and move with control.
- Repeat for 10 reps before switching sides.
How Long Does It Take for Muscles to Heal After a Hip Replacement?
The goal isn't to heal your muscles after surgery. Instead, it's to calm your muscles down if they have been aggravated by the surgery, Dr. Ast says. That's why most of the exercises you're doing are aimed at keeping your muscles calm; you want to avoid overdoing them.
"With too rigorous of activity, your muscles, especially your hip flexors, can be easily irritated," Dr. Ast says.
Exercises After Hip Replacement Surgery: 2 to 3 Months
Between the second and third month after surgery, you will continue to focus on increasing glute strength by progressing the exercises you're already doing.
This will prepare you to return to full activities and exercises at three months, where most surgeons will lift activity restrictions except high-impact ones, such as running, Eannucci says. High-impact activities are generally allowed at six months post-op.
"At three months, people can return to hiking, tennis and generally feel very well," she says. You can also start doing strength-training exercises with load, starting at a very light weight and slowly progressing.
"Outside of the gym, I would recommend adding exercises that strengthen your legs, core and balance. Squats, lunges and bird dogs are some of examples of what can be added at three months," Eannucci says.
After three months, you no longer have to do targeted exercises for your hip replacement. Instead, you can do activities you enjoy.
"I try to encourage patients to continue their core exercises as these are probably the more important exercises long term, regardless of a patient's desired activity level," Dr. Ast says.
1. Forward Step Down
As with the forward step up exercise, this move strengthens your glutes and quads and helps improve your balance to descend stairs, Eannucci says.
- Stand on top of a step with both feet on top.
- Lift your right foot off the step and place it on the ground in front of you, bending your left leg behind you.
- Press your left foot into the step to drive yourself back up to standing and bring your right foot back to the starting position. Make sure to keep your hips level throughout the exercise and move with control.
- Repeat for 10 reps, then switch sides.
2. Wall Squat
You'll need to squat down to pick up things off the floor, so training the squat pattern with this exercise will help strengthen the muscles around your hips and thighs to help you do that, Eannucci says.
- Stand in front of a wall with your back firmly pressed against it and your feet hip-width apart, about a foot or two in front of you.
- With your back against the wall, slide down until you feel your thigh and hip muscles engaged, up to a 90-degree angle. Your ankles should be aligned with your knees or slightly in front of them.
- Hold this position for a few seconds, engaging your core, glutes and quads.
- Press your feet into the ground to slide up the wall and stand back up.
- Repeat for 10 reps.
3. Lateral Band Walk
This exercise complements the side-lying hip abduction exercise. The mini resistance band (shop our picks for the best resistance bands here) around your thighs helps to further strengthen your side glutes and hips, Eannucci says, but feel free to try this move a few times without to get the hang of it.
- Place a mini band just above your knees and lower down into a quarter squat. Stand with your feet wide enough so you feel tension in the band, slightly wider than shoulder-width apart. Keep your hands at your hips.
- Maintaining tension in the band, step to your right with your right foot, following it with your left so your feet are about hip-width apart. Continue to walk the distance of the room.
- Then, step to your left with your left foot, following it with your right, and continue to walk the distance of the room until you're back where you started.
Exercises After Hip Replacement Surgery: 6 Months and Beyond
There are generally no exercise restrictions, including on high-impact workouts, after six months post-surgery. From six to 12 months post-op, you no longer have to do hip replacement rehabilitation exercises; you can transition into a workout routine that includes strength training, stretching, endurance and balance, Eannucci says.
Doing low-impact exercises, like swimming, cycling, rowing, yoga and strength training, are great ways to stay fit and strong while reducing stress on your implants. Dr. Ast recommends riding a stationary bike after hip replacement to get your joint moving smoothly.
"It is likely one of the best ways to warm up your hip at the start of an exercise session," he says. "Also, stationary bikes can be used very differently with everything from low-intensity warm-ups to high-intensity spin classes and HIIT rides."
Exercises to Avoid After a Hip Replacement
You want to limit high-impact exercises, like running and HIIT moves that involve jumping, in order to protect the longevity of your implants and reduce the stress on them.
"Personally, I think it is still important to keep in mind that these are artificial implants and there may be some concerns with their long-term durability with certain activities," Dr. Ast says.
"We tend to ask patients not to use running as their primary form of exercise, meaning if patients want to run from time to time that is probably fine, but to run multiple miles, multiple times a week may not be the best idea for the longevity of these implants."
Very high-impact activities, like skydiving, are not recommended because they can increase the risk of the bone breaking around the implant.