Recovery after hip replacement takes many months. Even after your pain has subsided and you no longer need your crutches, walker or cane for support, you might notice you have a limp and muscle weakness after a hip replacement.
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Muscle weakness following hip replacement surgery is very common. In order to access your hip joint, the surgeon has to cut through layers of muscle and/or connective tissue. The specific muscles that are affected depend on where your incision is — at the front, side or back of your hip.
Read more: Lower Back and Hip Strengthening Exercises
Heed Your Hip Precautions
Your hip is at a greater risk of dislocating after hip replacement surgery. The surgeon will instruct you regarding recovery, including specific movement precautions to reduce that risk. These precautions vary based on the location of your incision.
For example, precautions for a posterior hip replacement include not bending more than 90 degrees at the hip, not crossing your legs and not allowing your leg to rotate inward, according to Alberta Health. The amount of time these precautions last is up to your surgeon, but typically they are in place for a minimum of three months.
The best way to ensure that certain exercises are safe for you and that your limping is addressed correctly is to see a physical therapist. Although general strengthening exercises can be beneficial, it's important to identify your specific needs.
Sometimes, gait issues are not muscle-related at all — limping can also be the result of one leg being shorter than the other after surgery, requiring a completely different treatment intervention.
Weakness and Trendelenburg Gait
Weakness in the hip abductor muscles — gluteus medius and gluteus minimus —that stabilize your pelvis as you walk is one of the most common contributors to limping after hip replacement surgery. This type of limping is called a "Trendelenburg gait," named after the surgeon who first identified the walking pattern.
When standing on your affected leg, weakness in these glute muscles will cause the opposite side of your pelvis to drop suddenly. To compensate for this, some people automatically lean their upper body over the affected side to help keep the pelvis level.
Trendelenburg gait after total hip replacement is common, according to the International Congress for Joint Reconstruction. In mild cases, it can be addressed with exercises that strengthen the hip abductor muscles.
Hip Abductor Strengthening Exercises
Begin your glute strengthening exercise routine while lying down to minimize stress on your hip after surgery. Exercises should ultimately be performed while standing up to effectively reduce limping while walking.
Perform 10 repetitions of each exercise, working up to three sets in a row.
1. Side-Lying Leg Raise
The side-lying leg raise can be progressed by adding an ankle weight or holding a dumbbell against your thigh, as demonstrated on ExRx.net, as your strength improves.
- Lie on your unaffected side with your legs stacked on top of each other. Bend your bottom knee, if needed, for comfort.
- Lift your top leg up toward the ceiling as high as possible. Hold for one to two seconds; then slowly lower back down.
Leg raises can also be performed while lying on your back if you have quadriceps weakness after total hip replacement.
For an added challenge, perform 10 circles clockwise and another 10 circles counterclockwise while holding your leg in the elevated position.
2. Add Clamshells to Your Routine
Clamshells are also performed while lying on your unaffected side.
- Keeping your legs stacked, bend both knees to approximately 45 degrees.
- Tighten your abs to help stabilize your core.
- Keeping your feet together, lift your top knee up toward the ceiling — opening your legs like a clamshell.
- Hold for one to two seconds; then lower back down.
Make this exercise harder by looping an elastic resistance exercise band around your thighs.
3. Try the Fire Hydrant
While this exercise might feel a bit awkward (it mimics animal behavior, as its name implies) it is very effective for strengthening your hip abductors.
- Begin on all fours with your wrists in line with your shoulders and knees in line with your hips.
- Keeping your knee bent, lift the affected leg up and out to the side. Keep your back flat and abs tight during this movement.
- Hold for one to two seconds; then slowly lower the leg back down.
4. Perform Monster Walks
To make this exercise harder, if you wish, move the resistance band lower on your legs, according to the American Council on Exercise.
- Loop a resistance band around your thighs, just above your knees.
- Bend your knees and lower your hips slightly into a mini-squat. Push your knees apart to put tension on the band.
- Take wide, diagonal steps — both forward and backward — while keeping your abs tight. Maintain tension on the band throughout this activity.
Read more: Exercises to Isolate the Gluteus Minimus
5. Try Lateral Shuffles
This exercise can also be made harder by using a higher-resistance band or lowering the band on your legs.
- Loop a resistance band around your legs, just below your knees.
- Perform a mini-squat and push your knees apart.
- Step to the right 10 times while maintaining tension on the band. Repeat in the opposite direction.
6. Hip Hikes/Pelvic Drop
To perform hip hikes, use a 6-inch box or step. This exercise targets the leg you are standing on.
- Stand with the box on your affected side and place your hands on your hips.
- Step up onto the box, balancing on one leg.
- Lower your pelvis until the foot on your unsupported leg drops below the level of the box.
- Raise your hip back up until your pelvis is level. This is one repetition.
7. Side Plank With Leg Lift
Master the side plank before adding the leg lift component to this exercise.
- Lie on your unaffected side, propping your upper body up on your forearm.
- Keeping your legs stacked on top of each other, lift your hips off the ground. You should now be balancing only on your forearm and the side of your bottom foot.
- While maintaining this position, lift your top leg up toward the ceiling. Hold for two to three seconds; then lower your leg down.
- Repeat six to eight times in total. Work toward maintaining your plank position for an entire set of leg lifts.
- Alberta Health: "Hip Replacement (Posterior) Precautions: What to Expect at Home"
- ICRJ: "Abductor Mechanism Deficiency After Total Hip Arthroplasty"
- ExRx.net: "Dumbbell Lying Hip Abduction"
- American Council on Exercise: "6 Glute Med Exercises"
- Princeton University Athletic Medicine: "Pelvic Stabilization, Lateral Hip and Gluteal Strengthening Program"