Smart Moves Blog

Total hip replacement guide

May 21, 2018

physical therapy house calls

This guide summarizes best practices. The best care involves a combination of best practices, and the healthcare provider’s and patient’s inputs.

3 days - 3 weeks post surgery


  • Reduce swelling and pain
  • Increase range of motion within precautions
  • Increase strength
  • Increase independence with transfers and gait (follow weight bearing precautions as prescribed by surgeon)
  • Monitor wound healing for signs and symptoms of infection


Precautions vary based on the surgical approach and generally followed for six weeks post surgery. Follow your health care provider’s instructions.

  • Don’t bend the operated hip more than 90 degrees - don’t sit in a low chair with knee above hip and don’t lean forward in sitting where your trunk goes in front of your hip.
  • Don’t cross legs or bring legs together. Keep feet in line with knees, and knees in line with hips. Sleep with a pillow between the knees.
  • Don’t turn legs in or out. Don’t pivot with your feet fixed. Instead, move your feet.
  • Don’t let your knee go behind your hip.


  • Ice 10-15 minutes, multiple times a day to reduce swelling and pain
  • Exercises (with guidance of your therapist)
  • Ankle pumps
  • Heel slides
  • Quad sets
  • Glut sets
  • Short and long arc quads
  • Hip abduction
  • Gait: progress from walker or crutches to cane

3 - 6 weeks post surgery


  • Reduce swelling and pain
  • Increase hip range of motion within precautions
  • Increase strength
  • Improve balance
  • Normalize functional activities
  • Precautions still apply until at least six weeks after surgery. Follow your healthcare provider’s instructions.


  • Ice 10-15 minutes, as needed, to reduce swelling and pain
  • Additional exercises (with guidance of your therapist)
  • Standing hip abduction
  • Standing knee flexion
  • Standing heel and toe raises
  • Balance exercises
  • Stationary bike within precautions (don’t bend hip beyond 90 degrees)
  • Functional activities training
  • Sit to stand within precautions (don’t bend hip beyond 90 degrees)
  • Stairs
  • Gait without assistive device, as tolerated

6 - 12 weeks post surgery


  • Normalize all functional activities
  • Begin endurance activities
  • Precautions lifted unless otherwise instructed by your surgeon.


  • Progress strength and balance exercises
  • Begin light recreational and endurance activities (walking, swimming, progress stationary biking)

3+ months post surgery

  • Continue walking, swimming, and stationary biking for aerobic conditioning
  • Begin other recreational activities (golf, outdoor cycling, impact sports such as tennis or jogging) with clearance from surgeon

Manju Thomas

Written by Manju Thomas who lives and works in New York. Follow her on LinkedIn.