Hip replacement: rehabilitation guide
Last reviewed 5 August 2026 · Reviewed by Dr Matthew Broadhead, FRACS (Orth) · 23 minute read
Which approach did I have? Your discharge summary and operation record state the approach. If you are unsure, call the rooms. The precautions are different. This guide is for the anterior (direct anterior) approach, where the surgeon works from the front of the hip. If your operation was from behind the hip, use our posterior approach guide instead, its precautions are close to the opposite of the advice here.
This guide walks you through recovery after an anterior-approach total hip replacement, week by week, what to do, what to expect, and when to call us. Two headlines: you can stand and walk on the new hip from day one, and you do not need the traditional hip precautions, no raised toilet seat, no ban on bending or crossing your legs. There is one position to respect for six weeks, and it is explained below.
Every timeframe in this guide is typical, not a rule. Your hip, your health and your operation are your own, and Dr Broadhead’s instructions for you always override the general figures here.
The hip joint is a ball and socket. The worn ball (femoral head) is removed and replaced with a metal or ceramic ball on a stem that sits inside the thigh bone; the socket is resurfaced with a metal shell and a plastic or ceramic liner: the same implant used through any approach.
Through the anterior approach, the surgeon reaches the joint from the front of the hip through a natural plane between muscles, rather than through or off them, no muscle is divided or detached. The joint capsule (the sleeve of tissue enclosing the joint) is opened at the front and usually repaired. Because the capsule and the small rotator muscles at the back of the hip are left completely intact, the hip’s stability behind is preserved, which is why the traditional posterior precautions do not apply.
The back of your hip was not opened, so deep bending and crossing your legs are not the concern they are for a posterior approach. The front of the hip is where the repair is, so the position to respect is the opposite one: the leg extended behind you and turned outward.
Pooled trial evidence shows a modest but real advantage in the first weeks: less pain on days 1–2, better hip function at 2 and 6 weeks, walking aids discarded around 11 days sooner, and a hospital stay shorter by about a third of a day. Beyond about three to six months there is no meaningful difference in hip function or patient-reported outcomes. Overall revision rates are very similar; the Australian registry shows a difference in the kind of problem leading to revision: anterior somewhat more femoral loosening and fracture around the implant, posterior more dislocation. And the ERAS Society consensus is worth quoting: there is insufficient evidence that any one surgical approach or technique independently changes how quickly a patient meets discharge criteria.
The lateral femoral cutaneous nerve. A skin-sensation nerve crossing the front of the hip, is often stretched or irritated, leaving a patch of numbness, tingling or hypersensitivity over the front and outer thigh. Honest numbers: about 1–2% of patients complain of it spontaneously, but when every patient is asked, 20–35% describe some altered sensation. It affects skin sensation only: strength, walking and hip function scores are unaffected. About 96% improve without treatment, most within three to six months, with numbers continuing to fall out to two years; a minority are left with a permanent patch. It is not a sign anything has gone wrong.
Patients often arrive assuming the traditional restrictions apply. They do not. You may bend past 90 degrees, sit in a normal chair, use a normal toilet, bend to tie a shoe within comfort, cross your legs, and sleep on your side. No raised toilet seat, sock aid or reacher is needed, though they can be convenient in the first fortnight. Deep squatting and low seats are limited by comfort, not by rule.
Frequent short walks beat occasional long ones. Build the habit of getting up and moving at least hourly while you are awake.
Weight bearing
Full weight bearing as tolerated from day one
You will stand and walk on the new hip, taking as much weight as comfort allows, from the day of surgery, whether the implant was cemented or uncemented. The implant is fixed and stable immediately.
The walking-aid progression is typically quicker than after a posterior approach, in pooled trial data, anterior-approach patients discarded their aids around 11 days sooner. Progress by the criteria below, not by the calendar.
The frame or crutches are for balance and confidence, not to keep weight off the leg. Keep a stick for crowds, uneven ground and long distances for as long as it is useful.
| Stage | Typical timing | Move on when |
|---|---|---|
| Wheeled frame or two crutches | Day 0 to about day 3–10 | Safe balance; walking without a lurch |
| One crutch or a single stick (opposite hand) | About 1–3 weeks | Level walking without a limp; able to stand on the operated leg with control |
| No aid | About 2–4 weeks | Confident indoors and outdoors; no lurch; able to manage a kerb |
Be clear about what this is: there is no established, validated set of “anterior approach precautions”, and this list should not be read as a recognised protocol. Large published anterior series ran with no formal restrictions at all: one series of over 2,600 hips reported a 0.15% dislocation rate with no raised seats, no abduction pillows and no driving restrictions. What supports the list is anatomy: the joint capsule was opened and repaired at the front, and cadaveric work shows the ligament divided during the anterior approach provides most of the hip’s resistance to rotating outwards, especially with the hip extended, while the repair restores only a fraction of that resistance. So the theoretically vulnerable position is the hip extended and externally rotated: the leg back behind the body and turned out. One counterpoint you should hear: most dislocations after an anterior-approach hip are still backwards, not forwards. Treat the rules below as sensible anatomical caution for six weeks, not rules carved in stone.
| Rule | Why | How to manage |
|---|---|---|
| No large steps backward: avoid lunging or striding the operated leg behind you | Extension (the leg stretched behind the body) stresses the front-of-hip repair | Turn by stepping around in small forward steps. |
| Do not let the operated foot turn markedly outward, particularly while the leg is behind you | External rotation combined with extension is the at-risk combination | Keep the toes pointing forward when standing and walking; log-roll rather than twist. |
| Do not sleep face down, and do not lie with the operated leg trailing behind you | Prolonged, unguarded extension while you are asleep | Sleep on your back, or on either side with a pillow between the knees. |
| Avoid aggressive hip flexor stretching, bridging with the operated leg extended back, and prone-lying (face-down) hip extension exercises | These load the front-of-hip repair directly | These exercises return after 6 weeks. |
| Do not force the last few degrees of anything, no forced stretching in any direction | With an intact posterior capsule, comfort is a good guide | Move freely within comfort; let range return on its own. |
| Milestone | Earliest (weeks) | Typical | Latest |
|---|---|---|---|
| Walking with frame or crutches | 0 | 0 | 1 |
| One crutch or a single stick | 0 | 1 | 3 |
| Desk work | 1 | 2 | 3 |
| First review (wound check) | 2 | 2 | 3 |
| Walking without any aid | 2 | 3 | 4 |
| Driving (criteria met, discussed with us) | 2 | 3 | 4 |
| Front-of-hip caution period ends (unless told otherwise) | 6 | 6 | 6 |
| Clinical review with X-ray | 6 | 7 | 8 |
| Low-impact activity (golf, outdoor cycling) | 6 | 9 | 12 |
| Physical work | 8 | 10 | 12 |
| Three-month review (only if progress is slower than expected) | 12 | 13 | 14 |
| Six-month review with X-ray | 24 | 26 | 28 |
| Twelve-month review with X-ray | 50 | 52 | 56 |
| Thigh numbness (if present) typically improving | 12 | 20 | 26 |
| Most activities open (per surgeon consensus) | 13 | 20 | 26 |
You move to the next phase by meeting its exit criteria, not by the calendar. The week numbers are typical, nothing more.
Walk little and often, settle the swelling, wake the hip muscles up, and learn the one position to respect.
Ready for the next phase when…
Wean off any remaining aid, build outer-hip (abductor) strength, and hold off on extension work until the front of the hip has healed.
Ready for the next phase when…
With the front of the hip healed, reintroduce extension work, bridging included, and build the strength, balance and endurance for real life.
Ready for the next phase when…
Back to the activities that matter, at the right pace, with realistic expectations of what is recommended long term.
Ready for the next phase when…
Little and often beats one heroic session. Each exercise lists what you should feel, sharp pain that lingers afterwards means ease off and, if it persists, call.
Keep blood moving in the calf: your main clot-prevention exercise.
10 firm pumps, every waking hour, for the first 2 weeks
Feel: You should feel the calf muscles working. Move through the full range each time.
Keep the thigh muscle switched on. It supports every step you take.
10 holds of 5 seconds, 3–4 times daily
Feel: You should feel this in the front of the thigh. Keep breathing: do not hold your breath.
Wake the buttock muscles: the hip’s engine, untouched by this approach and ready to work.
10 holds of 5 seconds, 3–4 times daily
Feel: You should feel the buttocks firm under you. No movement of the hip is needed. This is a squeeze, not a lift.
Start strengthening the outer-hip (abductor) muscles that keep your pelvis level when you walk.
10 slow reps, 3–4 times daily
Feel: Toes to the ceiling the whole time. You should feel the outer hip working.
Easier: A smooth board or a plastic bag under the heel makes the slide easier.
Thigh and hip strength with the knee locked straight.
10 lifts, hold 3 seconds, 3 times daily
Feel: A working ache at the front of the hip is common after this approach, ease off if it is sharp or lingers.
Easier: Shorten the hold, or start with smaller lifts.
The abductor strength that abolishes the limp: the key hip exercise of Phase 2.
2–3 sets of 10 each side, once or twice daily
Feel: Stay upright: do not lean away to cheat the lift. Lift to the side, not behind you, keep the leg in line with your body.
Harder: Slow the lowering phase, then add a light ankle weight if advised.
Real-world leg strength: the movement you will do more than any other.
2–3 sets of 8–10, once or twice daily
Feel: Share the load evenly between the legs, no swinging or flopping.
Harder: Lower the chair height, then progress to no hands.
Calf strength for a normal push-off when walking.
2–3 sets of 10, once or twice daily
Feel: Even weight through both feet. Toes pointing forward.
Harder: More weight onto the operated side over time.
Thigh and hip strength through a small, comfortable range.
2–3 sets of 10 to about 45 degrees, once or twice daily
Feel: You should feel the thighs and buttocks working. Depth is limited by comfort, not by rule.
Endurance and circulation with almost no joint load.
10–20 minutes, most days, once the wound is fully healed
Feel: Comfort is the guide: bending the hip on the bike is not restricted after this approach.
Soften and desensitise the scar once fully healed: useful for the sensitive skin at the front of the thigh too.
2–3 minutes, twice daily, from about 3 weeks once healed and dry
Feel: Firm enough to blanch the skin slightly; it should not be painful. Numb or tingly skin nearby can be gently included. It helps desensitise it.
Gluteal and core strength: reintroduced now that the front-of-hip repair has healed.
2–3 sets of 10, hold 3–5 seconds, once or twice daily, from 6 weeks
Feel: Push through the heels. This exercise is deliberately held back until after six weeks, because the finishing position extends the hip and loads the front of the joint.
Single-leg strength for stairs and slopes.
2–3 sets of 8 each leg, once daily
Feel: Push through the whole foot. Keep the pelvis level: do not let it drop to one side.
Harder: Raise the step height, then reduce hand support.
Steadiness, abductor endurance and confidence: protects you from trips and falls.
Build to 3 holds of 30 seconds each leg, daily
Feel: Keep the pelvis level: do not sag onto the hip. Quiet foot, tall posture.
Sleep on your back, or on either side, including the operated side, with a pillow between the knees for comfort. Side sleeping is allowed from the start after an anterior approach.
For the first six weeks, do not sleep face down, and do not lie with the operated leg trailing behind you: both put the hip into prolonged, unguarded extension.
Get in and out of bed without twisting: log-roll.
Disturbed sleep is common in the first weeks and improves as things settle: ice before bed and timing pain relief for the night both help.
Expect real pain needing regular pain relief in the early weeks, settling steadily, pooled trial evidence shows anterior-approach patients have somewhat less pain in the first two days than posterior-approach patients, but this is still major surgery.
Take pain medication as prescribed and ahead of exercise sessions rather than chasing pain afterwards. Wean the strongest medications first as things settle.
You will usually be on a blood thinner for some weeks: take it exactly as directed.
Bruising tracking down the thigh, aches, warmth and tightness continue for weeks and are normal. Pain that is increasing week on week is not, call the rooms.
A patch of numbness, tingling or hypersensitivity over the front and outer thigh is expected after this approach and is not a sign anything has gone wrong: see the FAQ below.
You may drive when all of the following are true:
What the research actually measures is braking reaction time on a simulator. Those studies show braking performance returns to its pre-operative level at about 2 weeks after a right hip replacement and about 4 weeks after a right knee replacement, with movement time back to normal by 6 weeks. After knee arthroscopy the simulator evidence is more conservative than common practice: in the one study that measured it directly, braking was still slower one week after surgery than before it, and had recovered by four weeks, and a 2021 review of eight studies put the average return at about six weeks. Most people having a simple arthroscopy are driving well before that, which is why the criteria above matter more than the date. But these are averages, in one study, about one in three right-hip patients still could not meet an emergency-stop benchmark at six weeks. Treat the timeframes in this guide as targets for discussion with us, not as permissions.
No published study has compared automatic and manual cars. The logical point is simply that a manual needs the left leg for the clutch, so left-sided surgery is the relevant caution in a manual. Advice about driving earlier with a left-leg operation in an automatic is clinical judgement, not trial evidence.
In Australia, your treating doctor’s advice governs: under the Austroads "Assessing Fitness to Drive" standards, temporary post-operative impairment is a matter of clinical judgement, and commercial drivers are held to a higher standard. Driving while impaired may invalidate your insurance, check your insurer’s position. Do not drive for at least 24 hours after any general anaesthetic or sedation.
| Activity | Typical | When it’s right | Notes |
|---|---|---|---|
| Walking for exercise | From the outset | Comfort and steadiness | Frequent short walks first; build distance gradually. It is the core of the programme |
| Swimming and hydrotherapy | 2–3 weeks | Wound fully healed and reviewed | No baths, spas or pools before the wound is checked |
| Stationary cycling | 2–3 weeks | Wound fully healed | Saddle at a comfortable height; mount without twisting |
| Driving | 2–4 weeks | All the driving criteria below, discussed with us | Individually assessed: the criteria matter more than the date |
| Desk work | 1–3 weeks | Comfortable sitting; travel sorted | Normal chairs are fine after this approach |
| Golf and outdoor cycling | Generally 6–12 weeks | Confident balance; walking without a limp | Per European surgeon consensus (expert opinion, not trial data) |
| Physical work | 8–12 weeks | Strength and endurance for the actual duties | Modified duties in between where available |
| Doubles tennis | Usually 3–6 months | Strength, balance and confidence built in Phases 3–4 | Per surgeon consensus guidance |
| Most other activities | By 6 months | Progressing through the phases without setbacks | European surgeon survey: about 5 activities permitted within 6 weeks, 10 at 6–12 weeks, 26 at 3–6 months, and 37 of 47 by 6 months: expert consensus, not trial data |
| Handball, soccer and football codes, basketball, full-contact sport, martial arts | Not recommended | — | Not recommended at any stage in the surgeon consensus |
You will often hear "no flying for six weeks" after joint replacement. Be aware that this is a convention, not a proven rule: a 2025 review found limited data and no demonstrated difference in clot risk between people who did and did not fly after hip or knee replacement: mostly within the first week.
The six-week convention reflects practical realities rather than trial evidence: managing airports and cramped seating, being past the highest-risk clot window while still on prevention, the higher baseline clot risk of long-haul flights over four hours, and individual airline and travel-insurance rules, check both, as some airlines impose their own restrictions.
If you need to travel long-haul in the first six weeks, talk to the rooms first so clot prevention, an aisle seat, stockings and on-board movement can be planned.
None of these should be watched overnight to see how they go. Early treatment of a problem is simple; late treatment is not.
EMERGENCY: 000Emergency department / call 000
GP TODAYSee your GP today
CALL THE ROOMSCall the rooms: same day
For joint replacement patients, a wound problem is never something to "wait and see". Early treatment of an infected joint replacement is vastly more successful than late treatment, call the rooms the same day.
Your discharge summary and operation record state the approach. If you are unsure, call the rooms. The precautions are different. This guide covers the anterior approach, where the surgeon works from the front of the hip. If your operation was from behind the hip, use our posterior approach guide instead: its rules on bending, crossing the legs and sleeping positions are close to the opposite of the advice here.
There is no established, validated set of anterior precautions: large published series ran with no restrictions at all, with very low dislocation rates. What we ask instead is sensible anatomical caution for six weeks: avoid the operated leg stretched out behind you and turned outward, do not sleep face down, and do not force end-of-range stretches. You may sit in normal chairs, bend past 90 degrees and cross your legs from the start.
Typically a frame or two crutches for about 3–10 days, often shorter than after a posterior approach, then one crutch or a stick for about 1–3 weeks, and nothing from about 2–4 weeks. In pooled trial data, anterior-approach patients discarded their walking aids around 11 days sooner. You progress when you can walk without a limp, not on a set date.
Yes: full weight from day one, whether the implant was cemented or uncemented. The implant is fixed and stable from the moment of surgery, so you will stand and walk on it the same day, using a frame or crutches for balance rather than to keep weight off. Walking little and often is the main exercise of the whole programme.
A patch of numbness, tingling or hypersensitivity over the front and outer thigh is expected after this approach. The lateral femoral cutaneous nerve. A skin-sensation nerve that crosses the front of the hip, is stretched or irritated during surgery. It affects skin feeling only: your strength, walking and hip function are unaffected, and hip function scores are identical with or without it. It is not a sign anything has gone wrong.
Usually. About 96% of patients improve without any treatment: most within three to six months, with numbers continuing to fall out to two years. A minority are left with a permanent patch. The honest numbers: only about 1–2% of patients complain of it spontaneously, but when every patient is asked directly, 20–35% describe some altered sensation. Mention it at your reviews so we can track it with you.
Yes, from the start, on either side, including the operated side, with a pillow between the knees for comfort. Side sleeping is one of the things this approach frees up. The two positions to avoid for the first six weeks are sleeping face down and lying with the operated leg trailing out behind you: both put the hip into prolonged, unguarded extension.
No. After an anterior approach you may use a normal toilet, sit in a normal chair, bend past 90 degrees and reach down to your feet within comfort. The traditional equipment is not needed. That said, a sock aid or reacher can be convenient in the first fortnight while things are sore and swollen; convenience, not rule, is the reason to use them.
Yes to both. The back of your hip: the side those traditional rules protect, was not opened during an anterior approach, so deep bending, crossing your legs and low chairs are matters of comfort, not safety rules. The position to respect for six weeks is the opposite one: the leg stretched out behind you and turned outward. Deep squatting is limited by comfort, not by rule.
Typically 2–4 weeks, individually assessed. The date matters less than the criteria: off strong painkillers, comfortable in the driver’s seat, able to perform an emergency stop at full force without hesitation, and practised in a stationary car first. Confirm your own timing with us at review. Your insurer’s position is worth checking too.
Desk work typically at 1–3 weeks, once you are comfortable sitting and have transport sorted, normal chairs are fine after this approach. Physical work typically takes 8–12 weeks, sometimes with modified duties in between. Your own job’s demands set the real date, raise it at the two-week review so a plan is in place early.
Yes, though it is uncommon: one series of over 2,600 anterior-approach hips managed with no formal restrictions reported a 0.15% dislocation rate. Worth knowing: most dislocations after an anterior-approach hip still occur backwards, not forwards. That is part of why the sensible advice is simply to move freely within comfort and avoid forcing the extremes of any movement for six weeks.
Early on the anterior approach is modestly faster: less pain on days 1–2, better hip function at two and six weeks, walking aids discarded around 11 days sooner, and a slightly shorter hospital stay. Beyond about three to six months there is no meaningful difference in hip function or patient-reported outcomes. Overall revision rates are very similar. The Australian registry shows anterior hips have somewhat more femoral loosening and fracture around the implant, and posterior hips more dislocation.
Bruising travels with gravity. Blood from around the hip tracks down the thigh, into the knee and sometimes the ankle over the first couple of weeks. It can look dramatic and is expected: a consistent clinical observation rather than something formally studied. Bruising alongside a calf that is newly painful, firm or swollen is different: see your GP the same day.
| Claim | Source |
|---|---|
| Immediate unrestricted weight bearing on an uncemented stem does not compromise subsidence or bone ingrowth | Hol et al., Arch Orthop Trauma Surg 2010 (PMID 20012073); Woolson & Adler, J Arthroplasty 2002 (PMID 12375238) |
| Anterior/anterolateral approach with no formal restrictions: 0.15% dislocation in 2,612 hips | Restrepo et al., Clin Orthop Relat Res 2011 (PMID 21076896) |
| Medial iliofemoral ligament provides 68–80% of the hip’s resistance to external rotation; repair restores 17–25% | Bido et al., J Arthroplasty 2024 (PMID 38537838) |
| 58.8% of anterior-approach dislocations occur posteriorly | Christensen et al., J Arthroplasty 2023 (PMID 37236286) |
| Anterior approach, less pain days 1–2, better function at 2 and 6 weeks, no difference at 6–12 months | Nassar et al., Orthop Rev 2025 (PMID 40416593) |
| Anterior approach: shorter hospital stay (about a third of a day) and better Harris Hip Score at 6 weeks (24 RCTs) | Ang et al., Eur J Orthop Surg Traumatol 2023 (PMID 37010580) |
| Walking aids discarded about 11 days earlier after the anterior approach; lateral femoral cutaneous nerve injury RR 38.97 vs posterior | Yang et al., Orthop Surg 2020 (PMID 32558261) |
| AOANJRR, no overall difference in revision between approaches; anterior more femoral complications, posterior more dislocation | Hoskins et al., J Bone Joint Surg Am 2020 (PMID 32769807); Hoskins et al., Hip Int 2024 (PMID 38529902) |
| Insufficient evidence that any surgical approach or technique independently changes time to meeting discharge criteria | Wainwright et al., Acta Orthop 2020: ERAS Society consensus (PMID 31663402) |
| Lateral femoral cutaneous nerve numbness spontaneously reported by about 1% of patients | Gorur et al., Arthroplast Today 2024 (PMID 39100423) |
| Lateral femoral cutaneous nerve altered sensation in 21–36% of patients when specifically sought | Vasantharao et al., Hip Int 2022 (PMID 32787466); Sang et al., J Arthroplasty 2021 (PMID 34074541); Homma et al., Int Orthop 2016 (PMID 26224618) |
| 96% spontaneous improvement of thigh numbness; prevalence falling from 31.9% to 11.2% between 13 and 26 months | Ozaki et al., J Orthop Surg 2017 (PMID 28118808) |
| Lateral femoral cutaneous nerve injury does not affect hip function scores | Homma et al., Int Orthop 2016 (PMID 26224618) |
| Braking returns to baseline about 2 weeks after right hip replacement | van der Velden et al., Bone Joint J 2017 (PMID 28455464) |
| Pooled driving recommendation 4.5 weeks; individualise by side and transmission | Patel et al., Hip Int 2023 (PMID 33736494) |
| Return to sport, about 5 activities permitted by 6 weeks and 37 of 47 by 6 months; contact sport not permitted (expert consensus survey) | Thaler et al., J Arthroplasty 2021 (PMID 33277143) |
| Surgeons steadily more permissive about activity after hip replacement; perceived risk minimal | Vu-Han et al., Arch Orthop Trauma Surg 2021 (PMID 33258998) |
| Air travel, no demonstrated difference in clot risk after joint replacement; long-haul flights over 4 hours carry a higher baseline risk | Elmenawi et al., JBJS Rev 2025 (PMID 40259452) |
| Bruising tracking down the thigh after hip replacement | No primary literature identified: presented as a consistent clinical observation, not a studied finding |
This guide is general information for patients of Dr Matthew Broadhead (Harbour Orthopaedics & Sports Medicine) and is not a substitute for the specific advice given to you by Dr Broadhead, your physiotherapist or your hospital team.
Surgical findings vary, and your protocol may differ from what is written here: your operation record and your surgeon’s instructions always take precedence.
If in doubt, call the rooms on (02) 9052 1883. In an emergency, call 000.
Last reviewed: 2026-08-05 by Dr Matthew Broadhead, FRACS (Orth).
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