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 posterior approach, where the surgeon works from behind the hip. If your operation was through the front of the hip, use our anterior approach guide instead, its advice is close to the opposite of this one.
This guide walks you through recovery after a posterior-approach total hip replacement, week by week, what to do, what to expect, and when to call us. The headline is simple: you can stand and walk on the new hip from day one, and walking is the main exercise. What needs protecting for the first six weeks is not the implant but the repaired soft tissues at the back of the hip, and one specific combination of movements.
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.
Through the posterior approach, the surgeon works from behind the hip, splitting the gluteal muscle fibres and dividing the small rotator muscles at the back of the hip, which are then repaired. The joint capsule (the sleeve of tissue enclosing the joint) at the back is also repaired. This is the most widely used and most versatile approach worldwide. It gives excellent access, and it does not disturb the main hip abductor mechanism. The outer-hip muscles that keep your pelvis level when you walk.
The metal is fixed to bone from the moment you wake up, which is why you may put full weight through it straight away. The repaired muscles and capsule at the back of the hip take about six weeks to heal, which is why there are movement restrictions for six weeks, and not longer.
Everything you are asked to avoid is a version of the same risk: deep bending combined with turning the leg inward. Understanding the pattern is easier than memorising a list.
Frequent short walks beat occasional long ones. Build the habit of getting up and moving at least hourly while you are awake.
Bruising down the thigh and into the knee, and even the ankle, is expected and not a complication. It tracks downward from the hip over the first weeks and then fades.
Careful studies show that relaxing these restrictions has not been shown to increase dislocation, and dropping them has not been shown to be harmful, but nor has dropping them been shown to make hips safer. This guide takes a moderate position: full six-week precautions, because they are cheap, temporary and easily explained. Your surgeon may relax these for you, and that is a reasonable, evidence-supported decision.
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 press-fit (uncemented). The one exception: if something found during your operation means weight needs restricting, such as a crack in the bone, extra bone work or a fixation that needs protecting, Dr Broadhead will tell you before you first get up.
This is backed by evidence, not just habit. Systematic review evidence shows that immediate unrestricted weight bearing on an uncemented stem does not compromise the stem settling into position (subsidence) or the bone growing onto it; cement achieves immediate mechanical fixation.
The frame or crutches are for balance and confidence, not to keep weight off the leg. And keep a stick for crowds, uneven ground and long distances for longer than you think you need it.
| Stage | Typical timing | Move on when |
|---|---|---|
| Wheeled frame or two crutches | Day 0 to about 1–2 weeks | Safe balance; walking without a lurch |
| One crutch or a single stick (opposite hand) | About 2–4 weeks | Level walking without a limp; able to stand on the operated leg with control |
| No aid | About 3–6 weeks | Confident indoors and outdoors; no lurch; able to manage a kerb |
The repaired posterior capsule and short external rotators are the hip’s guard against the ball levering out of the socket backwards. The unsafe pattern is deep hip bending, the legs crossing the midline, and the operated leg turning inward, especially any two of these together. The usual formulation is: keep hip bending under 90 degrees, do not cross the midline, and do not turn the leg inward, for six weeks, but be aware that units vary (some use 12 weeks, some limit rotation in both directions, and one UK survey found advice ranging from six weeks to lifelong). The honest evidence summary: these restrictions do not appear to buy a safety benefit, dislocation rates are about the same with or without them, and dropping them has not been shown to be harmful. We ask you to follow the full six weeks because the rules are cheap, temporary and easily explained. Your surgeon may relax these for you, and that is a reasonable, evidence-supported decision.
| Rule | Why | How to manage |
|---|---|---|
| Do not bend the hip more than 90 degrees, keep the knee below hip height, and do not lean forward past your knees when seated | Deep flexion (bending) levers the ball toward the back of the socket | Use high chairs with arms; raise a low bed; use a toilet seat raiser and a shower chair for 6 weeks. No low sofas, beanbags, camping chairs or car seats reclined low. |
| Do not cross the operated leg over the midline: legs, ankles or knees | Adduction (the leg crossing the middle of the body) narrows the safety margin | Sleep with a pillow between the knees; sit with feet apart; do not cross your legs even briefly. |
| Do not turn the operated foot or knee inward | Internal rotation is the third component of the dislocating position | Pivot on your feet by taking small steps, not by twisting the hip; move the whole body to turn. |
| Do not combine bending with reaching down or twisting | The combination is the real risk, not any single movement | Use a long-handled reacher, sock aid, long-handled shoehorn and long sponge for 6 weeks. |
| Do not lie on the operated side without a pillow, and do not sleep face down | Your position is uncontrolled while you are asleep | Sleep on your back with a pillow between or under the knees, or on the non-operated side with a firm pillow between the knees. |
| Milestone | Earliest (weeks) | Typical | Latest |
|---|---|---|---|
| Walking with frame or crutches | 0 | 0 | 1 |
| One crutch or a single stick | 1 | 2 | 4 |
| First review (wound check) | 2 | 2 | 3 |
| Desk work | 2 | 3 | 4 |
| Walking without any aid | 3 | 4 | 6 |
| Driving (criteria met, discussed with us) | 4 | 5 | 8 |
| Posterior precautions finish (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 |
| 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 make the precautions automatic.
Ready for the next phase when…
Wean off the aids, build the outer-hip (abductor) strength that abolishes the limp, and keep the precautions automatic.
Ready for the next phase when…
With the precautions finished, gradually return to normal movement 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 muscles the surgeon worked through, and the hip’s engine.
10 holds of 5 seconds, 3–4 times daily
Feel: You should feel the buttocks firm under you. Mild pulling near the wound is normal; sharp pain is not.
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. This stops the leg rotating. 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: Keep the toes pointing at the ceiling. Ease off if you feel sharp pain in the groin. A dull working ache is fine.
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. Keep the pelvis level; the movement is small and controlled.
Harder: Slow the lowering phase, then add a light ankle weight if advised.
Gluteal and core strength for standing up, stairs and a stable pelvis.
2–3 sets of 10, hold 3–5 seconds, once or twice daily
Feel: Push through the heels. Keep the knees hip-width apart: do not let them fall together.
Real-world leg strength: the movement you will do more than any other.
2–3 sets of 8–10, once or twice daily
Feel: Operated leg slightly forward on the way down as well. Share the load evenly, no flopping into the seat.
Harder: Use the arms less over time; keep the seat high until the six-week mark.
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, safe range: well short of the 90-degree limit.
2–3 sets of 10 to about 45 degrees, once or twice daily
Feel: You should feel the thighs and buttocks working. Small range: this is not a deep squat.
Soften and desensitise the scar once fully healed.
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.
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.
Endurance and circulation with almost no joint load.
10–20 minutes, most days, from about 6 weeks
Feel: Comfort is the guide; lower the saddle gradually over the following weeks.
For the first six weeks: sleep on your back with a pillow between or under the knees, or on the non-operated side with a firm pillow between the knees.
Do not lie on the operated side without a pillow, and do not sleep face down. Your position is uncontrolled while you are asleep, which is exactly why these two rules exist.
Getting into bed: sit at the edge, slide back, then lift the legs up together with a pillow between the knees. Raise a low bed for the first six weeks.
After six weeks, unless you are told otherwise, sleep in whatever position is comfortable.
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, hip replacements generally hurt less early on than knee replacements, 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.
Numbness over the buttock or the outer thigh is not typical of the posterior approach: if you notice it, mention it at your review.
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 | From about 6 weeks | Wound fully healed; precautions finished or saddle set high | Saddle high; mount without twisting |
| Driving | 4–6 weeks | All the driving criteria below, discussed with us | Often earlier for a left hip in an automatic: clinical judgement, not trial evidence |
| Desk work | 2–4 weeks | Comfortable sitting in a suitably high chair; travel sorted | Set the workstation up to respect the 90-degree rule for the first six weeks |
| 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 posterior approach, where the surgeon works from behind the hip. If your operation was through the front of the hip, use our anterior approach guide instead: its advice on bending, crossing the legs and sleeping positions is close to the opposite of this one.
Typically a frame or two crutches for the first 1–2 weeks, then one crutch or a stick in the opposite hand from about 2–4 weeks, and nothing from about 3–6 weeks. You progress when you can walk without a limp, not on a set date. Keep a stick for crowds, uneven ground and long distances longer than you think you need it. That is sensible, not slow.
Yes: full weight from day one, whether the implant was cemented or press-fit. The implant is fixed to bone from the moment you wake up. The only exception is if something found during your operation means weight needs restricting, in that case Dr Broadhead will tell you before you first get up. The frame or crutches are for balance, not to keep weight off.
The usual formulation is: do not bend the hip past 90 degrees, do not cross the operated leg over the midline, and do not turn the operated foot or knee inward, for six weeks. All of it is a version of one risk: deep bending combined with the leg turning inward, especially together. Units vary in how long and how strictly they apply these, so follow the version you were given.
Follow the version you were given. The honest evidence: across about 6,900 patients, dislocation was 2.2% with precautions and 2.0% without, so the restrictions do not appear to buy a safety benefit, and dropping them has not been shown to be harmful. We ask for the full six weeks because the rules are cheap, temporary and easily explained. Your surgeon may relax these for you, and that is a reasonable, evidence-supported decision.
From the start you can sleep on the non-operated side with a firm pillow between the knees, or on your back with a pillow between or under the knees. For the first six weeks, do not lie on the operated side without a pillow, and do not sleep face down. After six weeks, unless you are told otherwise, sleep in whatever position is comfortable.
Typically 4–6 weeks after a posterior hip replacement, individually assessed, often earlier for a left hip in an automatic, which is clinical judgement rather than trial evidence. The date matters less than the criteria: off strong painkillers, comfortable in the driver’s seat, and able to perform an emergency stop at full force without hesitation. Confirm your own timing with us at review.
Desk work typically at 2–4 weeks, once you are comfortable sitting in a suitably high chair and have transport sorted. 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.
For the six weeks the posterior precautions apply. The raised toilet seat, shower chair and high chairs with arms all serve the same purpose: keeping the hip from bending past 90 degrees. After six weeks, unless you are told otherwise, the equipment can be returned and you can go back to normal seating gradually, within comfort.
About 1–2% in the first year, and up to about 3.5% within two years when every dislocation, including those put back without further surgery, is counted. Larger femoral heads reduce the risk, and dual-mobility bearings reduce it substantially further in higher-risk patients. The highest-risk position is deep bending combined with the leg turning inward: exactly the pattern the six-week precautions target.
Pooled trial evidence gives the anterior approach a modest early advantage: slightly less pain in the first two days, better hip function scores at two and six weeks, and walking aids discarded around 11 days sooner. 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 the approaches differ mainly in the kind of problem that leads to revision.
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.
Not in the first six weeks: bending to floor level takes the hip well past 90 degrees, and combining bending with reaching is the exact pattern to avoid. Use a sock aid, a long-handled shoehorn and a reacher; dress the operated leg first and undress it last. From six weeks, once the precautions finish, return to bending gradually within comfort.
| 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) |
| Dislocation 2.2% with precautions vs 2.0% without (systematic review, 7 studies, 6,900 patients) | Crompton et al., Acta Orthop 2020 (PMID 32718213) |
| No influence of precautions on early recovery; low-to-very-low certainty evidence | Korfitsen et al., Acta Orthop 2023 (PMID 37039064) |
| No need for precautions; better HOOS-JR and earlier walking-aid discontinuation without them | Guo et al., Medicine 2024 (PMID 39686472) |
| RCT, less difficulty with daily activities, earlier driving and side-sleeping when unrestricted | Tetreault et al., J Arthroplasty 2020 (PMID 32146109) |
| Counterpoint RCT, no benefit from removing restrictions; slightly lower HOOS-JR at 2 weeks in the unrestricted group | Dietz et al., J Arthroplasty 2019 (PMID 30975478) |
| Uncertain evidence for precautions and equipment provision | Smith et al., Cochrane Database Syst Rev 2016;7:CD010815 (PMID 27374001) |
| Danish registry, no significant increase in dislocation after dropping precautions, in the context of a simultaneous move to 36 mm heads | Iljazi et al., Acta Orthop 2024 (PMID 39023400) |
| True 2-year dislocation incidence 3.5% when every dislocation is counted | Hermansen et al., J Bone Joint Surg Am 2021 (PMID 33347013) |
| Larger femoral heads reduce dislocation risk | Hermansen et al., J Bone Joint Surg Am 2021 (PMID 33347013); Cnudde et al., Acta Orthop Belg 2025 (PMID 41928745) |
| Dual mobility, around 80% reduction in dislocation within 2 years in a large matched study | Hussein et al., Bone Joint J 2025 (PMID 39740683) |
| AOANJRR: dual mobility no advantage over heads ≥36 mm except in sockets <58 mm | Hoskins et al., J Arthroplasty 2021 (PMID 34088570) |
| 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) |
| 35% of right-hip and 15% of left-hip patients failed the 600 ms braking threshold at 6 weeks | Jordan et al., Arch Phys Med Rehabil 2014 (PMID 24685390) |
| 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) |
| Anterior approach, less pain days 1–2, better function at 2 and 6 weeks, no difference at 6–12 months; walking aids discarded ~11 days earlier | Nassar et al., Orthop Rev 2025 (PMID 40416593); 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) |
| 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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