Hip replacement is the surgery that surprises people. The pain drops dramatically within a week. Most patients walk in and out of the clinic on a stick after a fortnight. The challenge isn't the early phase. It's avoiding the bad habits that follow you for the next twenty years.
What the surgery actually does
The worn ball at the top of your femur gets sawn off and replaced with a metal ball on a stem driven into the bone. The hip socket in your pelvis gets lined with a cup and a plastic or ceramic surface. The two new surfaces glide on each other instead of bone grinding on bone.
Most patients have it done for hip osteoarthritis. By the time someone consents to surgery they've usually been limping for years. The hip muscles, especially the glutes, are weak from compensation. That weakness doesn't go away just because the joint is new. It has to be retrained.
Posterior vs anterior approach
The surgical approach matters because it changes your early restrictions. With a posterior approach the surgeon comes in from the back. The hip is more likely to dislocate during deep bending or twisting in the first six weeks, so you get hip precautions: don't bend past 90 degrees, don't cross your legs, don't rotate the operated leg inward.
With an anterior approach the surgeon comes in from the front. Less muscle is cut. There are usually no formal precautions. Most patients move faster early on. The trade-off is the surgical exposure is harder and not all surgeons do it.
Ask your surgeon which approach they used. If they used the posterior approach, the precautions are a six-week thing. They're not forever.
What the timeline looks like
- Day 0 to 7: In hospital one to four days. Walking with a frame the same day or next day. Standing, bed exercises, transferring in and out of a chair.
- Week 1 to 3: Home with a frame transitioning to crutches. Walking little and often. Daily glute and quad exercises. Pain controllable with paracetamol and short-term opioids if needed.
- Week 3 to 6: Crutches to a single stick. Stationary bike if the seat is high enough. Posterior precautions still in effect if applicable. Most patients driving by week four (legal restrictions vary, check with your surgeon).
- Week 6 to 12: Stick discarded. Precautions released. Strengthening progresses to single-leg work, step-ups, sit-to-stands without using hands.
- Month 3 to 6: Heavy hip and glute strengthening. Walking distance back to pre-surgery levels or better. Most people return to bushwalking, swimming, golf, cycling.
- Month 6 to 12: Long-term strength program. The implant typically lasts 20 years. Looking after the muscles around it is what makes it last on the lower end or the upper end of that range.
The Trendelenburg limp
If you watch hip replacement patients walk six months after surgery, a lot of them have a subtle hip drop on the operated side every time the leg takes weight. That's a Trendelenburg sign and it's a glute med weakness. The hip joint feels great. The muscle never got rebuilt. That limp creates back pain, knee pain, and stress on the new joint.
Fixing it is the entire reason late-stage rehab exists. Side-lying clamshells aren't enough. You need heavy single-leg work: split squats, step-ups, single-leg deadlifts, side planks with hip abduction. Three months of dedicated glute work in months three to six fixes the gait for life.
The hip replacement is a brand new joint. The muscles around it are not. Patients who think the surgery fixed the problem walk worse at month six than patients who understood the surgery was just the start.
What patients get wrong
Three patterns. First, treating week four as the finish line. The pain is gone, the stick is gone, the patient stops the rehab. Then twelve months later they're limping again. Second, ignoring the glutes. Quads alone aren't enough, the hip is run by the glute complex. Third, going back to high-impact sport. Running, contact sport and aggressive hiking shorten the implant's life. Recreational walking, cycling, swimming and weights are all fine.
What to bring to your first session
Your surgical report. Whether the approach was anterior or posterior, what precautions your surgeon set, and what implant was used. We typically see hip replacement patients twice a week for the first four weeks, then weekly through month three, then every two to three weeks through month six. Book a 60-minute initial within the first two weeks of surgery.