Hip replacement: care and rehabilitation after surgery

Purpose and why it matters: Bridging activates the gluteal and hamstring muscles for pelvic stability, standing, and walking while sharing the load between both legs.

Stage and starting criteria: After physiotherapist clearance, wound closure, tolerance of lying on your back, and the ability to bend your knees without exceeding approach-specific limits. It may be delayed after repair of the thigh-abducting muscles or the bony prominence at the top of the thigh bone. After surgery directly through the front of the hip, a full bridge may be restricted; clarify the permitted range with your care team before starting.

Equipment and environmental safety: A firm, nonslip bed or mat. Ask someone to help you get up from the floor, or exercise on a suitable bed.

Starting position: Lie on your back with the knees bent through the permitted range, feet hip-width apart, toes forward, and arms beside the body.

How to do it:

1. Gently tighten your abdominal muscles and activate your buttock muscles.
2. Press evenly through both heels.
3. Lift the pelvis only until the trunk and thighs form a comfortable line.
4. Pause briefly without rotation or dropping one side.
5. Lower the pelvis slowly, one segment at a time, and relax the muscles.

Range, side, and limits: Keep weight symmetrical. Do not overarch the lower back or move into prohibited end-range hip extension, and do not let the knees cross the midline.

Breathing, speed and rhythm: Exhale while rising and inhale while lowering; control both directions.

Documented dose: The American Association of Hip and Knee Surgeons (AAHKS) guide suggests 3 sets of 10 bridges with an approximately 5-second hold. Begin with less volume and approach that pattern only while maintaining good form.

Rest: Rest between sets until buttock or back-of-thigh cramping settles and breathing returns to normal.

Signs of correct performance and Expected response: Equal pressure through both feet, a level pelvis, and mild gluteal fatigue. The lower back should not carry most of the effort.

Stop immediately if: sharp pain in the groin, side of the hip, or back; persistent cramping; a sensation that the joint has shifted; or increased pain and limping after exercise occurs.

Common mistakes: Lifting too high, pushing more through the unaffected leg, letting the knees collapse inward, holding the breath, or driving the movement from the lower back.

Easier version: Perform a gluteal set only, or lift the pelvis just a few centimetres and reduce the repetitions.

Progression criteria: Complete the sets with a level pelvis and no pain or gait reaction lasting into the next day. Then, with your physiotherapist’s guidance, lengthen the hold or progress to standing work.

Purpose and why it matters: Strengthening the muscles at the side of the hip helps keep the pelvis level over one leg and reduces pelvic drop and limping during walking.

Stage and starting criteria: Only after explicit care-team clearance and when supported standing is safe. This movement may be prohibited or allowed later after surgery through the side of the hip, repair of the thigh-abducting muscles or repair of the bony prominence at the top of the thigh bone.

Equipment and environmental safety: A fixed counter or the back of a heavy chair, closed shoes, and a level surface. Keep the support within reach throughout.

Starting position: Stand tall with weight on the unaffected leg, both toes facing forward, the supporting knee slightly soft, and hands on the support.

How to do it:

1. Gently engage the abdominal and gluteal muscles and keep the pelvis level.
2. Move the operated leg a few centimetres out to the side with the knee straight.
3. Keep the trunk upright and toes pointing forward.
4. Pause briefly within the controlled range.
5. Slowly return the foot beside the other one without striking the floor or crossing the midline.

Range, side, and limits: Keep the range small without leaning your trunk. Add band resistance only after permission, and any restriction on moving the thigh outwards with your own muscles takes priority.

Breathing, speed and rhythm: Exhale as the leg moves out and inhale as it returns. Keep the movement even and slow.

Documented dose: American Association of Hip and Knee Surgeons (AAHKS) describes 3 sets of 10 standing hip-abduction repetitions with an approximately 5-second hold. The side, volume, and starting time must be confirmed for your approach.

Rest: Return to standing on two feet between sets and wait until shaking or fatigue at the side of the hip has settled.

Signs of correct performance and Expected response: The trunk stays nearly still and the pelvis level. Mild muscle work is felt at the side of the buttock, not sharp pain over the wound.

Stop immediately if: sharp lateral hip or groin pain, loss of balance, a sensation that the joint has shifted, increased limping, or inability to control the returning leg occurs.

Common mistakes: Leaning the trunk, turning the toes outward, swinging the leg, using too much range, or releasing the support.

Easier version: Practise two-leg weight shifts or a shorter movement without fully lifting the foot. Omit this exercise if the repair imposes a restriction.

Progression criteria: Complete repetitions without trunk lean or a next-day reaction. Add light resistance or progress to single-leg control only with your physiotherapist’s guidance.

Purpose and why it matters: A step-up builds functional gluteal and thigh strength and weight-transfer control for household stairs and a low kerb.

Stage and starting criteria: When walking on a level surface shows no obvious pelvic drop, full or prescribed weight bearing is permitted, and the physiotherapist has chosen an appropriate step height.

Equipment and environmental safety: A stable low step, handrail or counter, closed shoes, and another person nearby. Do not use an unstable stool.

Starting position: Face the step with the operated foot on it, the unaffected foot on the floor, pelvis level, and one or both hands on the support.

How to do it:

1. Place the whole operated foot on the step.
2. Lean the trunk slightly forward and engage the gluteal and thigh muscles of that leg.
3. Push up in a controlled way until both feet are on the step.
4. To return, use the rail and gently place the unaffected foot on the floor.
5. Control the weight, then bring the operated foot down.

Range, side, and limits: Keep the step low and the knee aligned over the toes. Do not twist on a planted foot or pull yourself up mainly with the arms.

Breathing, speed and rhythm: Exhale while stepping up and inhale while stepping down. Make the lowering phase slower than the rise.

Documented dose: Your physiotherapist adjusts step height and repetitions to your ability. Continue with control while the knee stays aligned with the toes and the pelvis remains level.

Rest: Between rounds, stand on both feet on level ground or sit until shaking and fatigue have settled.

Signs of correct performance and Expected response: The pelvis stays level, the knee faces forward, and the main effort is felt in the gluteal and thigh muscles. Mild fatigue is expected.

Stop immediately if: the leg gives way, you lose balance, sharp hip or knee pain occurs, you have to haul on the rail, or limping worsens after exercise.

Common mistakes: Using a high step, pushing mainly from the back leg, letting the knee collapse inward, throwing the trunk, or twisting on the operated leg.

Easier version: Use a lower step, more arm support, or practise weight transfer on level ground without stepping up.

Progression criteria: Step up and down at the selected height with controlled pelvis and knee and no next-day reaction. Increase either repetitions or height, not both at once.

Purpose and why it matters: Builds the hip flexors you need for stairs and for getting into a car.

Stage and starting criteria: During the second month, after permission to lift the thigh using your own muscles, begin with support from a firm table. You should be able to stand without dizziness and know your permitted hip-bending limit.

Equipment and environmental safety: A firm table or a stable chair back, closed shoes and a non-slip floor; for the first sessions have someone stand on the operated side.

Starting position: Stand tall, weight through both feet, one hand on the support, shoulders loose and eyes forward.

How to do it:

1. Shift your weight gently onto the unoperated leg without letting the pelvis drop to one side.
2. Raise the knee on the operated side until the thigh lifts from vertical, without passing your permitted hip angle.
3. Pause for a moment at that permitted height, keeping the trunk upright.
4. Lower the leg slowly and place the whole foot back on the floor.
5. Regain your balance before the next repetition.

Range, side, and limits: Only to your permitted hip angle; the thigh does not rotate inward and does not cross the midline. Leaning the trunk back to lift the knee higher is not allowed.

Breathing, speed and rhythm: Breathe out as the knee rises and in as it lowers; keep the movement measured, never swung.

Documented dose: Follow your physiotherapy plan for repetitions and sessions. Rest before losing balance or bending your trunk.

Rest: Between sets, stand on both feet or sit until the fatigue and any tremor in the thigh settle.

Signs of correct performance and Expected response: The trunk stays upright, the pelvis stays level, and the effort is felt at the front of the thigh rather than in the lower back.

Stop immediately if: you develop groin pain or a catching sensation in the joint, or lose your balance.

Common mistakes: Leaning the trunk backwards, lifting past the permitted angle, dropping the pelvis towards the lifted leg, and gripping the support instead of resting a hand on it.

Easier version: Lower the knee height, or hold the support with both hands until balance is secure.

Progression criteria: Repeat with the trunk upright, pelvis level and without heavy reliance on support; then reduce support to one finger rather than increasing the lifting height.

Purpose and why it matters: Controlled standing on the operated leg trains coordination between the lateral hip and trunk muscles for stepping, dressing, and negotiating uneven ground.

Stage and starting criteria: Once full weight bearing is permitted and you can transfer weight onto the operated leg for a few seconds without obvious pelvic drop.

Equipment and environmental safety: A firm counter, closed shoes, a level surface, and another person nearby at first. Do not practise beside stairs, loose rugs, or an unstable surface.

Starting position: Stand behind the counter with both hands near the support, feet hip-width apart, the operated knee slightly soft, and gaze forward.

How to do it:

1. Shift weight slowly onto the operated leg without leaning the trunk.
2. Engage the gluteal muscles and keep the pelvis level.
3. Lift the unaffected foot only a few centimetres from the floor.
4. Hold only while good form is maintained.
5. Gently replace the unaffected foot and return to standing on both feet.

Range, side, and limits: The operated leg is the support. Avoid pelvic rotation, locking the knee, or moving the free leg beyond an approach-specific restriction.

Breathing, speed and rhythm: Breathe normally, shift weight slowly, and finish with control. Do not hold your breath to prolong the time.

Documented dose: The American Association of Hip and Knee Surgeons (AAHKS) guide sets a goal of holding balance for up to about 30 seconds and does not specify a fixed repetition count. Begin with shorter holds and both hands on the support, and progress only with stable form.

Rest: Stand on both feet or sit between repetitions until shaking and fatigue have settled.

Signs of correct performance and Expected response: The pelvis and shoulders remain nearly level, and muscle work is felt at the side of the buttock rather than as joint pain.

Stop immediately if: balance is lost, sharp pain, dizziness, leg buckling, clear pelvic drop, or increased limping occurs.

Common mistakes: Moving away from the support, locking the knee, leaning the trunk, staring continuously at the feet, or lifting the unaffected foot too high.

Easier version: Keep both hands on the counter, leave the toes of the unaffected foot on the floor, or practise weight shifting without lifting the foot.

Progression criteria: Hold with a level pelvis and less hand contact without a next-day reaction, then practise brief multidirectional taps under supervision.

Purpose and why it matters: Controlled side steps strengthen the lateral hip muscles for stability during direction changes and help prevent pelvic drop.

Stage and starting criteria: After physiotherapist clearance, pain-free standing sideways leg raises, and removal of restrictions on moving the thigh outwards using your own muscles. It may be allowed later after repair of the thigh-abducting muscles or the bony prominence at the top of the thigh bone.

Equipment and environmental safety: A light band above the knees or in the prescribed position, a long counter, closed shoes, and a level route. Place the band around the ankles only at a more advanced stage.

Starting position: Stand beside the counter with feet hip-width apart, knees slightly soft, trunk tall, and gentle tension in the band. Keep both toes facing forward.

How to do it:

1. Engage the abdominal and gluteal muscles and keep the pelvis level.
2. Take a short side step with the leading leg.
3. Bring the other foot in under control without letting the feet touch.
4. Continue for several short steps in the same direction.
5. Reset your posture, then return in the opposite direction with control.

Range, side, and limits: Keep steps short without rotating the toes or trunk. Do not cross the feet, drag the trailing foot, or move through a painful range.

Breathing, speed and rhythm: Breathe freely and complete each step separately and slowly. Do not let the band snap the leg back.

Documented dose: Your physiotherapist sets band resistance, distance and the number of return trips. Rest before you start dragging a foot or leaning your trunk.

Rest: Stand on both feet or sit between passes until form and breathing have fully recovered.

Signs of correct performance and Expected response: Even band tension, an upright trunk, and mild fatigue on both sides of the buttocks without limping.

Stop immediately if: sharp lateral hip or groin pain, catching, loss of balance, increased limping, or inability to control the leg occurs.

Common mistakes: Using a band that is too heavy, taking long steps, letting the knees collapse inward, dragging the trailing foot, or swaying the trunk.

Easier version: Remove the band, shorten the step, or continue supported standing abduction.

Progression criteria: Complete the outward and return paths with toes forward and pelvis level and without reactive pain or limping. Increase either resistance or distance at one time.

Purpose and why it matters: This exercise strengthens the buttock and thigh muscles of the operated leg and their ability to control lowering the body when descending steps and slopes.

Stage and starting criteria: Once a low step-up, supported balance, and walking without obvious pelvic drop are controlled and the treatment team has approved starting.

Equipment and environmental safety: A very low stable step, a handrail or counter, closed shoes, and another person nearby. A wet surface or stool is not suitable.

Starting position: Stand with the operated foot on the step, the unaffected foot near the edge ready to touch the floor, pelvis level, and a hand on the rail.

How to do it:

1. Engage the gluteal and thigh muscles of the operated leg.
2. Move the hips slightly backwards and gently bend the supporting knee.
3. Bring the unaffected heel towards the floor or touch it down, without transferring your full weight onto it.
4. Keep the knee facing forwards and aligned with the toes; do not let it fall inwards. Keep the pelvis level.
5. Press through the operated leg to return to standing on the step.

Range, side, and limits: Keep the step height and knee bend small. Do not let the knee collapse inward, rotate the pelvis, or twist the planted operated foot.

Breathing, speed and rhythm: Inhale while lowering and exhale while returning. Lower slowly without dropping.

Documented dose: Your physiotherapist adjusts step height and repetitions to your ability. End the session before the knee falls inwards or the pelvis rotates.

Rest: Stand on both feet after each round and rest until muscle shaking has settled.

Signs of correct performance and Expected response: Smooth lowering, a level pelvis, and an aligned knee. Fatigue at the front of the thigh and in the gluteal muscles is expected.

Stop immediately if: sharp pain, buckling, loss of balance, clear knee or pelvic collapse, or worse walking after exercise occurs.

Common mistakes: Using a high step, dropping quickly, pushing too hard on the rail, letting the knee collapse inward, or twisting the trunk.

Easier version: Use a lower step and shorter touch, increase hand support, or return to the step-up.

Progression criteria: Lower with a steady rhythm and alignment and no next-day reaction, then practise everyday stairs or a short slope under supervision.