Physical Therapy After Hip Replacement Surgery: Guide & Tips!

Are you wondering about the timeline of physical therapy after hip replacement surgery, when to start, and the exercises to do or avoid?

Whether you underwent surgery due to osteoarthritis (coxarthrosis) or a femur fracture, this article should address your main questions regarding rehabilitation.

As a physiotherapist, I have been in daily contact with people who have undergone hip surgery for over 13 years, whether in hospitals, rehabilitation centers, or at home.

Based on my experience, as well as extensive research and readings in international medical literature, I have decided to write this blog post to provide you with the most up-to-date and rigorous information.

Enjoy reading 🙂!

No physical therapy after hip replacement: How bad is it?

Do you need physical therapy after hip replacement?

In a country like France, hip replacement rehabilitation is covered by social security and health insurance. The vast majority of people have their potential physical therapy sessions covered. However, even under these conditions, some individuals:

• Choose not to undergo physical therapy sessions after their hip surgery.
• Struggle to find a physiotherapist for their rehabilitation.

As a result, there are regularly people with total or partial hip replacements who do not receive physical therapy. We do not have data from studies that specifically track the long-term recovery of these people.

Personally, I encounter people every year who have not undergone rehabilitation following their hip replacement.

I believe that by self-educating, it is possible to recover well from a hip replacement without consulting a physiotherapist. Of course, this is provided that one gradually resumes daily activities and remains active in the weeks following the operation.

As a physiotherapist, our role primarily comes into play when people are unable to regain mobility as before. We assist when they feel lost about what they can or cannot do, or when they experience anxiety about potentially doing something wrong or experiencing pain.

Prevention is also important. But its effectiveness and “profitability” are harder to quantify.

I always say this to my patients: it’s up to you to make your own assessment of what physical therapy can do for you. The benefits, disadvantages and risks in your case of having sessions.

Doing no physical therapy after a hip replacement is a possibility. As long as you do your own research and manage to gradually return to an active lifestyle.

There is, however, a consensus in post hip replacement recommendations: physical therapy is recommended to maximize the chances of a good recovery.

When to start physical therapy after hip replacement?

It is recommended to start early physical therapy after a hip replacement. Research teams have found that people who begin rehabilitation within 2 weeks following the surgery:

• Have shorter hospital stays
• Incur lower costs (to society/insurance)
• Experience no additional adverse effects

In comparison to those who do not undergo rehabilitation or start it 2 weeks or later after the operation.

Source: Masaracchio 2017

What is the timeline of physical therapy after a hip replacement?

Here are some typical timeframes regarding recovery time after hip replacement.

Activity	Timeframe
Significant reduction in pain	Few days to a few weeks One-third of individuals are completely pain-free 6 months after the operation (Ninomiya 2020)
Reduced swelling in the hip, leg, or foot	Few weeks, occasionally a few months
Walking with crutches or a walker	Immediately to a few days Average duration of 4 days (Kim 2022)
Walking without a cane or assistive device Equal weight-bearing on the operated side as on the non-operated side	Few weeks to a few months 6 to 8 weeks for static activities, slightly longer for walking (Alves 2022)
Driving a car	1 to 2 months
Resuming cycling	Few weeks
Return to sports activities	Few months
Complete recovery from the surgery	Few months 80% average recovery of capabilities 6 to 8 months after the operation (Vissers 2011)

How long do you need physical therapy after hip replacement?

Here are some common timeframes:

• A stay in a rehabilitation center after a hip replacement typically lasts 2 to 12 weeks, often around 4 to 6 weeks. Afterward, people often transition to receiving physiotherapy treatment in private practice (although, in my opinion, it is often not necessary).
• Physiotherapy sessions at home or in a clinic are typically limited to a few sessions, regardless of whether or not the people went to a rehabilitation center. Generally, these sessions are spread over 3 to 8 weeks, with a frequency of 1 or 2 times per week.

Of course, these timeframes may vary depending on various factors, such as:

• Your overall health at the time of the surgery and your physical condition.
• The reason for the operation (advanced coxarthrosis, complex fracture of the femoral neck, revision of a gamma nail, etc.).
• Your living environment.
• Your general coping mechanisms for stress, pain, and change.

That’s why it is impossible to provide precise timeframes after hip replacement surgery, even though it would be helpful for better planning!

What is the best physical therapy for hip replacement?

Hip replacement rehabilitation is generally quite rapid. On the same day or the day after the hip surgery, most individuals can start walking with crutches or a walker, and even climb stairs under the supervision of a healthcare professional.

Hip replacement physical therapy protocol

There are typically two main phases in physical therapy after hip replacement surgery:

1. Recovery of basic transfers (getting out of bed, getting up from a chair, turning in bed, sitting on the toilet, etc.) and essential movements. This usually occurs in the early days at the hospital, upon returning home, or during the initial days at a rehabilitation center.
2. Gradual resumption of all other pre-surgery activities, gradually reducing the reliance on assistive devices (crutches, walker, raised toilet seat, transfer bars, shower seat, etc.). This also includes participation in sports activities.

Throughout these two phases, physical therapists will:

• Provide pain relief strategies
• Address any questions or concerns
• Demonstrate proper techniques for transfers, walking, and performing daily activities (such as bathing, household tasks, etc.) despite the discomfort associated with the prosthesis
• Gradually adjust the level of activity based on individual progress

There is typically no need for specific exercises like tiptoeing or lifting the leg to the side. The most important aspect, based on my experience, is to gradually resume one’s pre-surgery lifestyle. Exercises or passive hip mobilization performed by the physical therapist are not essential for this purpose and may even cause unnecessary discomfort.

Exercises for hip replacement after 1 or 3 months?

We often expect to receive a list of exercises to perform during physical therapy, with specified frequencies, prescribed movements, and therapists correcting us if we don’t perform them correctly.

Here is an illustration that summarizes the most commonly prescribed exercises by physical therapists after total hip replacement (based on my experience).

In my opinion, the execution of such exercises is secondary. My priority with my patients after hip surgery is to gradually and appropriately resume all their pre-surgery activities.

Because these exercises only represent a few minutes in a day. And even that is for the most dedicated people.

There are still more than 23 hours to fill! And what happens during those 23 hours is, in my opinion, the most important.

That’s why a significant part of rehabilitation and physical therapy sessions is focused on discussing what you do during your days in this post-operative recovery phase after hip replacement:

• Do you walk multiple times a day, both indoors and outdoors?
• How can we help you increase your walking?
• Are you frequently sitting or standing statically? Do you lie down regularly to rest?
• If you have a stationary bike, have you considered using it for rehabilitation?
• Do you engage in household tasks? How do you approach them?
• Do you usually perform stretching, flexibility exercises, muscle strengthening, or general conditioning exercises? If yes, have you resumed them? If not, are you considering implementing them? Gradually and appropriately resuming daily activities is as important (if not more) than performing a few exercises every day!

A research team has specifically investigated what is most effective in hip replacement rehabilitation (Cochrane 2022). They analyzed the results of 40 studies involving over 4,000 hip surgery patients from 11 different countries.

Here are their conclusions:

Interventions aimed at improving mobility after hip fracture may lead to clinically significant improvements in mobility and walking speed in both hospital and post-hospital settings, compared to usual care. Interventions that include walking training, balance exercises, and functional tasks are particularly effective. There were few or no differences between groups regarding the number of reported adverse events.

Cochrane 2022

What are the recommended long-term hip replacement exercises?

The most important aspect of long-term hip replacement recovery is to maintain an active lifestyle. There are no specific exercises that are universally recommended!

Staying physically active and engaging in regular daily activities are key.

As you progress in your recovery and regain strength and mobility, you can gradually incorporate activities that challenge and strengthen your hip joint. This can include activities such as walking, swimming, cycling, or participating in low-impact aerobic exercises.

The goal is to lead an overall active lifestyle that promotes cardiovascular health, muscle strength, and flexibility. By engaging in regular physical activity and maintaining a healthy weight, you can support the long-term success of your hip replacement.

Are there differences in rehabilitation based on the anterior or posterior surgical approach?

The approach refers to the way in which the surgeon has made the incision to implant the hip replacement. There are two different approaches for a hip replacement: anterior and posterior.

To determine which approach you had, the information is indicated in your surgical report. You probably have a copy of it, or your physiotherapist or primary care physician has one.

Alternatively, you can always request this information from the department where you had the surgery.

The rehabilitation is the same regardless of the approach! There are no specific exercises to perform based on the approach.

The only small difference is that movements that could cause dislocation are not the same. I provide more information on this topic in my article on movements to avoid after hip replacement.

However, this does not significantly change the rehabilitation process because modern prostheses have a reduced risk of dislocation. When dislocation does occur, it is often due to unfortunate circumstances rather than not following a gradual and cautious approach to different activities.

What about physical therapy after hip replacement in older adults?

The probability is higher that an elderly person may have:

• Other pathologies that may impact rehabilitation
• Pre-existing difficulties and functional limitations not related to the surgery itself
• Post-fall syndrome, balance disorders, or fear of falling

In my opinion, it is important to consider the person’s previous level of autonomy to establish realistic goals. This refers to their level of functioning just before the operation, not months or years ago.

Often, when asked, people recall their abilities when “everything was going well,” rather than right before the surgery. If the person does not remember well, it can be helpful to ask their loved ones, who often have a more objective perspective.

The rehabilitation of an elderly person is not different from that of a younger person.

Just like with any patient, physiotherapists, occupational therapists, and other rehabilitation professionals will adjust the workload and instructions based on the individual’s current condition and mutually agreed-upon realistic goals, not solely based on age.

Where should you undergo rehabilitation after a hip replacement?

The hospital stay lasts a maximum of a few days after a hip replacement surgery. Most often, you will then return home with a prescription for physiotherapy sessions to be done at home or at a clinic.

However, some individuals go to a rehabilitation center, either as inpatients (staying overnight) or on a day or half-day basis (in outpatient care).

Let’s take a closer look at this.

Inpatient rehab after hip replacement

In the United States, the decision for inpatient rehabilitation after hip replacement is typically based on certain criteria and considerations. They vary depending on individual factors and insurance coverage. Here are some general points to consider:

1. Functional status: Inpatient rehab may be recommended for people who have limited mobility or functional impairments that require intensive therapy to regain independence.
2. Medical stability: Inpatient rehab is typically considered for people who are medically stable but still require close monitoring and management of post-operative complications or other medical conditions.
3. Safety concerns: If there are safety concerns related to the home environment, such as obstacles or hazards that may hinder recovery, inpatient rehab can provide a controlled and safe setting for rehabilitation.
4. Support at home: If a person lacks a support system at home to assist with activities of daily living and ongoing care, inpatient rehab can provide the necessary support during the early stages of recovery.

You can consult insurance providers to determine the specific coverage and reimbursement policies for inpatient rehabilitation services. Coverage may vary based on insurance plans, including Medicare, Medicaid, or private insurance. Factors such as medical necessity, length of stay, and specific services provided will also influence coverage.

It is known that starting rehabilitation early after a hip replacement (within the first two weeks) is important. However, there is no evidence to suggest that “intensive” physical therapy is necessary.

It is reasonable to believe that people who receive:

• Daily rehabilitation sessions in inpatient rehab,
• 2-3 sessions per week at a private clinic, or
• 1 session per week of home-based physical therapy, or even through telephone consultations later on,

achieve similar average recovery outcomes.

I have personally supervised hip replacement rehabilitations with 1-2 sessions per day, 5 days a week, for 6-8 weeks, with sessions lasting between 30 minutes to 1 hour. I have also overseen rehabilitations with only 1 session per week, lasting around 20 minutes. I have not observed any differences related to the frequency of sessions.

At a private physiotherapy clinic

You should contact your insurance provider to understand the specific coverage details for hip replacement rehab in a private physiotherapy clinic. The extent of insurance coverage can vary based on your insurance plan, including factors such as deductibles, co-pays, or limitations on the number of sessions.

Some insurance plans may require prior authorization or a referral from a primary care physician or surgeon before accessing hip replacement rehab in a private clinic.

With home-based physiotherapy

To find out if you are eligible for home-based rehabilitation, you should consider factors such as medical stability, your ability to perform exercises safely at home, and the absence of any contraindications. Your healthcare provider will assess your specific needs and determine if home-based rehab is suitable for you.

Your insurance provider can provide information on the extent of coverage for home-based rehabilitation, including co-pays, deductibles, or limitations on the number of sessions covered.

Each insurance plan has different requirements and coverage policies, so it is best to contact your insurance provider directly to get accurate and personalized information regarding your eligibility and financial coverage for home-based hip replacement rehabilitation i