After a hip replacement: what you can do, and when

The operation is done, it already hurts less than it did before, and then come the questions nobody covers properly on the ward: how much should I walk, when can I drive, will I ever lift a barbell again. The answers depend on two things — how many weeks have passed, and which route the surgeon took into the joint. Here it is week by week.

The first two weeks: walking is the treatment

Most people stand and take a few steps on the day of surgery or the day after, using a frame or crutches. A hospital stay of one to three days is typical. At home the pattern is short and frequent: five to ten minutes of walking every couple of hours while you are awake, rather than one long outing that leaves the leg swollen all evening.

How much weight you may put through the leg is written on your discharge letter, and that is the only rule that counts. Most replacements allow full weight-bearing straight away. There are exceptions — a fracture around the implant, a bone graft, a particular fixation — where partial loading is required for weeks.

Swelling in the leg and foot lasts six to twelve weeks and is not in itself a sign of trouble. Elevating the leg above heart level for 20 minutes a few times a day helps, as does ice over a cloth for 15 minutes and 20 ankle pumps every hour you spend sitting. Numb skin around the scar and a faint click in the joint are common and usually harmless.

Hip precautions, and why yours may differ

If your surgeon used a posterior approach, the classic three restrictions apply for roughly the first 6 to 12 weeks: no bending the hip past 90 degrees, no crossing the operated leg over the midline, no turning the foot inwards. What actually causes trouble is all three at once — reaching for a slipper from a low sofa while twisting sideways.

With an anterior approach the restrictions are different or barely exist, and plenty of surgeons now give a freer regime even after a posterior approach. So don't borrow rules from a neighbour who was operated on five years ago. Ask your own surgeon what applies to you and for how long.

In practice this means a high chair with armrests instead of a low sofa, a raised toilet seat, a long-handled shoehorn and slip-on shoes. Sleep on your back for the first few weeks; rolling onto your side comes later, with a thick pillow between the knees, usually somewhere around week four to six. The risk of the hip dislocating is low — under two per cent for most replacements — and it is concentrated in those early weeks while muscle and capsule heal.

Driving, work and showers: when normal life returns

Crutches and sticks are dropped when the limp goes, not on a set date. For most people that is a frame for one to two weeks, a single crutch or stick for two to six weeks, then nothing. If you are still limping, keep the stick — the move back to walking unaided is safer when it isn't rushed. On stairs: good leg up first, operated leg down first, stick stays with the operated side.

Driving usually returns somewhere between four and six weeks, on three conditions. You are off the strong painkillers that make you drowsy, you can get in and out of the car without pain, and you can slam on the brake at full force. A right hip and a manual gearbox take longer than a left hip and an automatic.

Desk work typically resumes in two to six weeks, with a stand-up break every 30 to 45 minutes. Physical work involving lifting, squatting and ladders needs eight to twelve weeks, sometimes longer. Showering is fine once the wound is closed and dry, usually after 10 to 14 days; baths, pools and the sea wait for full healing, as a rule four to six weeks. Sex generally comes back around week six, with the same rules about hip position.

Get out of bed and out of chairs slowly, in two stages. After surgery and a change of medication, dizziness on standing up quickly is a common cause of falls, and a fall onto a new hip is the worst thing that can happen in the first few months.

Getting back into the gym

A new hip rarely suffers from load. It suffers from weak muscle around it. Gluteus medius, the muscle that keeps the pelvis level with every step, has usually been weak for years before the operation, and it is the main reason people limp long after the joint itself has healed. Everything else is built on top of it.

First six weeks: sit-to-stand from a chair without using your hands, 3 sets of 8–10; side-lying or standing leg abduction, 3 sets of 12; glute bridges, 3 sets of 10; walking as the base volume. Pain up to about 3 out of 10 during the exercise is acceptable if it has settled by the next morning.

From week six to twelve, load goes on: leg press through a limited range, step-ups onto a 10–15 cm box, Romanian deadlifts with a light bar, a stationary bike with the saddle higher than you would normally set it. The principle is the same as any return to training after a long break — volume before weight, technique before either.

After three months most people train like everybody else, with two caveats. Hip range of motion may stay permanently a little smaller, and squatting to the floor is neither necessary nor especially clever; clean squat technique through the range you actually have does the same job. If the other knee has arthritis, the rules for training with knee osteoarthritis still stand.

Sport, and how long the implant lasts

There is broad agreement on what is safe long term: walking, hiking, swimming, cycling, rowing machines, golf, doubles tennis, dancing and resistance training. All of these load the implant in the way it was designed for.

Running, jumping, sports with sharp changes of direction and contact sports sit in a grey zone. The implant will take them, but every impact wears the bearing surface and brings loosening forward. Some surgeons allow it for a younger, lighter patient; most do not recommend it as a weekly habit. In the pool, avoid breaststroke for the first couple of months because of the leg splay and rotation.

The evidence generally points to modern implants lasting 15 to 20 years or more in most people. The single biggest thing that shortens that figure is body weight, not training — every kilo is multiplied several times over at the joint with each step.

When to see a doctor

Same day, urgently: sudden severe hip pain with the leg feeling shorter or unable to take weight; a swollen, hot, painful calf; breathlessness or chest pain. The first suggests a dislocation, the other two a clot.

Within a day or two: a temperature above 38 °C, spreading redness around the scar, discharge from the wound, or a wound that reopens. An early infection is far easier to treat than a neglected one.

Book an appointment too if, months or years later, a new deep groin pain appears when you put weight through the leg, if a limp returns for no reason, or if you fall onto that hip — even when nothing hurts at the time.

The short version

• Walking starts on day one or two, in short frequent bouts; swelling for up to 12 weeks is normal.
• Hip precautions depend on the surgical approach — get your rules from your own surgeon.
• Driving usually at 4–6 weeks, desk work at 2–6, physical work at 8–12 weeks.
• Glute strength is what removes the limp; real loading comes in between weeks six and twelve.
• Walking, cycling, swimming and weights are fine long term; running and jumping wear the implant faster.