Hip replacement: how to get back to training after surgery

The operation is done, the stick is still by the chair, and the question is simple: when can you train again, and what are you allowed to do. There is no single date, only an order — walking first, then resistance, then real strength. What follows is the framework; the exact limits for your hip come from the surgeon who operated on it.

Why the leg is weaker than you expected

Most hips hurt for months, sometimes years, before they are replaced. All that time you were quietly protecting the leg: shorter stride, less weight through it, stairs avoided. Muscle responds to that fast by shrinking, and the ones that suffer most are the glutes on the side of the hip that keep your pelvis level when you stand on one leg.

That is why plenty of people six weeks after surgery have a hip that no longer hurts and a leg that still does not work. The surgeon fixed the pain. Strength comes back only under load. Weakness in the side hip muscles can linger for a year or more if nothing targets it directly.

If you were already inactive before the operation, part of that weakness has nothing to do with the hip and everything to do with the muscle loss that comes with age. Same tool fixes both: resistance.

The first six weeks: walking is the training

The goal here is not strength. It is range of motion, swelling under control and a clean walking pattern. Short frequent walks beat one long one: 5 to 10 minutes, four to six times a day, then stretch it out gradually. Most people are walking 20 to 30 minutes in one go by the end of week six.

Drop the stick or crutches when you can walk without limping, not when you feel brave. A limp is a habit your nervous system learns, and every day spent walking badly makes it stickier.

The exercises at this stage are modest and done daily: ankle pumps, quad and glute squeezes held 5 seconds for 10 reps, heel slides, standing leg raises to the side holding a chair for 2 sets of 10, and standing up from a high seat. If getting out of a chair is the hardest moment of your day, the sit-to-stand test is a decent way to track progress with no equipment at all.

Precautions depend on how the surgeon got into the joint. With a posterior approach, the first six to twelve weeks usually avoid bending the hip past 90 degrees combined with bringing the leg across the midline and rotating it inwards — in practice that means low armchairs, low toilets, crossing your legs and twisting over the operated side. With an anterior approach, the caution is on stretching the leg back with the foot turned out. Some surgeons now give no restrictions at all. Your discharge sheet outranks any article.

Weeks six to twelve: add resistance

This is the phase where most of the ground is gained and the one most people skip, because once the pain goes it feels like the job is finished. Train two or three times a week, 2 to 3 sets of 10 to 15 reps, with a load that leaves three or four reps in the tank.

A basic menu: leg press through a shortened range, step-ups onto a 10 to 15 cm box, banded hip abduction, calf raises, glute bridges and easy uphill walking. The stationary bike is the single most useful machine in the gym here — raise the saddle so the hip stays under 90 degrees, start with half revolutions back and forth if a full circle will not go yet, and keep resistance low until the pedal stroke is smooth. Once walking is comfortable, stairs become a genuine training tool rather than an obstacle.

The pain rule: up to 3 out of 10 during the exercise is acceptable if it settles within 24 hours. Swelling that hangs around for two or three days and a stiff hip in the morning mean you went too fast — take 20 per cent off the load rather than stopping.

After three months: real strength

From the three-month mark the hip tolerates serious load. Squats to a comfortable depth, light Romanian deadlifts, split squats, full-range leg press, sled pushes, rowing. Two hard sessions a week, 3 to 4 sets of 6 to 12 reps, and the weight goes up when the last set starts feeling easy.

Train the side hip muscles separately, and keep doing it for at least a year: side-lying leg raises, banded walks, 30 seconds of single-leg standing per side. That is the muscle that decides whether you limp at the end of a long day.

Food matters too. Older adults generally need more protein than they think — roughly 1.2 to 1.6 grams per kilogram of body weight a day, spread across three meals rather than piled into dinner. If you have been out of the gym for a long stretch, the progression logic is the same as any return after a long break: technique and consistency first, load second.

What stays on the caution list

An implant is not a joint. It is a mechanical bearing that wears with the number of cycles and the force passing through it. That is why the recommendations sit on low-impact activity: walking, cycling, swimming, cross-trainer, gentle hill walking, golf, dancing.

Running, jumping and sports with sharp changes of direction are a separate conversation. The evidence is not strong in either direction — there is no reliable figure for how many kilometres cost you how many years of implant life — but most surgeons advise against them, and the advice tightens further if your bone is thin. Ask the person who did your operation.

Two things stay permanent: avoid end-range bending combined with rotation under load, and avoid anything with a high chance of falling.

When to see a doctor

• Fever, redness, heat or discharge from the wound — infection needs looking at the same day, not next week.
• Calf pain and swelling, particularly on one side.
• Sudden inability to put weight through the leg, a clunk with a change in leg length, or a feeling that the hip has slipped out.
• Pain getting worse week by week instead of easing, or groin and thigh pain that shows up months after everything had settled.
• Numbness or weakness in the foot.

The short version

• First six weeks: short frequent walks, light daily exercises, keep the stick until the limp is gone.
• Weeks 6 to 12: two or three resistance sessions a week, 2 to 3 sets of 10 to 15, pain up to 3/10 that settles within a day.
• From month three: real strength work at 6 to 12 reps with load going up, plus side hip muscles trained separately for at least a year.
• Long term: low-impact activity is safe ground; running and jumping are a question for your surgeon.
• Same-day medical advice for signs of infection, calf swelling, sudden loss of weight-bearing or pain that keeps climbing.