Physiotherapy After A Total Hip Replacement

About Total Hip Replacement Surgery:

Total Hip replacement (THR) surgery is a regularly performed procedure in Australia, as over 50,000 THRs are performed nationally each year. A common reason people seek this procedure is to manage pain and disability due to osteoarthritis. Surgery involves replacing the damaged joint with an artificial implant. This prosthetic replacement replicates the function of the normal hip joint, allowing freedom of movement without pain.

There are different surgical techniques used to perform a hip replacement, and this will depend on the specific details of the injury itself as well as surgeon preference. The 3 most common techniques include:

  1. Posterior Approach (A)
  2. Direct Lateral Approach (B)
  3. Direct Anterior Approach (C)

The picture above highlights where the incision is made for each surgical technique. Once the incision is made, either the head of the femur, the acetabulum, or both aspects of the hip girdle are replaced with an artificial implant.

A Word on The Post-Surgery Hip Precautions:

It’s important to closely follow the post-operative instructions from your surgeon, especially during the early stages of your recovery. For THR surgery, there are specific precautions to be mindful of in order to reduce complications. These include:

  • Avoid bending at the hip past 90°
  • Crossing your legs
  • Twisting your leg in and out

This is especially important during the first 6 weeks of recovery, as we want to minimise the highly unlikely risk of hip dislocation post-surgery.

Physiotherapy For A Total Hip Replacement:

The goal of rehabilitation for a THR is to restore strength and function of the hip, and minimise complications so that you can continue to live a high quality life with minimal restrictions. This process begins as soon as the operation is completed, as most people recovering from a THR are able to walk the day of or after surgery. Below is an outline of the different phases and exercise goals of physiotherapy management.

Early Postoperative Phase:

Immediately following surgery, you are typically encouraged to start moving as soon as possible under the guidance of your treating practitioner. While initial movements may be limited and cautious, simple exercises like ankle pumps, gentle leg raises, and bed mobility exercises help prevent complications such as blood clots and promote circulation.

Ambulation and Weight-bearing:

Emphasis is also placed on regaining the ability to walk with assistance during the early stages of recovery. Initially, walking aids like crutches or a walker may be used to support weight-bearing. We aim to closely monitor gait patterns and provide guidance on proper techniques to prevent strain on the new hip joint and ensure walking looks and feels natural.

Restoring Range of Motion:

Restoring the full range of motion in the hip joint is a primary goal of rehabilitation. Treatment sessions include a variety of exercises and techniques aimed at improving flexibility and mobility. These may include gentle stretches, range of motion exercises performed by your physio,, and active exercises that you can perform at home independently. We always want to keep the previously mentioned hip precautions in mind when regaining range of motion, especially for the first 6 weeks.

Restoring Strength:

Muscle weakness and atrophy (i.e., loss of muscle size) is common after surgery due to reduced activity and the trauma of the procedure. Having a tailored strength program will be crucial to progressing through your rehab journey, as strengthening is such a fundamental pillar of THR recovery.

We need adequate strength to reduce unnecessary strain through the hip joint, as our surrounding muscles aim to protect and support the joint. This will include strengthening exercises of the quadriceps, hamstrings, glutes, calves, hip abductors, and adductors. These exercises help improve stability, support the joint, and enhance overall function.

Functional Retraining:

As strength and mobility improves, we can also progress to including functional activities that mimic daily tasks. This may involve practicing sitting and standing from various surfaces, climbing stairs, balance training, and performing activities like bending, reaching, and squatting. Functional training aims to prepare you for a smooth transition back to regular activities and lifestyle.

Gradual Return to Activities:

Recovery from a THR is a gradual process, and it is always advised to gradually reintroduce activities based on functional progress and surgeon recommendations. Physiotherapists provide guidance on safely increasing activity levels, setting realistic goals, and recognising signs of overexertion or potential complications.


To wrap things up, the road to recovery after a THR is a journey that truly shows the strength and resilience of both the body. Through dedicated rehabilitation, you can see incredible improvements in how you move, how strong you feel, and ultimately, your quality of life.

While it is completely normal to experience flare ups during the rehab journey, the last thing we want to do is complicate the process by doing too much too soon.

Remember, this journey is a marathon, not a sprint!

Morrie Toum – BeFit Training Physio Coogee

Morrie Toum – BeFit Training Physio Coogee

Morrie completed a Doctor of Physiotherapy at Macquarie University after completing his undergraduate degree and Honours thesis in Sport and Exercise Science at University of Technology Sydney.

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