After total hip replacement surgery, your surgeon will recommend physical therapy to help you recover fully from the surgery and reduce pain associated with the surgery.

The goal of physical therapy is to strengthen the hip joint, so your physical therapist will help you exercise and teach you ways to strengthen your body and ensure a complete recovery.

In addition to working one-on-one with patients, Duke physical therapy provides the following tips and handouts to ensure patients make a full recovery after hip surgery.

Positions to Avoid for Six to Eight Weeks After Hip Surgery

Following hip surgery, certain positions need to be avoided so you can fully heal. Your physical therapist will tell you which surgical approach your doctor used so you can follow one of these precautions.

Posterior Approach

• Do not bend the operated hip past 90 degrees.
• Do not cross the midline of body with the operated leg.
• Do not rotate the operated leg inward. Your toes and kneecap should point toward ceiling when in bed.

Download the Posterior Total Hip Home Instructions handout (PDF, 111 KB) for more instructions.

Anterior Approach

• Do not extend your leg behind you. If backing up, lead with the "good leg." Do not lie on your stomach.
• Do not cross your midline with operated leg.
• Do not rotate your leg outward.

Download the Anterior Total Hip Home Instructions handout (PDF, 111 KB) for more instructions.

Other Positioning Concerns

• Avoid prolonged sitting of more than one or two hours at a time. Stand up, walk, or lie down instead.
• Do not put a pillow under your knee while in bed or sitting.
• You are encouraged to spend 30 minutes a day lying flat on your back in order to maintain flexibility of the hip muscles. Six weeks after surgery you may roll onto your stomach.

Walking and Steps

Use a walker or crutches until your doctor says you no longer need them (approximately four to six weeks post-op). You will be instructed on how much weight you can put on your leg, usually about 50 percent.

Always go up with your stronger leg first, followed by weaker leg, then assistive device. To go down, use the assistive device first, then the weaker leg, then the stronger leg. Remember to use the railing if one is available to you.

Activities of Daily Living -- Next Six to Eight Weeks

• Do not drive until given permission by your doctor.
• Riding in a car is permitted as long as you stop every hour to walk around for several minutes before resuming your ride. A reclining car seat or reclined position is recommended for comfort and safety.
• When sitting, avoid low chairs and sofas. Instead, sit on a higher chair or a chair with a firm pillow in it. A recliner would be more comfortable. Avoid crossing your legs.
• You may roll to either side in bed. When rolling to your non-operative side, place two pillows between your legs to help maintain a good hip position.
• Avoid gaining excessive weight. Try to maintain your ideal weight.
• Avoid low/conventional toilet seats. An elevated toilet seat should be used instead. If in public, use handicapped facilities to assure adequate toilet height.
• Avoid stooping, squatting, or bending forward. If an item is needed from a lower cabinet or floor, call for assistance or use a reacher.
• When sitting or standing, always place your operated leg out in front to prevent excessive pressure on the hip. Studies show a hip receives more pressure during sit-and-stand transfers than actual walking.

Exercise

Next Six to Eight Weeks

• Continue the exercise program that your physical therapist has given you. After four weeks, you can add small, one- to three-pound ankle weights.
• You may be instructed by your therapist to progress your exercise program after six weeks. You may do this on your own or with a family member's help.
• Continue to walk with your walker or crutches to help increase your endurance.
• You may ride a stationary bike four weeks after surgery with no resistance on the pedals. Raise the seat a little higher than usual so you don’t bend your hip too far.
• You may begin swimming after your incision heals (usually two weeks after surgery). Use a ramp or steps with a railing to get in and out of the pool. Do not use the ladder.

After Eight Weeks

• Continue a walking, swimming, or stationary biking program for aerobic conditioning.
• You may resume golf or cycling after three months.
• Avoid jarring or stop-start activities such as jogging or aerobics -- these activities
  might loosen your prosthesis.

Download the posterior total hip Home Exercise Program (PDF, 274 KB)

Download the anterior total hip Home Exercise Program (PDF, 250 KB)

Duke Orthopaedics offers physical therapy programs at locations throughout North Carolina, including Raleigh, Durham, Cary, and Chapel Hill.