If you or a loved one is considering total hip replacement (THR), you might be wondering what to expect before and after surgery. The good news? Physical therapy plays a huge role in improving recovery, reducing complications, and getting you back to the activities you love as quickly as possible.
Let’s walk through how physical therapy helps before and after THR, what the latest evidence says about rehab, and how you can set yourself up for success.
Why Do People Need a Total Hip Replacement?
The hip joint is one of the most important weight-bearing joints in the body. When it becomes damaged, even simple activities like walking, standing, or getting in and out of a chair can become painful and difficult.
Some of the most common reasons people need a THR include:
• Osteoarthritis (the most common cause)
• Rheumatoid arthritis
• Osteonecrosis (bone death due to poor blood supply)
• Severe hip fractures or trauma
• Hip deformities from birth (congenital conditions)
A key sign that surgery might be needed is when hip pain doesn’t improve with conservative treatments like physical therapy, medications, or injections.
The Role of Pre-Surgical (Prehab) Physical Therapy
You might assume rehab starts after surgery, but research suggests that pre-surgical physical therapy (prehab) can significantly improve outcomes.
A structured prehab program can:
• Strengthen the muscles around the hip to support the joint after surgery.
• Improve flexibility and balance to reduce fall risk.
• Teach proper movement patterns and weight-bearing precautions.
• Help mentally prepare patients for the rehab process.
What does prehab look like?
A typical program includes:
• Strength training for the glutes, quads, hamstrings, and core.
• Range of motion exercises to prevent stiffness.
• Gait training to ensure safe walking patterns.
• Education on assistive devices (like walkers or canes) to help with mobility post-surgery.
Studies show that patients who do prehab recover faster, have less pain, and regain function more quickly compared to those who skip it.
Post-Surgical Rehab: What to Expect After THR
After surgery, physical therapy is crucial to regain strength, mobility, and independence. Recovery typically happens in stages, and here’s what you can expect:
Stage 1: Hospital & Early Recovery (Days 1-7)
• Most patients begin walking on the same day or the day after surgery with a physical therapist.
• The focus is on preventing complications like blood clots and teaching safe movement strategies.
• Common early exercises include ankle pumps, gentle range of motion movements, and bed mobility training.
Stage 2: First Few Weeks at Home (Weeks 1-4)
• Patients work on walking more independently and performing daily activities safely.
• Exercises become more targeted, focusing on strengthening the hip, improving balance, and normalizing gait.
• Precautions may be necessary (depending on the type of hip replacement) to avoid dislocations.
Stage 3: Outpatient Physical Therapy (Weeks 4-12)
• Rehab shifts toward regaining full function, with exercises emphasizing strength, flexibility, and endurance.
• Patients work on stairs, standing balance, and functional movements like getting in and out of a car.
Stage 4: Return to Full Activity (Months 3-6)
• Higher-level exercises (like squats, light resistance training, and stability drills) are introduced.
• Some patients return to low-impact activities like swimming, cycling, or golf within this timeframe.
The Latest Rehab Techniques: What the Science Says
Recent research has refined our approach to THR rehab. Here are some evidence-backed strategies used today:
Early Mobilization – Walking as soon as possible post-surgery improves outcomes.
Strength-Based Rehab – Progressive resistance training enhances function and reduces long-term weakness.
Gait Training – Focuses on normalizing walking patterns to avoid limping and imbalance.
Neuromuscular Re-Education – Helps improve hip control and stability to prevent future injuries.
Aquatic Therapy (Optional) – Water-based exercises reduce joint stress while improving strength and mobility.
What about passive treatments like ultrasound or electrical stimulation?
• The latest research shows these are less effective for long-term recovery compared to active movement-based rehab.
• While modalities like heat or ice can help with short-term pain relief, they should be used alongside exercise—not as a replacement.
Key Takeaways: Your Road to Recovery
• Prehab can significantly improve post-surgical recovery—start physical therapy before your THR if possible.
• Early movement is key—patients should begin walking as soon as it’s safe after surgery.
• Strength-based rehab leads to better long-term outcomes—don’t skip strengthening exercises!
• A structured physical therapy plan can get you back to the activities you love—but recovery takes consistent effort over several months.
If you or someone you know is considering a total hip replacement, reach out to a physical therapist today. The sooner you start preparing, the better your results will be!
