Hip Replacement: Understanding, Recovering, and Improving Mobility

Hip replacement surgery is a common procedure used to reduce pain, improve mobility,
and restore function in individuals experiencing significant hip joint damage. While
surgery can provide substantial improvements in pain and physical function,
rehabilitation and ongoing exercise play an important role in helping individuals regain
strength, mobility, confidence, and independence.
Accredited Exercise Physiologists can play an important role in supporting individuals
before and after hip replacement surgery by developing safe, progressive, and
individualised exercise programs. Exercise can assist with rebuilding strength,
improving physical capacity, restoring functional movement, and supporting a return to
everyday activities.

What Is a Hip Replacement?
A hip replacement, also known as total hip arthroplasty, is a surgical procedure in which
damaged portions of the hip joint are replaced with artificial components.
The hip is a ball-and-socket joint that allows the leg to move in multiple directions.
Damage to the joint can affect movement and function and may result in persistent
pain, stiffness, and difficulty performing everyday activities.
Hip replacement surgery generally involves replacing:

• The damaged femoral head, or “ball” of the hip joint
• The damaged surface of the hip socket
• The affected joint surfaces with artificial components
  The goal of hip replacement surgery is to reduce pain and improve mobility and
  function.

Why Do People Need a Hip Replacement?
Hip replacement is most commonly performed when damage to the hip joint causes
significant pain and functional limitations that have not been adequately managed with
non-surgical treatment.
Common reasons for hip replacement include:

• Osteoarthritis
• Rheumatoid arthritis
• Other forms of inflammatory arthritis
• Hip fractures or significant trauma
• Avascular necrosis
• Other conditions causing significant joint damage
  Individuals may experience increasing difficulty with walking, stairs, getting in and out of
  chairs, dressing, exercise, work, and other everyday activities.

Common Symptoms Before Hip Replacement
Hip joint damage can cause a range of symptoms, including:

• Hip or groin pain
• Pain that may extend into the thigh or buttock
• Joint stiffness
• Reduced hip range of motion
• Muscle weakness
• Difficulty walking
• Difficulty climbing stairs
• Difficulty standing for prolonged periods
• Difficulty getting up from a chair
• Reduced participation in exercise and physical activity
• Reduced independence and quality of life
  Persistent pain and reduced activity before surgery can also contribute to muscle
  weakness and physical deconditioning.

What Happens After Hip Replacement?
Recovery following hip replacement varies between individuals and depends on factors
such as age, overall health, pre-operative fitness, surgical approach, previous activity
levels, and the presence of other health conditions.
Following surgery, individuals may initially experience:

• Pain and swelling around the surgical area
• Reduced hip and leg strength
• Reduced walking capacity
• Changes in walking pattern
• Reduced balance and confidence
• Difficulty with transfers and stairs
• Reduced physical fitness
• Muscle weakness and deconditioning

Rehabilitation focuses on gradually restoring movement and function while allowing the
body to recover from surgery.
The aim is not simply to recover from the operation, but to progressively rebuild the
physical capacity required for everyday life.

The Importance of Exercise After Hip Replacement
Exercise is an important component of recovery following hip replacement surgery.
A progressive exercise program can help individuals:

• Rebuild muscle strength
• Improve walking capacity
• Improve balance
• Increase cardiovascular fitness
• Improve functional mobility
• Reduce physical deconditioning
• Improve confidence with movement
• Return to everyday activities
• Increase independence
• Support participation in recreational activities
  Exercise should be introduced progressively and adjusted according to the individual’s
  stage of recovery, symptoms, surgical instructions, physical capacity, and goals.
  Early Rehabilitation
  Early rehabilitation generally focuses on restoring basic movement and functional
  independence.
  Depending on the individual’s circumstances and healthcare team’s recommendations,
  early exercises may include:
• Gentle range-of-motion exercises
• Ankle movements
• Quadriceps activation exercises
• Gluteal muscle activation
• Supported standing exercises
• Sit-to-stand practice
• Short periods of walking
• Basic balance exercises
  The focus during this stage is on gradually increasing movement and function without
  placing excessive stress on the recovering joint and surrounding tissues.

Walking is often progressed gradually from shorter distances to longer periods of
activity as tolerated.

Strength Training
Muscle weakness is common following hip replacement surgery and may also have
been present before surgery due to pain and reduced activity.
Strength training can help rebuild the muscles required for walking, stairs, transfers,
balance, and other functional activities.
Exercises may include:

• Sit-to-stands
• Supported squats
• Step-ups
• Hip strengthening exercises
• Knee strengthening exercises
• Calf raises
• Resistance band exercises
• Machine-based resistance exercises where appropriate
  Resistance should be progressively increased as strength and tolerance improve.
  Progressive resistance training can help individuals transition from basic rehabilitation
  exercises toward the physical demands of everyday life and recreational activities.

Improving Walking and Functional Mobility
Walking is an important part of recovery following hip replacement.
Individuals may initially experience changes in their walking pattern due to pain,
weakness, reduced balance, or reduced confidence.
Exercise can help address these factors by improving:

• Leg strength
• Hip strength
• Balance
• Coordination
• Cardiovascular fitness
• Walking endurance
• Confidence with movement

Functional exercises such as sit-to-stands, step-ups, and controlled walking can help
prepare individuals for everyday activities.
As physical capacity improves, exercise can be progressed to reflect the individual’s
lifestyle and goals.

Balance and Falls Prevention
Balance can be affected following hip replacement, particularly when there has been
significant muscle weakness or a prolonged period of reduced physical activity.
Balance exercises can form an important part of rehabilitation and may include:

• Supported single-leg activities
• Weight-shifting exercises
• Stepping exercises
• Controlled changes of direction
• Functional balance activities
• Lower-limb strengthening
  Improving strength and balance can help individuals feel more confident when walking
  and performing everyday activities.

Cardiovascular Exercise
Cardiovascular fitness may decrease following surgery due to reduced activity during
the recovery period.
Low-impact cardiovascular activities can help gradually rebuild endurance.
Depending on the individual’s recovery and medical recommendations, suitable
activities may include:

• Walking
• Stationary cycling
• Cycling
• Swimming once the surgical wound has appropriately healed
• Other low-impact aerobic activities
  The intensity and duration should be gradually progressed according to the individual’s
  physical capacity and recovery.
  Improving cardiovascular fitness can make everyday activities feel easier and support a
  return to work, recreation, and community participation.

Exercise and Pain Management
Pain and discomfort can be a normal part of the recovery process following hip
replacement. However, persistent or worsening symptoms should be discussed with
the individual’s treating healthcare team.
Fear of movement can sometimes lead individuals to become less active following
surgery. Prolonged inactivity can contribute to muscle weakness, reduced
cardiovascular fitness, stiffness, and loss of confidence.
A carefully structured exercise program can help individuals gradually become more
comfortable with movement and rebuild their physical capacity.
Exercise should be adjusted according to:

• Pain and discomfort
• Swelling
• Surgical recovery
• Muscle strength
• Balance
• Fatigue
• Walking ability
• Medical and surgical recommendations
• Individual goals and preferences
  The aim is to progressively increase activity while allowing appropriate recovery.
  Returning to Everyday Activities
  One of the major goals following hip replacement is returning to normal daily activities.
  Exercise can help individuals regain the physical capacity required for:
• Getting in and out of chairs
• Getting in and out of bed
• Walking around the home
• Climbing stairs
• Shopping
• Household activities
• Returning to work
• Driving when medically cleared
• Participating in recreational activities
• Returning to community activities
  Functional exercise should therefore reflect the individual’s actual lifestyle and goals.

For example, someone who wants to return to gardening may require different strength,
mobility, balance, and endurance goals compared with someone who wants to return to
golf, swimming, work, or longer-distance walking.

Returning to Exercise and Sport
Hip replacement does not necessarily mean an individual needs to give up physical
activity.
Many people can return to a range of recreational activities following appropriate
rehabilitation. However, the timing and type of activity should be individualised.
Lower-impact activities are often easier to incorporate into a long-term exercise routine,
while higher-impact or more physically demanding activities may require additional
consideration and guidance from the individual’s healthcare team.
Exercise progression may involve:

• Increasing walking distance
• Increasing resistance
• Improving balance and coordination
• Increasing cardiovascular endurance
• Introducing more complex functional movements
• Gradually returning to preferred recreational activities
  The goal is to develop the strength and physical capacity required for the activities that
  are meaningful to the individual.

The Role of an Accredited Exercise Physiologist
An Accredited Exercise Physiologist can help individuals safely transition from surgery
and early rehabilitation toward long-term physical activity.
An individualised exercise program may include:

• Strength training
• Cardiovascular exercise
• Mobility exercises
• Balance training
• Functional exercises
• Walking programs
• Exercise progression
• Education around physical activity
• Strategies to manage fatigue and recovery
• Support for returning to recreational activities
  Exercise Physiologists can also consider other health conditions, previous injuries,
  current fitness levels, work demands, lifestyle, and individual goals when developing an
  exercise program.
  The goal is not simply to complete rehabilitation exercises, but to help the individual
  develop the physical capacity and confidence required for long-term independence and
  participation.

The Importance of a Holistic Approach
Successful recovery following hip replacement involves more than the surgical
procedure itself.
A holistic approach considers:

• Strength
• Mobility
• Balance
• Cardiovascular fitness
• Walking ability
• Pain and symptoms
• Confidence with movement
• Sleep and recovery
• Body weight where appropriate
• Lifestyle
• Work requirements
• Recreational goals
• Long-term physical activity
  Combining these areas can help individuals move from post-operative rehabilitation
  toward maintaining an active and independent lifestyle.

Long-Term Exercise After Hip Replacement
Once the initial recovery period has passed, maintaining regular physical activity
remains important.
Long-term exercise can help individuals maintain:

• Muscle strength
• Cardiovascular fitness
• Balance
• Mobility
• Functional capacity
• Healthy body weight
• Confidence with movement
• Independence
  Exercise should ideally become part of the individual’s regular lifestyle rather than
  something that stops once formal rehabilitation finishes.
  Regular walking, resistance training, cardiovascular exercise, mobility work, and
  recreational activities can all contribute to maintaining physical function.

From Surgery to Independence
Hip replacement can provide an important opportunity to reduce pain and improve
physical function. However, the surgical procedure is only one part of the recovery
process.
Progressive exercise and rehabilitation can help individuals rebuild strength, improve
walking, restore balance, increase physical capacity, and return to the activities that are
important to them.
With appropriate guidance, individualised exercise, and a gradual approach to
progression, individuals can work towards regaining mobility, independence,
confidence, and quality of life following hip replacement.
An Accredited Exercise Physiologist can play an important role in supporting this
process by developing a safe and progressive exercise program that considers the
individual’s recovery, capabilities, lifestyle, and goals.