What to expect week by week after hip replacement surgery

Day of surgery to going home

Rehabilitation starts almost straight away. The Hospital for Special Surgery (HSS) says rehabilitation begins within 24 hours of surgery and that most hip replacement patients progress to walking with a cane, walker or crutches within a day or two. HSS's patient guide to hip replacement recovery, written with surgeon William Long, MD, describes meeting a physical therapist in the recovery room on the day of surgery to sit up, stand, start moving with a walker or crutches, and learn to manage stairs.

How long you stay depends on the hospital and on how you are doing. The American Academy of Orthopaedic Surgeons (AAOS) says a hospital stay typically lasts 1 to 2 days, and that people having the operation as outpatients go home the same day. The NHS says people who are generally fit and whose surgery went well can usually go home around 1 to 3 days after the operation. Dr. Long says advances in anesthesia, surgical technique and pain management have made it possible for most healthy people to go home the same day.

Before discharge, AAOS lists the goals hospitals usually look for: getting in and out of bed by yourself, acceptable pain control, eating, drinking and using the bathroom, walking with a cane, walker or crutches on a level surface, climbing two or three stairs, doing the prescribed home exercises, and understanding any hip precautions. If those are not yet possible, or there is no one to help at home, AAOS says a short stay at a rehabilitation or skilled nursing center may be arranged.

Weeks 1 and 2: walking aid, wound and swelling

The first two weeks are mostly walking, exercises and rest. HSS surgeon Mathias Bostrom, MD, writes that patients may need a cane or crutches for a week or two, and describes the standard HSS protocol as two weeks of recovery and rehabilitation at home followed by two to four weeks of outpatient physical therapy. The NHS advises walking every day as far as is comfortable.

Wound care depends on how the incision was closed. The NHS says a nurse takes out stitches or clips after about 10 days, and AAOS says stitches or staples are removed approximately 2 weeks after surgery. Some hospitals use dissolvable stitches instead. HSS says its waterproof dressing comes off about a week after surgery and the incision is then left open to the air.

Swelling and bruising are at their most obvious now. AAOS says to expect moderate to severe swelling in the first few weeks and suggests raising the leg slightly and using ice, with compression stockings as a possible help. The NHS says pain and swelling in the legs and feet usually get better in a few weeks. HSS's rehabilitation guide says that for the first 6 weeks, sitting for a long time with the foot down tends to worsen swelling, and advises not sitting for more than 30 to 45 minutes at a time while awake.

Plan for help at home. AAOS says people who go straight home will need some help for anywhere from several days to several weeks, and that tasks such as cooking, shopping, bathing and laundry may need help for several weeks.

Weeks 3 to 6: more independence, precautions still in place

This is the stretch where ordinary days start to come back. AAOS says most people can resume most normal light activities of daily living within 3 to 6 weeks, and that some discomfort with activity and at night is common for several weeks. Follow-up visits fall in or near this window: Dr. Long likes to see HSS patients between three and six weeks after surgery, and the NHS says a follow-up appointment is usually around 6 to 12 weeks.

Hip precautions usually still apply. AAOS says you may be asked to take special precautions when sitting, bending or sleeping, usually for the first 6 weeks, to help prevent the new joint from dislocating, and that the details vary with the surgical approach. Examples in AAOS and NHS guidance include not crossing your legs, not bending the hip past 90 degrees, and avoiding low chairs and low toilet seats. AAOS notes that not all surgeons recommend the same precautions, so the list your surgeon gives you is the one to follow.

Driving is where the sources differ most. HSS gives a typical range of 2 to 4 weeks, often about two weeks for a left hip and about four for a right hip, because you need to be off narcotic pain medication and able to move quickly from the gas to the brake. The NHS says to wait at least 6 weeks. AAOS ties it to being off opioid pain medication with strength and reflexes back to a more normal state, and says your doctor will help you decide.

Work follows a similar spread. The NHS says returning to work usually takes about 6 weeks. HSS says most people can go back to a desk job within days to a few weeks, and AAOS says it may take from several weeks to several months, depending on the job and the speed of recovery.

Weeks 6 to 12 and beyond

This is the window where most of the early limits start to lift. Dr. Long says that within six to eight weeks, most people see their function return to its pre-surgery level or better. AAOS says that whatever surgical approach was used, most patients should be able to do most of the usual don'ts after 6 to 8 weeks without any impact on the implant, although its list includes not crossing the legs at the knees for at least 6 to 8 weeks. The NHS advises avoiding sex for 6 to 8 weeks after the operation.

Exercise carries on. AAOS says to keep doing the exercises your physical therapist prescribed for at least 2 months after surgery. On sport, Dr. Long says higher-impact activities that involve agility are possible after about six to eight weeks, while Dr. Bostrom encourages hiking, biking and swimming after three months of recovery. AAOS prefers lower-impact activities such as golf, cycling and doubles tennis or pickleball over singles tennis, jogging, basketball and skiing.

The end point depends on what you count as recovered. HSS says full recovery generally takes anywhere from 2 to 8 weeks, depending on general health and other factors. The NHS says it may take several months to recover from a hip replacement, and AAOS says mild to moderate swelling can continue for 3 to 6 months. AAOS says some people feel numbness in the skin around the incision and some stiffness with deep bending, and that these often lessen with time. Longer term, the NHS says modern hip replacements are designed to last at least 15 years.

Warning signs that do not follow the timeline

This timeline summarizes public patient information from AAOS, the NHS and HSS. It is not medical advice, and your own schedule depends on your surgery, your health and your surgeon's instructions. If something worries you, call your surgeon or physical therapist.

Blood clots and infection can happen at any point in the early weeks. AAOS lists warning signs of a clot in the leg as pain in the calf and leg that is unrelated to the incision, tenderness or redness of the calf, and new or increasing swelling of the thigh, calf, ankle or foot. Its guide to activities after hip replacement adds severe swelling that does not go away when the leg is propped up above the level of the heart.

The NHS says to ask for an urgent GP appointment or contact NHS 111 after a recent hip replacement if you have throbbing or cramping pain in the hip or leg, a high temperature or feel hot, cold or shivery, oozing or pus from the wound, or redness, tenderness, swelling or pain in the hip or leg that is not getting better or is getting worse. AAOS also lists persistent fever above 100°F taken by mouth, chills and drainage from the wound as signs of possible infection. The NHS adds that a hip replacement can occasionally dislocate, including soon after surgery before the joint has fully healed.

Chest symptoms are an emergency. The NHS says to call 999 or go to A&E if you have pain and swelling in the hip or leg together with difficulty breathing or chest pain, because it could be a clot in the lungs. AAOS lists sudden shortness of breath and sudden chest pain as warning signs of the same problem. Outside the UK, call your local emergency number.

Common mistakes during hip recovery

Comparing your week with someone else's. Every figure above is a range, and the NHS says recovery varies with age and general health. AAOS adds that weight-bearing may be allowed immediately or delayed by several weeks depending on the type of hip replacement, and that precautions depend on the surgical approach, so a friend who had a different operation may have been given a different list.

Sitting too long, or too low. HSS's 30 to 45 minute limit covers the first 6 weeks, and the NHS warns against low chairs, low toilet seats and chairs without arms because getting up again is hard. AAOS suggests setting up a firm chair with a higher-than-average seat and a raised toilet seat before surgery.

Letting walking replace the exercises. Dr. Bostrom calls walking the best therapy after a hip replacement, but AAOS says walking is not a substitute for the exercises your physical therapist prescribes, which should continue for at least 2 months.

Losing track of questions between visits. With follow-ups anywhere from 3 to 12 weeks after surgery depending on the hospital, questions about driving, sleeping positions or when to put the cane away pile up. JointRoad, for example, keeps a list of questions that goes onto the last page of its summary PDF, and for a hip its range-of-motion entry records how far the hip bends, copied from therapy, along with your current walking aid, from walker to crutches to cane to no aid.

Frequently asked questions