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Recovering after a total hip replacement
A total hip replacement (THR) replaces the worn ball and socket of the hip joint with an artificial implant, most often because of osteoarthritis. It is one of the most successful operations in modern medicine for relieving pain and restoring mobility.
Physiotherapy usually begins in hospital, often on the day of surgery, with the focus on getting you moving and home safely [1]. After discharge, however, the amount of rehabilitation people receive varies [1], and some find their progress slows or stalls once hospital-based support ends. This is where ongoing physiotherapy can make a real difference. Below are the questions people most often ask about recovery. Numbers in square brackets refer to the reference list at the end.
1. How long does it take to recover from a hip replacement?
Recovery is gradual. Many people are walking more comfortably within weeks, and in one study, the walking pattern of people after hip replacement had largely returned to normal by six months [5]. Strength takes longer: the same study found the hip muscles were still around 12% weaker than the other side at six months, and 6% weaker at two years [5].
Most people's pain improves significantly, but at least 14% still report some pain 6 to 12 months after surgery [2].
National guidance recommends that people who are not reaching their goals with self-directed rehabilitation are offered supervised physiotherapy [1], and physiotherapy exercise after discharge from hospital may help improve function, walking and muscle strength [3]. If you have been discharged from hospital physiotherapy and feel your recovery has slowed, your physiotherapist can reassess your hip, set new goals with you, and provide the one-to-one support you need to keep progressing.
2. Can I sleep on my side, and which side?
This depends on the advice from your surgeon. Many people are advised to sleep on their back for the first few weeks, and when side-lying is allowed, to start on the non-operated side with a pillow between the knees for comfort and support.
Your physiotherapist can advise on comfortable sleeping positions for your stage of recovery, and on managing night-time discomfort if it is disturbing your sleep.
3. When can I drive after a hip replacement?
Follow your surgical team’s advice before returning to driving. The braking-time findings below are research results, not clearance to drive at that time.
A review of studies measuring braking reaction time found that it returned to pre-operative levels around two weeks after a right hip replacement [4].
However, being ready to drive also means being able to get in and out of the car comfortably, turn safely, and perform an emergency stop. You should be off any painkillers that cause drowsiness, follow any precautions you have been given, and check with your surgeon and insurance provider. Your physiotherapist can assess your strength, movement and control to help you judge when you are physically ready.
4. How long will I need crutches or a walking aid?
This varies from person to person. Most people progress from a frame or crutches, to a single stick, to walking unaided over the first few weeks to months.
Rather than going by a set date, your physiotherapist will judge when you are ready to reduce your walking aid based on your walking pattern, balance, strength and confidence. If you are still relying on a stick or walking with a limp after discharge, physiotherapy can help correct this before it becomes a habit that is harder to change.
5. What exercises should I do after a hip replacement?
Every hip replacement and every person is different, so there is no single programme that suits everyone. Most people leave hospital with a starting set of exercises, but these need to be progressed as the hip recovers. Your physiotherapist will assess the strength and control of your hip, along with your balance and walking, and will provide you with a tailored set of exercises that are progressed as you improve.
Research suggests that physiotherapy exercise after discharge may benefit function, walking and muscle strength [3]. If you are not reaching your goals with exercises on your own, supervised physiotherapy is recommended [1].
6. Why do I have a limp, and will it go away?
A limp after hip replacement is common and is often linked to weakness in the muscles on the side of the hip (the hip abductors), which keep the pelvis level when you walk. Hip muscle weakness can persist long after surgery, and researchers have suggested that rehabilitation should be more intensive and specifically target these muscles [5].
For most people, a limp improves as strength returns. If you are still limping after hospital rehabilitation, your physiotherapist can look into the cause, work on strength and help you improve your walking technique.
7. Why does one leg feel longer than the other?
This is a common feeling after hip replacement. Often the legs are actually the same length, but tight muscles around the hip tilt the pelvis, making the leg feel longer. This is known as an apparent leg length difference, and it usually settles within six months [6]. In one long-term study, around a third of people still felt a difference in leg length six years after surgery [6].
Your physiotherapist can assess whether the difference is apparent or true, work on the muscles that may be tilting the pelvis, and advise whether you need to discuss it further with your surgeon.
8. How do I put on socks and shoes, or get in and out of a car?
These tasks require a good amount of hip bend, which can be limited in the early weeks, particularly if you have been given precautions. Long-handled aids, such as sock aids and shoehorns, can help in the meantime.
As your recovery progresses, your physiotherapist can help you regain the hip movement, strength and confidence to do these everyday tasks independently, and show you safe techniques for getting in and out of the car.
9. When can I return to work, sport and other activities?
Most people return to work and sport after hip replacement. A review found that eight out of ten people returned to sport, typically within 16 to 28 weeks, and around seven out of ten returned to work, typically within 1 to 17 weeks depending on the type of job [7]. Return to lower-impact activities such as walking, cycling, swimming and golf is most common [7].
For other activities, such as gardening or flying, the timing depends on your recovery and any precautions you have been given, so check with your surgeon if you are unsure.
Hospital rehabilitation tends to focus on everyday tasks such as walking, stairs and getting in and out of a chair. Your physiotherapist can take you further, planning a gradual return to work or sport and building the strength, stamina and movement needed for your specific job or activity.
When to see a physiotherapist
Consider booking an assessment if:
- you have finished your hospital physiotherapy but feel your recovery has stalled
- you are still using a walking aid or walking with a limp
- pain, stiffness or weakness is limiting your daily activities
- you want help returning to work, sport or hobbies
When to seek medical advice
Contact your surgical team, GP or NHS 111 promptly if you develop worsening pain or swelling, new calf pain, fever, or redness or discharge from the wound. Call 999 for sudden breathlessness or chest pain, particularly with leg pain or swelling.
References
- National Institute for Health and Care Excellence (NICE). Joint replacement (primary): hip, knee and shoulder. NICE guideline NG157. London: NICE; 2020. Available from: https://www.nice.org.uk/guidance/ng157
- Cheng HY, Beswick AD, Bertram W, Siddiqui MA, Gooberman-Hill R, Whitehouse MR, et al. What proportion of people have long-term pain after total hip or knee replacement? An update of a systematic review and meta-analysis. BMJ Open. 2025;15(5):e088975.
- Minns Lowe CJ, Davies L, Sackley CM, Barker KL. Effectiveness of land-based physiotherapy exercise following hospital discharge following hip arthroplasty for osteoarthritis: an updated systematic review. Physiotherapy. 2015;101(3):252–265.
- van der Velden CA, et al. When is it safe to resume driving after total hip and total knee arthroplasty? A meta-analysis of literature on post-operative brake reaction times. Bone Joint J. 2017;99-B(5):566–576. doi:10.1302/0301-620X.99B5.BJJ-2016-1064.R1
- Rasch A, Dalén N, Berg HE. Muscle strength, gait, and balance in 20 patients with hip osteoarthritis followed for 2 years after THA. Acta Orthop. 2010;81(2):183–188. doi:10.3109/17453671003793204
- Iversen MD, Chudasama N, Losina E, Katz JN. Influence of self-reported limb length discrepancy on function and satisfaction 6 years after total hip replacement. J Geriatr Phys Ther. 2011;34(3):148–152. doi:10.1519/JPT.0b013e31820e16dc
- Hoorntje A, Janssen KY, Bolder SBT, Koenraadt KLM, Daams JG, Blankevoort L, Kerkhoffs GMMJ, Kuijer PPFM. The effect of total hip arthroplasty on sports and work participation: a systematic review and meta-analysis. Sports Med. 2018;48(7). doi:10.1007/s40279-018-0924-2