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Hip Replacement Rehab: who to see and what helps

Hip Replacement Rehab · Kitchener, Waterloo & Cambridge

A hip replacement puts an artificial ball and socket in place of the worn hip joint, and the weeks that follow are about walking, rebuilding strength and protecting the new joint while the tissues heal. Recovery may take several months, and research has not shown that one rehabilitation programme works better than another, so the plan is built around your surgeon’s instructions and your own goals. Rehab at CARESPACE runs alongside your surgeon and hospital team: the first visit is with a physiotherapist, who assesses and treats you that day.

What hip replacement rehab involves

It starts in hospital, where nurses and physiotherapists help you walk as soon as possible after the operation, on crutches or a walking frame at first. At home the work is a walking programme that grows from indoors to outdoors, exercises several times a day to restore movement and strengthen the hip, and getting back to stairs and the car.

The particular concern after a hip replacement is the ball coming out of the socket in the first months, and the movement rules some surgeons set because of it. A hip broken in a fall is on Fracture Rehab, and getting ready before a planned operation is on Joint Replacement Rehab. If you still have your own arthritic hip, see Hip Osteoarthritis.

What recovery usually feels like

  • Some discomfort with activity and at night, which is common for several weeks
  • Pain and swelling in the leg and foot that usually improve within a few weeks, with some joint stiffness and swelling for up to 8 to 12 weeks
  • Bruising, which can spread up the leg and toward the lower back, and is normal
  • Sometimes, a leg that feels slightly longer or shorter than the other; the difference is often too small to notice, and a raised heel or shoe lift can help when it is not

Hip precautions and dislocation

A dislocation is the ball coming out of the socket, and the risk is greatest in the first few months after surgery while the tissues heal. To lower it, many people are asked to follow hip precautions. The guidebook that Waterloo Regional Health Network (WRHN) gives people having a hip replacement sets them for at least six weeks unless the surgeon says otherwise:

  • Do not pivot or twist to either side while standing or sitting
  • Do not bend the hip excessively; use a reacher and a sock aid for dressing
  • Do not cross your legs at the knees or ankles, sitting or lying down
  • Sit on chairs and surfaces that keep your hip higher than your knee

The same guidebook says these precautions do not apply after an anterior approach. It also sets a lifting limit of 5 to 10 pounds for six weeks. Whether you have precautions, which ones and for how long is your surgeon’s decision: follow the sheet you were given, and ask your surgeon before dropping any of them.

Warning signs after a hip replacement

Call 911 if you develop chest pain, shortness of breath or you are coughing up blood. A blood clot that has travelled to the lungs can show itself this way: as sudden shortness of breath, sudden chest pain, or chest pain in one spot when you cough. The instruction is the one in the guidebooks Waterloo Regional Health Network (WRHN) gives people having a hip or knee replacement.

Call 911 or go to the nearest emergency department immediately if your new hip moves out of place: it will be very painful and you will not be able to stand. Do the same if you have severe hip pain after a fall or injury, cannot walk or put weight on the leg, or have any tingling or loss of feeling in the hip or leg after an injury. That is the list the NHS, the UK’s health service, gives for hip pain, in Ontario terms. After any other fall onto the new hip, contact your surgeon’s office the same day. If you are home from hospital and cannot urinate, go to the nearest emergency department.

The emergency departments in Waterloo Region are:

  • WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
  • WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
  • Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

Contact your surgeon’s office or hospital care team right away, the same day, for any of the signs below. If you cannot reach them, go to an urgent care clinic or an emergency department that day. Do not save these for a rehabilitation appointment: nobody at CARESPACE can rule out a blood clot or an infection.

  • Signs of a blood clot in a leg: redness, swelling, warmth, tenderness or pain anywhere in either leg, including severe pain in the calf
  • Signs of infection: a fever above 38°C, or chills; redness, swelling, warmth, tenderness or increasing pain around the incision; any drainage from the wound, above all thick or foul-smelling discharge (green, brown or creamy yellow); an incision that opens; or pain in the joint that keeps increasing, with activity and at rest
  • Lots of bleeding, or a dressing that is soaked through
  • A sudden increase in pain that is not related to activity, or pain that is not controlled by the medication you were prescribed
  • Dizziness
  • Nausea or vomiting you cannot control, or severe constipation or diarrhea that does not improve with medication
  • Pain, burning, urgency or frequency when you urinate
  • A bloody nose, or blood in your urine or stool

What the evidence says about rehab after a hip replacement

  • Start within a day, on your own programme unless you need more. The UK’s NICE guideline (2020) has rehabilitation offered within 24 hours of the operation, advice on doing it yourself before you go home, and supervised sessions offered to people who are struggling; Joint Replacement Rehab sets that model out.
  • One programme has not been shown to beat another. A 2021 review for the United States Agency for Healthcare Research and Quality, covering 83 studies of hip and knee replacement, found that different programmes after hip replacement may lead to comparable pain, strength, daily activities and quality of life, on low-strength evidence, and that rehabilitation may not increase harms. There was too little evidence to say which components, settings or providers work best.
  • Extra exercise did not beat usual care on average. A 2021 analysis of exercise before and after hip replacement (26 trials and 1,004 people in its pooled results, both timings together) found that exercise programmes after the operation were not associated with better self-reported physical function than usual care or minimal intervention at 4, 12 or 26 weeks (moderate certainty) or at one year (low certainty). We could read this study only as its published summary.
  • Precautions are common and not clearly protective. A 2020 review of seven studies and 6,900 people who had the posterior approach found dislocation in 2.2% of those given precautions and 2.0% of those without, with no significant difference. The studies were not all randomized trials.

What your surgeon and hospital team look after

Your surgeon sets how much weight goes through the leg, any movement precautions and when you may drive. The wound, blood thinners and pain medication belong to your surgeon, physician, nurse practitioner or pharmacist, not to CARESPACE. At WRHN, the follow-up visits are at the fracture clinic, two to three weeks and six weeks after surgery. Months or years on, a replaced hip that hurts more, makes you limp or does less than it did should be seen by a physician, who can refer you back to the orthopaedic service.

How each CARESPACE service helps after a hip replacement

Physiotherapy

A physiotherapist can watch how you walk and move you from walker to cane to no aid as your surgeon’s rules allow, progress the exercises for hip movement and strength, and practise what precautions make awkward: stairs, low seats, the car, getting dressed.

See our physiotherapy team →

Kinesiology

Once you walk without an aid and your surgeon has lifted the early restrictions, a kinesiologist can supervise a graduated walking and strengthening programme. The pooled trials found no average advantage for extra exercise, so book this when you have a specific target or a home programme is not meeting your goals.

See our kinesiology team →

Personal Training

A personal trainer can keep an exercise routine going once rehabilitation ends. Orthopaedic surgeons list walking, swimming, golf, hiking, biking and dancing as realistic with a replaced hip, and most advise against running, jogging and jumping. WRHN’s guidebook adds tennis and downhill skiing to the activities to limit.

See our personal training team →

Other services people ask about

Massage therapy: we found no review of massage after hip replacement; the one we read is in knees, reported on Knee Replacement Rehab. Pain, redness or swelling in a leg after surgery is a warning sign for your surgeon’s team, not something to have massaged. Occupational therapy is covered on Joint Replacement Rehab.

Where most people start

With a physiotherapist. Bring the exercise sheet and precautions your hospital gave you, and the date of your next visit with the surgeon.

How your team works together

Your precautions, your weight-bearing limit and your driving date come from your surgeon, and your physiotherapist works the walking and exercises around them. Once you are off the cane and cleared, a kinesiologist can supervise the strengthening and a personal trainer can keep a low-impact routine going. Anything on the warning list goes to your surgeon’s team or an emergency department, not to us.

  1. Available this week

    Ian Alishaw, BHSc, CPTN, RKin, FST

    Kinesiologist/Fitness Trainer/Fascial Stretch Therapist, Clinic Director

    CARESPACE Weber North

    You should not have to choose between getting stronger and respecting a body that needs a smarter plan.

    Book now About Ian

Browse by service: physiotherapists, kinesiologists and personal trainers.

What to expect at your first visit

  1. Your operation and your instructions. The date, the surgical approach if you know it, your precautions and weight-bearing limit, and the hospital’s exercise sheet.
  2. How you are moving. Walking with your aid, getting out of a chair, and stairs.
  3. The hip itself. Movement and strength within your precautions, and swelling.
  4. Treatment that day, an updated home programme, and what to aim for before your next surgeon visit.

What you can do at home

  • Walk every day, as far as is comfortable.
  • Do the exercises you were given several times a day. Starting early helps the long-term strength and movement of the hip.
  • On stairs, the good leg leads going up; going down, the cane or crutch goes first, then the operated leg.
  • Ice the hip after your exercises if your hospital sheet includes it, for the time it gives.
  • Keep to your lifting limit: in a Waterloo Region winter, that rules out shovelling snow.
  • A fall in the first few weeks can damage the new hip. Stairs are a particular hazard until it is strong, so use the handrail and your cane, and stay off icy steps and driveways.
  • Tell your dentist and other health providers about the artificial joint before any procedure.

How long recovery takes

It may take several months. Most normal light daily activities come back within three to six weeks, and return to work usually falls between six weeks and three months, depending on the job. Replacement hips are designed to last at least 15 years. None of these is a promise for one person: your surgeon’s follow-up visits are where your own timeline is set.

Hip replacement rehab in Kitchener, Waterloo and Cambridge

Kitchener. Physiotherapy in Kitchener, Kinesiology in Kitchener and Personal Training in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Physiotherapy in Waterloo, Kinesiology in Waterloo and Personal Training in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Physiotherapy in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

How long will I need a walker or cane after a hip replacement?

Toronto’s University Health Network tells people having a hip replacement there to expect to walk without a walker or cane at about four to six weeks. WRHN’s guidebook sets no date: your physiotherapist decides when you change aids.

Can I sleep on my side after a hip replacement?

While precautions apply, do not lie on the operated side. You can lie on the other side with one or two pillows between your knees, or on your back with a pillow lengthwise under the operated leg, close to the hip, and part of it pulled up between your legs so they cannot cross.

When can I drive after a hip replacement?

Not until your surgeon clears you, which is usually four to six weeks after surgery, and never while you are on prescription pain medication. The NHS tells people in the UK to wait at least six weeks.

Does Ontario pay for physiotherapy after a hip replacement?

It can. Ontario’s government-funded physiotherapy clinics take people with a valid health card who meet the province’s criteria, such as having been discharged after an overnight hospital stay, or having had day surgery within the last 12 months, and needing physiotherapy for that condition. Whether you qualify is for those clinics to assess, so check with your hospital team before paying for care anywhere; Joint Replacement Rehab sets the criteria out. CARESPACE is pay-per-visit, and you are given a receipt for your extended health plan.

Where can I get hip replacement rehab in Cambridge?

Physiotherapy in Cambridge is the place to start. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

Related conditions

Joint Replacement Rehab
Knee Replacement Rehab
Hip Osteoarthritis
Hip Pain
Fracture Rehab

The CARESPACE Central Reception Team

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