Hip Surgery: Movement, Recovery, and Rehabilitation

Can You Move After Hip Surgery?

Yes, movement is not only possible but crucial after hip surgery, beginning almost immediately under professional guidance to facilitate recovery, restore function, and prevent complications.

The Immediate Post-Operative Period

Gone are the days when extensive bed rest was prescribed after major joint surgery. Modern orthopedic protocols strongly advocate for early mobilization following hip surgery. This approach is grounded in extensive research demonstrating improved outcomes, reduced complication rates (such as deep vein thrombosis and pneumonia), and faster return to function.

Within hours or, at most, a day after surgery, patients are typically encouraged to begin gentle movements. This initial phase is highly supervised by a team of healthcare professionals, including surgeons, nurses, and most critically, physical therapists. The very first movements often involve:

• Ankle Pumps and Circles: To promote circulation and prevent blood clots.
• Gentle Bed Mobility: Learning to safely shift position in bed.
• Sitting Up at the Edge of the Bed: With assistance, to acclimate to an upright position.
• Chair Transfers: Moving from bed to a chair with appropriate support.
• Short Walks with Assistive Devices: Using a walker or crutches for very short distances, often just to the bathroom, under close supervision.

The specific timing and extent of these initial movements depend on the type of surgery, the patient's overall health, and the surgeon's specific post-operative instructions.

The Role of Physical Therapy

Physical therapy (PT) is the cornerstone of recovery after hip surgery. A dedicated physical therapist will work closely with you from the very first day, developing a personalized rehabilitation program designed to:

• Manage Pain and Swelling: Through appropriate exercises and modalities.
• Restore Range of Motion (ROM): Gradually increasing the joint's flexibility.
• Regain Strength: Targeting the muscles surrounding the hip and core.
• Improve Balance and Proprioception: Essential for stability and preventing falls.
• Re-educate Gait: Helping you walk safely and efficiently without compensatory patterns.
• Educate on Precautions and Body Mechanics: Teaching safe movement patterns for daily activities.

Your physical therapist will guide you through a progression of exercises, ensuring that movements are performed correctly and safely, minimizing the risk of re-injury or complications.

Types of Hip Surgery and Movement Considerations

The specific movement protocols and precautions will vary significantly based on the type of hip surgery performed:

• Total Hip Arthroplasty (THA) / Total Hip Replacement: This is the most common hip surgery. Movement is critical, but specific hip precautions are often emphasized to prevent dislocation of the new joint:
  • Posterior Approach: Traditionally, patients are advised to avoid hip flexion beyond 90 degrees, adduction (crossing the midline), and internal rotation.
  • Anterior Approach: Often allows for fewer hip precautions, particularly regarding flexion and internal rotation, but may have some limitations regarding hip extension and external rotation initially. Despite potential differences in specific precautions, early mobilization remains key for both approaches.
• Hip Arthroscopy: A minimally invasive procedure often used to repair labral tears, impingement, or remove loose bodies. While less invasive, movement is still carefully controlled. Protocols typically involve:
  • Limited Weight-Bearing: Often for several weeks to protect the repaired structures.
  • Controlled Range of Motion: Exercises to restore motion without stressing the repair.
  • Gradual Strengthening: Focusing on hip abductors, gluteals, and core.
• Hip Fracture Repair: The approach to movement here is highly variable, depending on the type of fracture (e.g., femoral neck, intertrochanteric) and the method of fixation (e.g., screws, plates, rods).
  • Weight-Bearing Restrictions: Often the primary concern, ranging from non-weight-bearing to partial weight-bearing for several weeks or months.
  • Gradual ROM and Strengthening: Introduced as tolerated and as the fracture heals.

Key Phases of Rehabilitation

Rehabilitation after hip surgery typically progresses through distinct phases:

• Phase 1: Acute Post-Operative (Days to Weeks): Focus on pain and swelling management, protecting the surgical site, gentle range of motion, basic mobility (bed mobility, transfers, short walks), and isometric muscle activation (contracting muscles without joint movement). The goal is independent mobility within the home environment.
• Phase 2: Sub-Acute / Intermediate (Weeks to Months): As pain decreases and initial healing occurs, the focus shifts to progressive strengthening, improving balance, advancing gait training (reducing reliance on assistive devices), and increasing the range of motion. Functional activities like climbing stairs and standing for longer periods are targeted.
• Phase 3: Advanced / Return to Activity (Months Onward): This phase aims to restore full strength, endurance, and agility. It may involve sport-specific drills, higher-level balance exercises, and a gradual return to recreational activities or work. The emphasis is on long-term joint protection and maintaining an active lifestyle.

The duration of each phase is highly individualized, depending on the surgery type, individual progress, adherence to the program, and overall health.

Essential Movement Principles and Precautions

To ensure a safe and successful recovery, adherence to specific principles is paramount:

• Listen to Your Body: Pain is your body's signal. While some discomfort is normal during recovery, sharp or increasing pain should prompt you to stop and consult your therapist or surgeon.
• Adhere Strictly to Precautions: Whether it's avoiding specific hip movements (e.g., no crossing legs, no extreme bending) or weight-bearing restrictions, these guidelines are non-negotiable for protecting the healing joint or preventing dislocation.
• Gradual Progression: Do not try to rush your recovery. Pushing too hard, too fast, can lead to setbacks, re-injury, or complications. Follow your physical therapist's prescribed progression.
• Maintain Proper Body Mechanics: Learn and practice safe ways to perform daily activities, such as standing up, sitting down, bending, and reaching, utilizing your core and larger muscle groups rather than stressing the hip. Use assistive devices as recommended.
• Consistency is Key: Regular, diligent performance of your prescribed exercises, even when you feel tired or discouraged, is vital for optimal recovery.

Potential Complications and When to Seek Medical Attention

While movement is encouraged, it's crucial to be aware of potential complications and know when to seek immediate medical attention:

• Signs of Infection: Fever, chills, increasing redness, swelling, warmth, or pus from the incision site.
• Deep Vein Thrombosis (DVT) / Blood Clot: Sudden calf pain, tenderness, swelling, or redness, often in one leg.
• Hip Dislocation (for THA): A sudden, sharp increase in pain, inability to move the leg, leg appearing shorter or rotated.
• Nerve Damage: Persistent numbness, tingling, or weakness in the leg or foot.
• Persistent or Worsening Pain: Pain that is not relieved by rest or medication, or pain that suddenly worsens.
• Unusual Sounds: Popping, clicking, or grinding noises from the hip joint.

Long-Term Outlook and Returning to Activity

For the vast majority of individuals, hip surgery significantly improves pain, mobility, and quality of life. With diligent adherence to a rehabilitation program, most patients regain the ability to perform daily activities independently and return to many of their desired recreational pursuits.

Returning to higher-impact activities or sports will depend on the type of surgery, individual progress, and your surgeon's and physical therapist's clearance. Many people successfully return to activities like walking, swimming, cycling, golf, and doubles tennis. High-impact sports like running, jumping, and contact sports are often discouraged after total hip replacement to minimize wear and tear on the prosthetic joint.

Ongoing exercise and maintenance of a healthy lifestyle are crucial for the long-term success of your hip surgery, ensuring continued strength, flexibility, and overall well-being.