Exercise and Hip Replacement Surgery
The information in this guide is not a replacement for medical advice. Consultation with your medical and care team should be sought.
Can I exercise whilst awaiting hip replacement surgery?
Hip replacement surgery is an elective procedure (scheduled in advance and not a medical emergency) and is normally only performed when all other forms of treatment have not achieved the desired outcome. The medical team will only perform surgery when they are ready and when you, their patient, feels ready for surgery. The most common reason for hip surgery is osteoarthritis, however, rheumatoid arthritis, a fracture, a fall or other reasons could lead to your surgeon recommending hip surgery. The desired outcome of surgery is to reduce pain, improve walking and functional movement, help the hip joint work well, and improve overall quality of life.
An exercise programme can support and improve your sense of well-being in preparation for surgery. Strengthening the muscles prior to surgery is important and can lead to a better outcome. In particular, exercises to strengthen muscles around the hip will help support your new joint.
Preoperative exercise can also improve muscle memory and maintain some range of movement (ROM), reduce risk of blood clots, improve circulation and reduce fatigue and muscle soreness.
So a low impact type exercise programme such as Pilates can be highly beneficial prior to total hip replacement surgery and improve patient outcomes. You will need to work within limitations and should not work through pain. A chartered physiotherapist, physical therapist or trained Pilates instructor with specialist knowledge can provide suitable exercises and appropriate modifications. Their guidance should support you with simple exercises to practice daily for 10-15 mins at home.
And how do I exercise following hip replacement surgery?
Exercise is a critical part of your post-surgical care. Your surgeon will inform you of postoperative precautions dependent on the stage of your rehabilitation. In the first six weeks you should avoid any movement or exercise that crosses the midline of the body, internally rotates the leg, any external rotation of the leg, crossing the knees when sitting or flexing the hip above 90 degrees. Your medical care team will normally include a physiotherapist, physical therapist or occupational therapist to provide guidance.
It takes up to three months for the joint capsule to heal following total hip replacement surgery and exercise and movement should be progressive and the precautions advised by your surgeon or consultant should be adhered to.
From 6 weeks to one year:
Crossing the midline – no greater than 20 degrees for first 6 months, then as tolerated
Internal rotation of the leg – no greater than 20 degrees with the knee flexed for up to 6 months, then 30 degrees for 6 months to one year or more.
External rotation of the leg – up to 30 degrees with hip flexion, no external rotation and extension of the hip.
Crossing knees while sitting – after 6 weeks following surgery, gently crossing knees whilst sitting can be introduced according to tolerance.
Flexing the hip – 90 to 100 degrees 3 months after surgery, up to 110 degrees at 6 months, and working towards 115 degrees between 6 months and a year if tolerated.
Lifting heavy objects or weights – heavy lifting is not recommended of more than 23 kilograms (about the weight of a fully packed holiday suitcase).
Despite these precautions, moving and exercising are crucial and significant in recovery, rehabilitation and well-being. The goals and benefits of exercise post surgery are to:
- Increase muscular strength
- Avoid injury to the new hip joint
- Increase circulation and overall fitness
- Increase well being
In the early weeks following surgery exercises will be functional and advice will be provided– how to get out of bed, walk with an aid or help, and move around safely. You will also be given exercises for strengthening with a small range of movement. As healing progresses exercises will increase to improve range of movement, muscular strength, fitness and well-being. Returning to an exercise class such as Pilates or going swimming may be achievable at 8 to 12 weeks but it is likely a full one hour session may be too long so it is important to manage your own expectations and discuss this with your instructor, physiotherapist or physical therapist and if possible attend a private or time flexible session. Driving or getting to a Pilates class or a swimming pool before 8 weeks may be difficult or not advisable, so an alternative such as having your Pilates instructor visit you at home if affordable could be beneficial, and ask your Pilates instructor to provide some simple exercises to perform in your own home. If using swimming pool facilities great care should be taken not to slip, so plan ahead with regard to changing and getting in and out of the pool. You should check with your surgeon and medical team before taking part in an exercise class. Physical therapists, physiotherapists, exercise trainers and instructors are required to demonstrate they have knowledge and skills that are appropriate and have a responsibility to act within the boundaries of their knowledge. During the early stages of rehabilitation your therapists or Pilates instructor should maintain notes to record their decisions about the content and duration of the exercises, and record any positive or negative effects they observe. How you respond to exercise will vary greatly and is dependent on your own individual response.
Will I ever ski, run, dance or resume my favourite sport again?
Gradual and progressive return to exercise following the advice of your surgeon or consultant will lead to the most successful outcomes. However, you may need to adjust or choose another form of exercise to avoid risk and to prolong the life span of your new hip. Normally, you will be advised to avoid high- impact and high- risk exercise, sport and activities such as running, jumping, high-impact aerobics, competitive tennis, basketball, ballet, skiing etc. However, where a patient has previously achieved a high level of experience in performing a higher risk activity they may be able to return to their sport or exercise by resuming at a lower level and increasing the demands gradually.
Generally, caution and assessment of risk needs to be made before attempting highly competitive, or demanding physical activities. In the UK more than 80,000 total hip replacement procedures were performed in 2012, and in the US over 310,000 procedures were performed in 2010. The number of procedures is increasing year on year, and the percentage of revision procedures is increasing. Looking after your health and fitness and taking part in appropriate exercise will prolong the life of your new hip joint and improve the quality of your life.
Blog article by Celia Carron, Celia is a Pilates instructor at Basel Pilates, and lives and works in Basel, Switzerland and previously director of Little Venice Pilates and Physiotherapy in London.
Levine B, Kaplanek B, Jaffe William L. Clin Orthop Relat Res. 2009 Jun; 467(6): 1468–1475. Published online 2009 Mar 13. doi: 10.1007/s11999-009-0779-9
Kaplanek A, Levine B, Jaffe WL. Pilates for Hip and Knee syndromes and Arthroplasties.. Human Kinetics; 2011.