Part of Total hip replacement rehab
The first exercises after a hip replacement: weeks 0 to 6
Warning signs, and when to get help
What are the first exercises after a hip replacement?
Small jobs, done often instead of hard. You move the ankles and feet, you tighten and release the thigh, and you work a little bend and a little straightening back into the hip. Once your team is happy for you to be up, you stand at a kitchen counter with your hands on something solid and move the leg in each direction. That is the whole of it for a while.
On this site those are stages 1 and 2 of total hip replacement rehab, where every exercise has its own page, its own video and its own starting dose. Stage 1 is bed and chair work: ankle pumps, quad sets, heel slides, short arc quads and the straight leg raise. Stage 2 arrives when you are walking with your frame or walker, your crutches or your stick or cane, and your team is happy for you to exercise standing up: standing hip flexion, standing hip abduction, standing hip extension, calf raises, the side to side weight shift, sit to stand using armrests, the glute bridge and walking with a cane.
Four of those carry a limit that has nothing to do with technique, and it is worth having them here rather than only on the program page. For heel slides, bend the hip only as far as your team allows, which is often no further than a right angle. In standing hip extension, take the leg back only a short way, and ask how far if your hip was replaced from the front or from the side, since both of those routes open the front of the hip. Leave the side leg lift, standing hip abduction, out altogether if your team has asked you not to work the side of your hip yet, and if nobody has mentioned it, ask before you do it rather than reading the silence as a yes: a hip reached from the side has the muscles on the side of the hip lifted off the top of the thigh bone and stitched back through it (Agarwala and Jagani, 2018), and how soon that repair may be worked is their decision and not a figure anyone can publish. And for sit to stand, use a firm, high chair with arms, high enough that your knees stay lower than your hips.
Two smaller ones belong with them. When you lift the leg in front of you in standing hip flexion, keep the knee lower than your hip. And start the glute bridge only when your team says so, on your bed rather than down on the floor, with your knees staying apart over your feet instead of rolling together. None of that is a reason to skip an exercise you were given. They are the questions to have answered first.
If you do not know which route your surgeon took into the hip, you are in the majority, and you do not have to guess this morning. Until somebody tells you, keep to all of those limits at once instead of the famous ones: the hip bending no further than a right angle, the knee below the hip when you lift the leg in front, the leg going back only a short way, nothing crossing the middle of your body, no twisting on that leg, and no loaded or resisted work for the side of the hip. That covers every approach, it costs you almost nothing in these six weeks, and it is not a substitute for being told. The leaflet you came home with, your discharge letter and the ward that looked after you can all tell you which route it was, and the scar on its own cannot, because a scar on the side of the hip can belong to more than one approach.
You will not find a repetition count anywhere on this page. The program carries the figures the hospital leaflets give, and each exercise page carries its own starting dose, so the numbers you work to come from them and not from us. Your physio or physical therapist sets them to your hip.
And one thing outranks the whole of it. The sheet you came home with was written by people who know how your hip was reached, how steady it is and what you may put through it. Where that sheet and this page disagree, the sheet wins, and so does anything your surgeon said about weight through the leg or how far the hip may bend. What hip precautions are and how long they last explains why two hospitals hand out two different lists, and why a movement that is routine after one operation is off limits after another.
Those last two get filed under the same word and they are not the same thing. A precaution list limits position. It says nothing about load. How much weight may go through the leg, how long the crutches or frame stay, and how much you may lift are separate instructions with their own end dates, decided by what was done to the bone as much as by what was done to the joint. A graft, a wire or a plate around the top of the thigh bone, a revision of an earlier replacement, or a break fixed during the same operation can each carry a weight limit that no standard precaution list mentions. So if you were told to keep some weight off that leg, that applies to every standing exercise on this page. If nobody has told you how much weight may go through it, ask before you start the standing ones rather than waiting for the six week review. And the day your precautions end is not automatically the day a weight limit ends.
That is not a formality. General hip exercise lists, hospital ones included, contain movements that would breach a classic precaution list or a limit on taking the leg backward, and nothing on the page tells you which. Check anything you find, here or anywhere else, against your own sheet before you try it.
What the first six weeks are for
Three jobs, and strength is the one that comes last.
Circulation comes first. OrthoInfo gives one reason for its whole early set before it mentions muscle or movement at all: these exercises increase circulation to the legs and feet, which is important for preventing blood clots. The ankle and foot work is the part of that set doing nothing else, which is why it leads the list and why it is the hardest thing on it to skip.
The hip also has to keep moving. It has to keep bending and straightening while everything around it is sore, swollen and unwilling, because movement is cheaper to keep now than it is to win back later.
Last, the muscles have to wake up. Months of a painful hip had already wasted them before you went in, and the operation has not helped. Leeds Teaching Hospitals, in the Hip School session it gives its own patients, explains that some of the muscles and ligaments holding the ball in the socket are cut during the operation and that those tissues need at least six weeks to heal and become strong again. Cambridge University Hospitals gives the same six weeks for the ligaments and soft tissues of the joint, with a further six for them to strengthen. That is why this window runs six weeks and not two.
It all starts earlier than most people expect, too. NICE asks for a physiotherapist or occupational therapist to begin rehabilitation on the day of the operation where that is possible, and within 24 hours otherwise, with a home program and advice before you are discharged (NICE NG157). So by the time you are reading this at your own table, you are carrying something on rather than starting it.
For the shape of the whole recovery, not just this window, the hip replacement recovery timeline sets out what each source says and when.
Why the exercises that feel like nothing matter most
Because in these weeks frequency is the dose, not effort.
Look at how OrthoInfo treats ankle pumps compared with everything else on its list. The other early exercises belong to a handful of sessions through the day. Ankle pumps are the one it asks you to come back to again and again, from straight after the operation until you are fully recovered. Nothing else is handled that way, and that tells you what they are for. Ankle pumps and quad sets carry the technique.
They are not a replacement for the clot prevention your team prescribed. If you were sent home with stockings, injections or tablets, those are doing the main work and the exercises sit alongside them. Never stop or change a prescribed medicine on your own.
The difficulty with these exercises is that nothing seems to happen while you do them. No effort, no visible progress, no sense of having trained. So they are the first thing to slide in week two, usually in favor of walking, which at least feels like exercise. Read the section on the exercises that look pointless on the main program page before you decide they are not worth the bother. It has the technique points worth getting right, including the common fault of letting the hip take over from the ankle.
Why your leg will not lift, and what to do about it
This is the commonest question of the first fortnight and one of the least talked about. You lie flat, you are asked to lift the straight leg off the bed, and nothing moves. The leg feels borrowed.
It is usual enough that not every hospital keeps the exercise in the program at all. The Cambridge University Hospitals leaflet has no straight leg raise in its early set, where the OrthoInfo guide does include one, so if yours does not list it, that is correct and not a shortcut you have been handed.
Trying harder once is also not the answer. A muscle that is not yet answering the instruction does not come back through one big effort. It comes back through short, repeated attempts at a smaller version of the same thing, which is exactly why quad sets and short arc quads sit ahead of the straight leg raise in the program. Tightening the thigh with the leg flat, and straightening the knee over a rolled towel, both ask that muscle to switch on with far less weight to move.
So do the small version properly, several times a day, and tell your physio at the next session that the straight leg raise is not happening yet. That is ordinary information for them rather than a confession.
One version of this is not ordinary, and it is worth separating now. A leg that could lift and suddenly cannot, a foot that drags, catches or slaps down when you walk, or new numbness or tingling beyond the numb patch of skin around your scar all need medical advice the same day, as the warning signs at the foot of this page set out. The difference is a sudden change against a slow return.
The same distinction applies to lifting the leg out to the side, and here the sudden version has a particular cause. Muscle and tendon on the side of the hip are cut and stitched back during this operation. If you felt a pop, a snap or a sudden tearing pain over the side or the back of the hip, or the hip will not take the leg out to the side any more, or it will not hold you up on that leg so you drop or lurch to one side, stop the exercises, go back to your crutches or frame and get advice the same day. People usually keep walking on this one, which is exactly why it gets saved for the follow-up.
How much should it hurt?
Enough to notice and not enough to flatten you, and there is a sourced line to steer by. Gateshead Health tells its own hip replacement patients that extra discomfort while doing the exercises, and for up to an hour afterward, is normal. That gives you the shape to look for: discomfort during a session, settled within about an hour, and a hip no worse the next morning. The pain monitoring model is the clinician's version of the same idea, if you want to see where it comes from.
Gateshead also makes a practical point that changes how a whole day runs. It asks patients to take their pain relief before the exercises, particularly while the exercises are hard, and to use ice afterward. Pain relief in these weeks is part of the rehabilitation and not something sitting beside it, because too little of it and the exercises simply do not happen. Two cautions come with the stronger painkillers from OrthoInfo: opioids can be addictive, so it asks you to use them only as your doctor directs and to stop them as soon as your pain begins to improve. If yours is not improving, that is a conversation with the prescriber rather than a reason to keep going on your own.
Direction matters more than level. OrthoInfo asks you to talk to your doctor if the pain has not begun to improve within a few days of the operation. Pain easing slowly is the expected picture. Pain climbing week on week is a reason to make a call rather than to push through.
There is an exception, and it is the half of this section that matters most. A hip that is more painful and more swollen does not always mean you did too much yesterday. An overdone session and an infection around the new joint can feel much the same from the inside, and you cannot tell them apart by how sore you are. If the hip is also hot or red, if you have a temperature or feel hot, cold or shivery, if the wound is leaking, or if the pain keeps building while you rest as well as when you move, do not file it as training soreness. OrthoInfo puts increasing hip pain both with activity and at rest on its list of things to contact your doctor about immediately. Get medical advice the same day, at the level the warning signs below set. A normal temperature is not an all clear either: OrthoInfo's page on infection after a joint replacement says fever is no longer considered a sign of an infection after a joint replacement, and that the signs can be as little as mild redness and swelling.
What a day looks like: short and often, and what sits around it
Several short rounds spread from morning to bedtime beat one determined session, and the gap between the two is wider than it sounds. OrthoInfo's own figures show what that looks like: most of its early exercises at 3 to 4 sessions a day, a total of 20 to 30 minutes of exercise daily and sometimes that much two or three times a day while you are still in early recovery, and the ankle pumps on their own schedule of every 5 or 10 minutes. Your sheet and your physio set yours, and nothing here replaces either. Those session counts belong to OrthoInfo's own program, and they are higher than the starting doses our exercise pages give for the same movements, several of which say once or twice a day. Where two numbers disagree, the one to follow is the one your own sheet or your own physio gave you, not the bigger one. More is not better in these six weeks, and a hip that is sorer the next morning is the sign you took the wrong figure.
The pattern that fails is the ambitious morning. Everything is done before lunch, the hip is sore by two o'clock, and nothing else happens until tomorrow. What works instead is hanging each round on something already in your day: after a cup of tea, at the end of the news, every time you sit back down from a trip to the bathroom, the last round once you are in bed. Nobody follows a timetable in the first week after an operation, because the week is a fog. Most people can follow a habit they already had.
A few things sit around the exercises and decide whether they happen at all.
Walking is one of them, and it belongs with the exercises, not instead of them. The NHS asks you to avoid sitting still for long stretches, which it says helps reduce the swelling, and the walking program on the main page builds from short, frequent walks and not from distance. Short and often again.
Your walking aid matters as much. Use the frame or walker, the crutches, or the stick or cane the way your physio set it up, and do not trade down to a lighter one until they say you are ready. OrthoInfo gives the blunt reason: a fall in the first few weeks after surgery can damage the new hip and may result in a need for more surgery, and calls stairs a particular hazard until the hip is strong and mobile. It asks you to use a cane, crutches, a walker or handrails, or to have someone help you, until your balance, flexibility and strength have improved.
Swelling and ice come last. Gateshead uses ice after the exercises, and once you are home it asks for an ice pack three to four times a day for 15 to 20 minutes, with the frequency coming down after that. Your own team will tell you how long and how often they want it, and theirs is the figure to use. One caution belongs to this window specifically. The patch of skin around the scar is often numb, which the warning signs below treat as expected, and numb skin cannot tell you the ice has been on too long. Check that patch with your eyes rather than waiting to feel something.
Why the sheet you were given beats anything you find online
That sheet knows two things no general page can: which operation you had, and what your surgeon will allow.
The OrthoInfo exercise guide, published by the American Academy of Orthopaedic Surgeons, opens by telling readers to check with their therapist or surgeon before trying any of the exercises on it. If a guide written by a surgeons' academy says that about its own content, take it as read for this one.
The risk here is specific, not theoretical, and you do not have to find a bad source to meet it. The Cambridge University Hospitals leaflet is a good one, and from six weeks it has its patients lie on their front and lift the operated leg up behind them, and squat down onto a chair with no limit stated on how far the hip may bend. Cambridge gives no precautions to anybody, so that is consistent for its own patients. Lifting the leg behind you takes the hip backward, which some teams limit after a hip replaced from the front, and an unlimited squat down onto a chair is deep hip bending, which is the first thing a classic list written for a hip reached from the back rules out. Either can be exactly right for one reader and exactly wrong for the next, and a web page cannot tell which of the two you are. What hip precautions are and how long they last covers how to find out which applies to you, including how to find out which approach your surgeon used.
A short test before you add anything from anywhere: is this on the sheet my hospital gave me, and if it is not, have I asked? Two more questions are worth asking at your next appointment if nobody has told you yet. How much weight may go through the leg. And how far the hip may bend, and which way it may turn.
What tells you the window is ending
An appointment, mostly. After that the work changes in kind more than in amount.
The follow-up usually lands around 6 to 12 weeks after surgery (NHS), while Gateshead puts its own orthopedic clinic appointment at 6 to 8 weeks. Stitches or clips come out at about 10 days (NHS), well before either. The six week mark is a review date, not a release date, and what you are cleared for comes out of that conversation and not out of the calendar.
The hospital leaflets change gear at about the same point. Cambridge University Hospitals asks its patients to start the more advanced exercises at six weeks, when they feel able to. The wording there is worth noticing: when you feel able, not on the day.
The signal on this site is the same. You move up a stage when your team says so and the current one feels easy. Hip replacement exercises after 6 weeks covers what actually changes then, which is a shift away from getting the hip moving and toward rebuilding strength and getting your walking back to normal.
One last thing about this window. If you reach the end of it still limping badly, unable to manage the exercises you were given, or with your walking stuck for a week or two, that is a reason to ask for a review instead of waiting it out. NICE says people whose own rehabilitation is not getting them to their goals should be offered supervised rehabilitation, in a group or one to one (NICE NG157). Asking is using the system the way it was designed.
When to stop and get help
A few of the problems in these six weeks need attention today, and one or two need it immediately.
The warning signs below are grouped by how fast to act. The ones under "Get emergency help now" mean calling emergency services rather than your team. The ones under "Get help today" mean your surgical team today, not a note for the follow-up. The ones under "Book an appointment" still need raising in the next week or two rather than saved for later.
Have the numbers before you need them. Write your ward or surgical team number down, with whatever out of hours route they gave you, and keep it somewhere you can find it at three in the morning instead of hunting for it then. NICE expects anyone doing their own rehabilitation at home to have clear goals and a point of contact for advice and support (NICE NG157), so if nobody gave you one, ask.
A few are worth naming here, because these are the ones people talk themselves out of. Sudden severe hip or groin pain with a leg you cannot move or stand on, or a leg that suddenly looks shorter or turned in or out, is an emergency, and the thing not to do is try to walk on it. Sudden breathlessness or chest pain is an emergency even when the leg looks completely normal. A calf or thigh that is newly swollen, warm or tender needs advice the same day. And a fall or a knock, even a small one you walked away from, means stopping the exercises, going back on the crutches or frame and getting the hip checked the same day.
One more gets saved for the follow-up more than any other sign on the list: a hip that clunks and feels as though it partly slipped out and went back, even when it settles immediately and the leg looks normal. That is a same day call.
The warning signs after a hip replacement works through the full set with the urgency attached to each. If you cannot tell which tier you are looking at, make the call anyway. Nobody on a surgical team minds a phone call in week one about something that turns out to be nothing.
Related exercise programs
Warning signs
Get emergency help now
- Emergency: sudden severe pain in your hip or groin, sometimes with a clunk or pop, and you cannot move the leg or put weight on it, or the leg suddenly looks shorter or turned in or out. Do not try to walk on it or push it back into place. Keep still and call emergency services or go to an emergency department, and do not drive yourself. Your new hip may have come out of its socket (dislocated), and a medical team needs to put it back.
- Emergency: your operated leg looks shorter than it did, or its foot turns in or out more than before, or the hip moves in an unusual way, even if the pain is not severe. Keep your weight off it and go to an emergency department straight away, and do not drive yourself. If you are in severe pain or cannot move the leg, call emergency services.
- Emergency: you have just fallen and cannot get up, or you think you may have hurt your head, neck, back or hip. Stay where you are, keep warm and call emergency services, or get someone to call for you. If you got up and walked without trouble and only notice pain later, use the same-day lines in this list instead.
- Emergency: you have had a fall or an injury and now have severe hip pain, or you cannot walk or put weight on the leg. Call emergency services or go to an emergency department. This can be a sign of a broken hip (hip fracture).
- Emergency: since your operation, you suddenly become short of breath, you get chest pain or pain in your upper back that may be worse when you breathe in, you cough up blood, your heart is beating very fast, or you faint. Call emergency services straight away, even if your leg looks normal. These can be signs of a blood clot in the lungs (pulmonary embolism).
Get help today
- Same day: after a fall or a knock, even a small one, your hip, groin or thigh is newly painful, bruised or swollen, even if you can still walk and your leg looks normal. Stop the exercises, go back to your crutches or frame and keep your full weight off that leg, and contact your surgical team or get medical advice the same day. A break in the bone around a new hip is not always obvious at first, and walking normally on one can move the broken ends apart.
- Same day: a calf or thigh that is newly swollen or getting more swollen, warm, tender, red or darker than usual, has swollen veins that are sore to touch, or has a throbbing or cramping pain that does not fit your injury or condition, or that feels different from normal muscle soreness after exercise. This can be a sign of a blood clot (deep vein thrombosis), especially after surgery, an injury, time in a cast or boot, a long trip or a spell of being much less mobile than usual. Get medical advice the same day. If you are also short of breath or have chest pain, call emergency services.
- Same day: you are taking tablets or having injections to lower your risk of a blood clot and you notice blood in your urine, black or bloody stools, bleeding gums, a nosebleed that goes on and on, bruising far beyond what the knock would explain, or you are being sick or coughing up blood. Get medical advice the same day, and do not stop the medicine on your own. Bleeding more easily is the known trade-off of these medicines (NHS), and the dose or the type may need looking at. Go to an emergency department if the bleeding will not stop, you feel faint, or you bang your head while you are taking it, even if you feel fine, because the NHS advises getting urgent advice after a head injury on medicine that thins your blood and only a hospital can scan for a bleed inside the head.
- Same day: your wound becomes more red, hot, swollen or painful, starts to leak or ooze, is still leaking in the second week or has never stopped, has pus coming out of it or its edges start to come apart, or you have a high temperature or feel hot, cold or shivery. Contact your surgical team or get medical advice the same day. Redness can be harder to see on brown or black skin. If you feel very unwell, go to an emergency department. If you have a very high or very low temperature, shivering you cannot control, you are breathing very fast or finding it hard to breathe, you are confused or your speech is slurred, your skin, lips or tongue look blue, gray, pale or blotchy (on brown or black skin this can be easier to see on the palms of the hands or soles of the feet), or you have a rash that does not fade when you press it, call emergency services, as this can be sepsis.
- Same day: in the days or weeks after your operation you are getting more and more tired, breathless doing everyday things such as walking to the toilet or getting dressed, dizzy or lightheaded, your heart is racing, or your skin looks paler than usual. Contact your surgical team or get medical advice the same day. Tiredness and breathlessness that build up like this are not part of the usual recovery. Blood loss during and after a hip replacement can leave you short of red blood cells (anemia), which is treatable, and a slow bleed or an infection can show up the same way. If breathlessness comes on suddenly, or you get chest pain, call emergency services, as the emergency line above explains.
- Same day: dizziness, lightheadedness, blurred vision or feeling faint when you stand up that is new for you, does not pass within a minute or two, keeps happening, or has made you fall. Sit or lie down, and get medical advice the same day. This can be a drop in blood pressure on standing (postural hypotension), a type of low blood pressure, which the NHS lists among the causes of falls, and your doctor can check it. Tell them about your medicines, because some can cause it. If it does not settle within a few minutes of sitting or lying still, call emergency services. If you faint, call emergency services, even if you come round quickly, because the NHS says to call them when someone faints while exercising or is badly hurt, and a faint onto a new hip can dislocate it or break the bone around it.
- Same day: dizziness or feeling faint during or after exercise, other than the brief lightheadedness as you stand up covered in the line above, without any of the emergency signs above. Stop the exercises and get medical advice the same day. If you faint, it does not settle within a few minutes of sitting still, or you cannot stand or walk steadily, call emergency services.
- Same day: since your operation, the pain, redness, warmth, tenderness or swelling in your hip or leg is not getting better or is getting worse, for example the hip pain keeps building both when you move and when you rest, or you have a new throbbing or cramping pain in your hip or leg. Contact your surgical team or get medical advice the same day, as this can be a sign of infection around the new joint or a blood clot. If you feel very unwell, go to an emergency department.
- Same day: at any time after your operation, even years later, new pain in your new hip along with a high temperature or feeling hot, cold or shivery, or a hip that becomes hot, red or swollen, which counts on its own, with or without pain and with or without a temperature. Contact your surgical team or get medical advice the same day. A new joint can become infected long after the operation, and that needs treating quickly. A normal temperature is not an all clear: OrthoInfo says fever is no longer considered a sign of an infection after a joint replacement, that the signs can be as little as mild redness and swelling and sometimes there are none at all, and that increased pain or stiffness in a joint that had been working well is one of them. So do not wait for a temperature before you report new or increasing pain in your new hip to your surgical team.
- Same day: your hip clunks and feels as if it partly slipped out of place and went back, even if it settles straight away and your leg looks normal. Stop the exercises, avoid the movement that brought it on, go back to your crutches or frame, and keep away from deep bending, crossing your legs and twisting on that leg until you have been seen. Contact your surgical team or get medical advice the same day. If the leg then looks shorter or turned, or you cannot move it or put weight on it, call emergency services.
- Same day: you felt a pop, a snap or a sudden tearing pain over the side or the back of your hip, or your hip will not lift the leg out to the side any more, or it will not hold you up when you stand on that leg, so your hip drops or you lurch to one side. Stop the exercises, go back to your crutches or frame, and contact your surgical team or get medical advice the same day. Muscle and tendon are cut and stitched back during a hip replacement, and a repair that has given way needs assessing rather than exercising. If you cannot put weight on the leg at all, or the leg looks shorter or turned, call emergency services.
- Same day: a leg or foot that is getting weaker, for example your foot drags, catches on the ground or slaps down when you walk (foot drop). Get medical advice the same day. If the weakness is getting worse by the hour, go to an emergency department.
- Same day: new numbness, tingling or burning in your operated leg or foot, beyond the numb patch of skin around your scar. Contact your surgical team or get medical advice the same day. If it started after a fall or an injury, or your foot or toes turn cold, pale, blue or gray, call emergency services or go to an emergency department straight away, and do not drive yourself.
Book an appointment
- Within a few days: you have had a fall, even if you were not hurt, or you keep tripping, stumbling or feeling that your legs might give way. Book an appointment with your doctor within a few days and ask about a falls assessment. Tell them about every fall, even the ones where you were not hurt.
- Routine: since the operation your leg has felt a little longer or shorter than the other one, with no sudden change and no new pain. This is not unusual after a hip replacement. Mention it to your physio or at your follow-up appointment, as some people are more comfortable with a shoe raise.
- Routine: your walking or movement has stopped improving over a week or two, you still limp badly, or you cannot manage the exercises your team gave you, but your pain, redness and swelling are not getting worse. This is not an emergency, but ask your physio or surgical team for a review in the next week or two.
Common questions
What are the first exercises after a hip replacement?
Ankle and foot movements for the circulation, thigh tightening to wake the muscle up, a heel slide for a little bend and a little straightening, and then standing work at a counter once your team is happy for you to be up. On this site those are stages 1 and 2 of the total hip replacement rehab program, where every exercise has its own page, its own video and its own starting dose. Start with the ones your hospital sheet lists, because that sheet was written for the operation you actually had.
How often should I do them in the first weeks?
Short rounds spread across the day beat one long effort, and the figures come from the program and not from this page. The main program carries the repetitions and frequency the hospital leaflets give, and each exercise page carries its own starting dose, so you are following their numbers and not a second set from us. For a sense of the scale, OrthoInfo says your surgeon and physical therapist may ask for 20 to 30 minutes of exercise a day, or even two or three times a day in early recovery, puts most of its early exercises at 3 to 4 sessions a day, and asks for ankle pumps as often as every 5 or 10 minutes. Your physio or physical therapist will adjust all of it to your hip, and if your own team gave you something different, theirs is the one to follow.
Why will my leg not lift off the bed?
Because the muscle is not answering the instruction yet, which is one of the most common experiences of this window and not a sign that anything has been damaged. It is common enough that some hospital programs leave the straight leg raise out altogether, the Cambridge University Hospitals leaflet among them, while the OrthoInfo guide keeps one, so if yours does not list it, that is correct and not a shortcut. What helps is the smaller version done often: tightening the thigh with the leg flat, and straightening the knee over a rolled towel, both ask the same muscle to work with far less to lift. Tell your physio that it is not happening yet. A leg that could lift and suddenly cannot is a different matter and needs advice the same day.
Is it meant to hurt this much?
Extra discomfort while you do the exercises, and for up to an hour afterward, is normal for this operation (Gateshead Health), so the shape to look for is discomfort during a session that settles within about an hour and a hip no worse the next morning. What is not ordinary: pain that keeps building while you are resting as well as when you move, a hip that is hot or red, a temperature, or a wound that is leaking. OrthoInfo also asks you to talk to your doctor if the pain has not started to improve within a few days of the operation, so the direction it is heading in matters as much as the level.
What if I cannot manage all of them?
Do fewer of them more often instead of abandoning the lot, and say so at your next appointment. The exercises that get dropped first are the ones that feel like nothing, and those are the ones doing the circulation work, so protect them if something has to give. If you are near the end of the six weeks and still cannot manage the program you were given, ask for a review. NICE says people whose own rehabilitation is not getting them to their goals should be offered supervised sessions, in a group or one to one (NICE NG157).
When do the exercises change?
When your team says so and the stage you are on feels easy, which usually means somewhere around the six week review and not a date you can mark now. Hospital leaflets line up with that: Cambridge University Hospitals asks patients to begin its more advanced exercises at six weeks, when they feel able to. The follow-up appointment itself is often 6 to 12 weeks after surgery (NHS). What changes then is the kind of work and not the amount.
References
- National Institute for Health and Care Excellence. Joint replacement (primary): hip, knee and shoulder. NICE guideline NG157. Published 4 June 2020. https://www.nice.org.uk/guidance/ng157
- NHS. Recovering from a hip replacement. Page last reviewed 6 March 2024. https://www.nhs.uk/tests-and-treatments/hip-replacement/recovering-from-a-hip-replacement/
- American Academy of Orthopaedic Surgeons. Total hip replacement exercise guide. OrthoInfo. https://www.orthoinfo.org/en/recovery/total-hip-replacement-exercise-guide/
- American Academy of Orthopaedic Surgeons. Total hip replacement. OrthoInfo. https://www.orthoinfo.org/en/treatment/total-hip-replacement/
- American Academy of Orthopaedic Surgeons. Infection after joint replacement. OrthoInfo. https://www.orthoinfo.org/en/diseases--conditions/joint-replacement-infection/
- Gateshead Health NHS Foundation Trust. Physiotherapy following hip replacement surgery. Patient information. https://www.gatesheadhealth.nhs.uk/resources/physiotherapy-following-hip-replacement-surgery/
- Leeds Teaching Hospitals NHS Trust. Total hip replacement: a guide to your rehabilitation. Patient information. https://www.leedsth.nhs.uk/patients/resources/total-hip-replacement-a-guide-to-your-rehabilitation/
- Cambridge University Hospitals NHS Foundation Trust. Hip replacement, total: advice and exercises following. Patient information. https://www.cuh.nhs.uk/patient-information/hip-replacement-total-advice-and-exercises-following/
- NHS. Deep vein thrombosis (DVT). Page last reviewed 30 April 2026. https://www.nhs.uk/conditions/deep-vein-thrombosis-dvt/
- NHS. Pulmonary embolism. Page last reviewed 25 May 2023. https://www.nhs.uk/conditions/pulmonary-embolism/
- NHS. Anticoagulant medicines. Page last reviewed 9 September 2024. https://www.nhs.uk/conditions/anticoagulant-medicines/
- NHS. Head injury and concussion. Page last reviewed 29 May 2025. https://www.nhs.uk/conditions/head-injury-and-concussion/
- NHS. Sepsis. Page last reviewed 14 May 2026. https://www.nhs.uk/conditions/sepsis/
- NHS. Iron deficiency anaemia. Page last reviewed 26 January 2024. https://www.nhs.uk/conditions/iron-deficiency-anaemia/
- NHS. Falls. https://www.nhs.uk/conditions/falls/
- NHS. Low blood pressure (hypotension). Page last reviewed 11 July 2023. https://www.nhs.uk/conditions/low-blood-pressure-hypotension/
- NHS. Fainting. https://www.nhs.uk/symptoms/fainting/
- Royal Orthopaedic Hospital NHS Foundation Trust. Orthopaedic surgery and anaemia. https://roh.nhs.uk/news-events/orthopaedic-surgery-and-anaemia
- Agarwala S, Jagani N. Osteotendinous suturing for anchorage of hip abductor mechanism in total hip arthroplasty through a lateral approach: a technical note. Journal of Orthopaedic Case Reports. 2018;8(2):26-29. https://pubmed.ncbi.nlm.nih.gov/30167407/
- University Hospitals Plymouth NHS Trust. Hip dislocation. Patient information leaflet. https://www.plymouthhospitals.nhs.uk/display-pil/pil-hip-dislocations-4038/
Written and checked by the PocketPhysio editorial team. Last updated 2026-10-17.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.