Part of Total hip replacement rehab
Hip precautions after a hip replacement: what they are and how long they last
Warning signs, and when to get help
What are hip precautions after a hip replacement?
Hip precautions after hip replacement are positions and movements you are asked to keep away from for a while, so the new joint is not carried toward the edge of its socket while the tissues around it heal. They are not exercises and not something you do. They are a short list of things you leave alone.
One thing they are not, and it catches people out because the two get filed under the same word. Hip precautions are limits on position. They are not limits on load. How much weight you may put through the leg, whether you need crutches or a frame and for how long, and how much you may lift are separate instructions with their own reasons and their own end dates. They depend on what was done to the bone as much as on what was done to the joint, so someone whose operation involved a graft, a wire or a plate around the top of the thigh bone, a revision of an earlier replacement, or a break fixed at the same time may have been given a weight limit that no standard precaution list mentions. If nobody has told you how much weight to put through that leg, ask, and do not read the end of your precautions as the end of a weight limit you were given.
OrthoInfo frames them as extra care with how you sit, bend and sleep, normally through the first 6 weeks after the operation, so the new hip does not dislocate while recovery happens.
Here is the part that catches people out. The content of that list is a decision somebody made about your operation, not a fixed property of hip replacements. Leeds Teaching Hospitals says it plainly: the surgeon makes this decision, and a clinician will tell you whether hip precautions apply to you. Your surgeon and the hospital team decide what you do and when, and their protocol comes before this page.
If you came home with nothing of the kind, you have probably not been forgotten. The Cambridge University Hospitals leaflet gives no list of hip precautions at all and tells its readers they may lie in bed however they feel comfortable. Some teams give a long list, some give a short one, and some give none.
If nobody has told you either way, or you have a list but do not know which approach your surgeon used, do not try to work it out from this page. Keep to the six cautious limits in if you do not know yet which list is yours for the few days it takes to ask, and ask this week.
So this page sticks to the shape of the thing: where the lists come from, why yours and someone else's differ, what the common ones contain, roughly how long they run, and what to do about the situations a leaflet never mentions. The one thing it cannot give you is your own limits. Those belong to the people who were in the room.
Why your list and someone else's are different
People compare two leaflets and then worry that one of them must be wrong. Usually neither is, and the reasons are worth knowing.
Most of it comes down to how the hip was reached. A hip can be replaced from the back, from the front or from the side, and what has to be passed through differs each time, so what the joint is least steady against afterward differs too. OrthoInfo puts it simply: which precautions you get differs from one patient to the next, according to the approach the surgeon used.
The rest comes down to the surgeon. When the American Association of Hip and Knee Surgeons and the Canadian Arthroplasty Society surveyed their members, 44% of them always prescribed precautions and 33% never did. Prescribing precautions and equipment went together with the posterolateral approach, with surgeon experience and with larger head sizes, while surgeons using a direct anterior approach were significantly less likely to prescribe either precautions or equipment (Carli and colleagues, 2018).
So your leaflet, your neighbor's from the same hospital and your brother's from five years ago can all be correct at once. One hospital's handout is one team's protocol, which is why reading two of them leaves people more confused than reading none.
Which makes the approach worth knowing. Most people have no idea which one they had. If you do not know which approach was used, the leaflet you came home with, your discharge letter and the ward that looked after you can all tell you, and the scar on its own cannot, because a scar on the side of the hip can belong to more than one approach. The NHS account of the operation goes no further than one cut, or several, at the back or the side of the hip, which is a fair measure of how much the general description leaves open.
Ask at your follow-up if nobody has said. It is a short question and it changes the answer to almost everything else on this page.
The movements most posterior lists cover, and the 90 degree rule
The classic lists were written for a hip reached from the back, and they keep circling the same few movements: deep bending at the hip, crossing the leg over the middle of your body, turning the leg inward, twisting on it.
The NHS recovery page asks you not to sit with your legs crossed, not to bend the hip past a right angle, which it gives as 90 degrees, not to reach down to your feet or ankles, and not to use a low chair, a low toilet seat or a chair with no arms, since the trouble there is getting back up. It mentions that raised toilet seats are available, which a reader in the United States or Canada may have been offered as an elevated toilet seat.
Leeds asks for four things: no crossing your legs or the midline of your body, no bending the hips past a right angle, no lifting the knee above the hip, and no twisting the leg or waist. Its Hip School session spells the first one out as the knee or the ankle, which is the strictest reading of a rule most leaflets leave open. Newcastle asks you to avoid bending beyond a right angle, to avoid over-twisting and to avoid crossing your legs in sitting and in lying, and says you may also need to lie on your back for a period of time, which its leaflet puts at four to six weeks. Cambridge, as above, asks for none of this and says either side is fine in bed if it is comfortable. Three respected hospitals, three different answers, all current.
The 90 degree rule is the one everybody has heard of, and understanding it beats memorizing it. The angle it refers to is the one between your thigh and your trunk, so it closes from either end. A deep sofa closes it. Leaning forward over the hip to pick up a sock closes it, and so does pulling the knee up toward you to get a shoe on.
That is why the same list usually comes with a high firm chair, a raised toilet seat and a long-handled shoe aid, and why OrthoInfo suggests a cushion that keeps your knees lower than your hips.
There is one thing the list of separate rules hides, and it is worth more than any single rule on it. The position a hip reached from the back is least steady against is not one of those movements. It is two or three of them at once: the hip bent up, the leg brought across the middle of your body, and the knee rolled inward. The Cochrane review describes the standard precautions in those terms, as avoiding positions of flexion beyond 90 degrees, or adduction or rotation past the midline (Smith and colleagues, 2016). That is why the rules are given as a set rather than one at a time, and why the places two of them meet deserve the most care. Standing up out of a low chair while turning toward a side table is all three in one movement. So is rolling into bed and letting the top knee fall across. So is reaching for something behind you while you are sitting down. Each of those is the sort of thing a leaflet never names, and each is worth slowing down for.
Two exercises on this site run straight into that angle, and they show why your own limit is the number that counts. Heel slides bend the hip as the heel travels, so the program asks you to go only as far as your team allows. Sit to stand using the armrests depends entirely on seat height, because a low seat puts you under your own angle before you have moved at all. The numbers for both live on the total hip replacement rehab program, and your physio or physical therapist will set them to your hip. The first exercises after a hip replacement runs the same check across the rest of the early program.
If you were never given the 90 degree rule, nothing has gone wrong. If you were, the date you can stop using it is your surgeon's to give, and it is the same question as the next section but one.
What changes after an anterior or a lateral approach
Quite a lot. This is where a leaflet written for one operation misleads the reader of another.
After a front approach, many teams give fewer restrictions and some give none, which is the clearest finding in the surgeons' survey above. Where cautions are given, they often point the other way from the familiar ones: toward taking the leg back behind you and turning it outward, rather than toward deep bending.
There is an anatomical reason behind that, and it comes off a laboratory bench, not out of a protocol. In a cadaveric study, nine hips were replaced through the direct anterior approach and tested with a robotic arm. One ligament at the front of the hip turned out to provide most of the resistance to the leg being turned outward at the end of its range, and it held more of that resistance with the hip in 10 degrees of extension than with the hip in neutral. Stitching it back at the end of the operation restored only a fraction of what it had held before (Bido and colleagues, 2024). Nine specimens on a bench is not an instruction for your leg, but it does explain why the back of the range and turning out get asked about after a front approach while deep bending often does not, and why the two are worth more care together than separately. Leg behind you and foot turned out is one position, not two.
Fewer restrictions is not the same as carelessness. One hospital compared dislocations in the first year after surgery across the two routes and reported none in 690 hips done from the front, against 8 in 797 done from the back, where the average time to dislocation was about seven and a half weeks and five of the eight needed further surgery (Jungwirth-Weinberger and colleagues, 2022). That is a single center looking back at its own records, the two groups come from different years (the posterior hips from 2009 to 2012, the anterior ones from 2012 onward), and the front approach there was chosen partly for people who wanted more flexibility afterward or were judged at higher risk of dislocation, so it settles nothing on its own. It does show why a team with that experience may hand you a thinner leaflet than the one your neighbor got.
A side approach raises a different question again, and in truth two of them. In that route the front part of the muscles on the side of the hip (the abductors, gluteus medius and gluteus minimus) is lifted off the bone at the top of the thigh, in continuity with the sleeve of thigh muscle just below it, and the front of the joint capsule is opened along with it. All of that is stitched back through the bone at the end of the operation, as a published surgical account of closure after the Hardinge and modified direct lateral approaches describes (Agarwala and Jagani, 2018).
The first question is therefore the one a front approach raises, not the one a back approach raises, because it is the front of the capsule that was opened: whether taking the leg back behind you and turning it outward are restricted, and those two together more than either alone. A side approach is not a back approach, and the familiar posterior list is not automatically the one that belongs to it. Ask which list is yours rather than assuming the famous one.
The second question is a side approach's own, and it is about load rather than position: how soon and how hard that abductor repair may be worked. Crossing the operated leg over the midline lengthens the muscle that was repaired, which is a reason to keep the crossing rule until your own team tells you otherwise, even though the rule was written for a hip reached from the back.
There is a measurement of what that costs early on, and it is a small one. A hospital in India followed people having a hip replaced from the side or from the back and tested their hip strength at intervals: 48 patients met its criteria and 42 finished the six months. Strength pushing the leg out to the side was lower in the side approach group at two weeks and still lower at six weeks, with no difference left at three months or six months. Strength pushing the leg down and back, which the authors measured with a leg press and read as the extension mechanism, was lower at two weeks but not at six. There was no difference in pain or hip scores at any point (Ansari and colleagues, 2023). Forty-two people at one hospital is a thin base, and the authors say their patients had less rehabilitation than is usual elsewhere, so take it as the shape of the thing rather than a number for your leg. We found no published date for when that repair may be loaded, which is the honest reason this is a question for your team and not a rule on a page. Standing hip abduction is the exercise that asks it most directly, and the program already says to leave it out if your team has told you not to work the side of the hip yet. Standing hip extension raises the same sort of question after a front approach, which is why the program asks you to check how far the leg may travel back.
If you do not know yet which list is yours
While you are waiting to find out which applies to you, the cautious option is all three lists at once, not the familiar one. If your own team has given you a list, or has told you that you have no restrictions, that is your answer and this interim set is not for you. For everybody else, keep to these six until somebody tells you otherwise.
- No deep bending at the hip. Keep the angle between your thigh and your trunk at a right angle or wider. A low seat closes that angle as surely as reaching down to your feet does.
- No crossing the operated leg over the middle of your body, at the knee or at the ankle, sitting or lying.
- No twisting on that leg. Turn by stepping your feet round rather than pivoting on the foot, and do not let the knee roll inward.
- No taking the leg far back behind you. Do not stretch it back on purpose and do not stand with it trailing behind you. Walking at your ordinary stride is not this.
- No turning the foot far outward, and above all not with the leg behind you at the same time.
- No loaded or resisted work for the side of the hip. No bands, no ankle weights and no repeated lifting of the leg out to the side, until you know whether your abductors were detached and repaired.
The first three are the posterior set, and a front approach does not usually restrict them. The next two are the ones a front and a side approach raise. The last one belongs to a side approach, and leaving it out for a few days costs nobody anything, because none of the early program depends on it.
Two things that set is not. It is not a list of six separate risks to be weighed one at a time: the positions that take a new hip to the edge of its socket are combinations, as the section above says, so care matters most where two of these meet. And it is not a reason to walk less or to shorten your stride. The NHS asks you to walk every day as far as it is comfortable and to avoid sitting still for long periods, which is part of how the clot risk after this operation is kept down, so this is about not pushing the leg deliberately to the back of its range or twisting it out, never about moving less.
Keeping to all six until somebody tells you which list is yours leaves you covered either way, and it is days of waiting, not weeks. It is not a substitute for being told, so ask this week rather than at your six week appointment.
How long do hip precautions last?
Every number here belongs to the source that published it, and none of them is yours until your own team says so.
OrthoInfo puts precautions, where they are used, at usually the first 6 weeks after surgery. Leeds asks for six weeks, or longer for some people. Newcastle says its restrictions are usually to be followed for 6 to 12 weeks depending on your consultant, and makes a practical point that nobody else does: the equipment should not go back before the restrictions have ended, which it says can be up to 12 weeks. The NHS recovery page sets no end date for most of its list, leaving the exercise restriction to run while your hip is recovering and the lifting one until you are told it is safe. Cambridge, giving no list, gives no duration either.
Line those up and the honest summary is a range of about six weeks to three months, with real hospitals sitting at both ends of it and some outside it altogether. That is why the question cannot be answered by a web page. Ask for your date at your follow-up, ask whether anything comes off the list earlier than the rest, and write the answer down, because six weeks of restriction and twelve weeks of it are quite different plans for a summer.
One thing behind those numbers is worth knowing. OrthoInfo says the risk of dislocation is greatest in the first few months after surgery while the tissues are healing, which is the window the lists are built around. The NHS notes that a hip replacement can dislocate soon after surgery before the joint is fully healed, and also many years later, so the end of your precautions is not the end of the subject. The warning signs at the foot of this page stay relevant for the life of the joint.
What the research says about routine precautions
The evidence behind giving precautions to everybody is thin, and the reason to tell you so is not to talk you out of yours. It is so that a shorter leaflet stops looking like a worse one.
A Cochrane review found three trials with 492 participants, two of which tested precautions. Dislocations were so rare in them that nothing could be settled. One trial, which compared precautions, equipment and activity restrictions against none of the three, had no dislocation in either group over the first twelve months. In the other, both groups were given precautions and only the equipment and the restrictions differed, and there was one dislocation among the 152 people who got the equipment and restrictions against none among the 151 who did not. The authors graded the evidence low and very low and said they were uncertain whether precautions prevent dislocation (Smith and colleagues, 2016).
A larger review looked only at hips replaced from the back in people with hip osteoarthritis: four randomized trials and five non-randomized studies, 8,835 people between them. For dislocation in the first three months there may be no or negligible difference between precautions and minimal or no precautions, with certainty rated low for the trials and very low for the rest. Self-reported function, quality of life, pain and time back to work showed no differences either, and the authors concluded that the current evidence does not support routinely prescribing hip precautions after surgery (Korfitsen and colleagues, 2023).
Here is where a quick read of those conclusions goes wrong.
Do not stop following precautions you were given. Those reviews are addressed to the people deciding what to hand out before an operation, not to someone three weeks into six. The studies compared whole plans, set before surgery, with the equipment and the teaching that went with them. None of them tested a patient deciding alone, in week three, that the leaflet was out of date. And a review that cannot find an effect is not a review that found safety: the dislocation numbers were too small to settle the question either way, which is exactly what the authors said.
If reading this makes you want to ask whether your own list could be shortened, that is a sensible question and your surgeon is the one to answer it. Ask it at your next contact rather than acting on it.
When your leaflet does not cover what you are about to do
This is the real problem with precautions, and no handout solves it. The leaflet covers chairs and beds. Life brings a taxi with low seats, a dropped sock under the table, a cat, a bath, a flight, and the far side of a double bed.
A usable way through it: work out which item on your own list the thing would break. If you cannot tell, hand it to your team instead of deciding it yourself, and ask about the actual situation, not the principle. "Can I sit in the passenger seat of a small car for two hours on Friday" gets a useful answer. "Can I bend my hip" does not.
A handful of subjects come up so often that it pays to ask about them in advance, before you need the answer.
Getting in and out of a car, and on and off a toilet, are the two transfers that press hardest on the bending rule, because the height of the seat decides both of them, not how careful you are. A raised toilet seat and a cushion in the car are the usual answers, and your team can tell you whether yours matter. Stairs, getting in and out of a car, and the toilet takes those three one at a time.
Sleeping and turning over at night is the subject where the hospitals disagree most openly. Leeds asks for six weeks on your back, Newcastle says you may need four to six weeks on your back, and Cambridge says you may lie however you are comfortable and suggests a pillow between your legs if you lie on the side that was not operated on. Follow your own team on this one, and how to sleep after a hip replacement sets out what each of those hospitals asks and where they part company. If your other hip is arthritic and that is what is keeping you awake, sleeping positions and night pain with hip arthritis covers the non-operated side of the problem.
Driving has its own answer: the NHS says to wait at least 6 weeks and to check with your doctor that you are fit to drive, and your surgeon may ask for longer depending on your operation and which leg it was. Driving after a hip replacement goes through what is being judged when that date is set.
Sex belongs on this list as well, and it is the subject people leave out. The NHS asks you to try to avoid sex for 6 to 8 weeks after the operation, and OrthoInfo says precautions may apply to it too, so if you were given a list, ask your team what it rules out and when that changes. Ask before the 6 weeks are up rather than after, because the answer depends on the approach and on the position, and it is a routine question for them.
And a few things apply whichever approach you had, because they belong to the joint and not to the route into it. The NHS asks you to leave out exercise involving jumping or sudden turns, or where there is a high risk of falling, while the hip is recovering, and to avoid lifting or moving heavy objects until you are told that it is safe. The total hip replacement rehab program sets out what to leave out of your exercise in more detail, and things to avoid after a hip replacement sorts the question by which kind of avoiding it is.
Who to ask, in rough order of usefulness: the physio or physical therapist who saw you on the ward or in the clinic, the ward itself, your surgeon's secretary, and the follow-up appointment. Keep those numbers somewhere you can find them without hunting.
What to do if you think you have broken a precaution
First, this happens constantly and is usually uneventful. People reach for a dropped sock, drop into a chair that turns out to be deeper than it looked, or roll over in their sleep. Most of them have no problem at all.
What to do in the moment is simple. Come out of the position slowly rather than snapping out of it, get yourself to a firm seat, or lie down on a bed if one is nearer, and take stock. Do not get down onto the floor to rest, because getting back up off it is the harder job and it asks for the movements you are trying to keep away from. If the hip feels as it did an hour ago, the leg looks the same length and sits at the same angle as before, and you can stand and walk the way you could this morning, it has almost certainly come to nothing. Mention it at your next contact with the team and carry on, and if any of that changes over the next day or two, use the warning signs below rather than this paragraph.
What changes that, and the warning signs below give the full wording: sudden severe pain in the hip or groin, a clunk or a pop with a leg that will not move or take your weight, a leg that now looks shorter or turned in or out, a feeling that the hip slipped out and went back in, or a pop over the side of the hip after which the leg will not lift out to the side or hold you up. The first three of those are an emergency, and the last two need your surgical team the same day even if the hip settles immediately and the leg looks normal.
Two things not to do. Do not repeat the movement to find out whether it still feels wrong, which is the most common way a non-event becomes an event. And if the hip has clearly dislocated, do not try to put it back or walk it off, as the first warning sign below says.
Falls deserve a mention of their own here, because they break precautions faster than anything on the list. OrthoInfo warns that 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. So keep your walking frame or walker, and your stick or cane, for as long as your physio asks, rather than for as long as you feel you need it. Balance and falls prevention covers the rest.
Plan for the fall as well as against it, because every emergency line on this page assumes you can reach help. Keep your phone in a pocket rather than in another room, so you can reach it from the floor, and ask about an alarm you wear. If you do fall 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. Do not let anyone haul you up first. That line and the rest of the fall routes, including what to do if you got up fine and only hurt later, are in the warning signs below.
Signs that need help the same day, and the ones that are an emergency
A few things in this recovery should not wait for your next appointment, and two or three should not wait at all. The warning signs at the foot of the page are sorted by that. 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 whenever you next think of it.
The dislocation signs are the ones to know by heart, since they are the whole reason precautions exist. Sudden severe pain in the hip or groin with a leg that will not move or take weight is one. So is a leg that has quietly changed shape, looking shorter or turning in or out more than it did, even when the pain is mild. That second version is the one people sit on for a day, and it should not be sat on.
One more sudden sign is less famous and easily put down to having overdone it. A pop, a snap or a tearing pain over the side or the back of the hip, or finding that the leg will not lift out to the side any more or will not hold you up when you stand on it, needs your surgical team the same day. Muscle and tendon were cut and stitched back to reach the joint, and a repair that has given way is something to have looked at rather than something to push through.
Then the two that have nothing to do with your list and everything to do with having had an operation. Sudden breathlessness, chest pain or coughing up blood is an emergency call even if your leg looks perfectly normal. A calf or thigh that is newly swollen, warm or tender needs advice the same day. And if you are on tablets or injections to lower your clot risk, bleeding or bruising out of all proportion to the knock that caused it needs advice the same day too, with the dose and the type left to whoever prescribed them. Never stop or change a prescribed medicine on your own.
Then the slower ones. Pain, redness or swelling in the hip that is not improving or is getting worse, especially pain that builds while you rest as well as when you move. New hip pain at any time, even years later, with a temperature or a hip that turns hot, red or swollen. A wound that is leaking or opening. And dizziness on standing, or feeling faint with exercise, which matters more than usual here because a faint onto a new hip can dislocate it or break the bone around it.
And two in the last group that are easy to read as nothing. A leg that has felt slightly long or short since the operation, with no sudden change and no new pain, is common and belongs at your follow-up, not at an emergency department: it is the sudden change that is the emergency. Pain in the hip that had settled and has come back, or that is getting worse month by month, is a review rather than an emergency, unless the hip is also hot, red or swollen or you have a temperature, in which case it moves to the same day. Without either of those it is still a review and not nothing. OrthoInfo names increased pain or stiffness in a joint that had been working well among the signs of an infection around a new joint, says the signs can be as little as mild redness and swelling, and says fever is no longer considered a sign of one.
Problems after a hip replacement works through the whole set one at a time, with who to call for each. If you are not sure which of those you are looking at, make the call anyway. Your surgical team would far rather hear from you about a clunk that turned out to be nothing than hear nothing until your follow-up.
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: pain in your new hip that had settled and has come back, or pain that is getting worse month by month, for example in the groin or thigh when you first stand up and start to walk. This is not an emergency, but ask your surgical team for a review, as the parts of a new joint can loosen or wear over the years. Get medical advice the same day instead, not a routine appointment, if the hip also becomes hot, red or swollen, or you have a high temperature or feel hot, cold or shivery, or the pain is building week by week rather than month by month. A new joint can become infected years after the operation, and the two can feel similar at first.
- 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 hip precautions after a hip replacement?
Positions and movements your surgical team asks you to keep away from for a while after the operation, so the new joint is not pushed toward the edge of its socket while the tissues around it heal. OrthoInfo's version is that you are usually asked to be careful how you sit, bend and sleep for the first 6 weeks. The content of the list is somebody's decision and not a fixed rule of the operation: Leeds Teaching Hospitals says the surgeon makes that decision, and that a clinician will tell you whether precautions apply to you. If you were given a list, follow it, and if you were given none, that may well be deliberate.
How long do hip precautions last?
There is no single number, and the honest answer is the date your own team gives you. OrthoInfo puts precautions, where they are used, at usually the first 6 weeks after surgery. Leeds Teaching Hospitals asks for six weeks, or longer for some people. Newcastle Hospitals says its restrictions are usually followed for 6 to 12 weeks depending on your consultant, and adds that the equipment should not go back before the restrictions have ended, which it says can be up to 12 weeks. The NHS recovery page gives no end date for most of its list at all. Ask for your own date at your follow-up and write it down, because the gap between 6 and 12 weeks is where most of the confusion lives.
What is the 90 degree rule, and when can I stop following it?
It is the best known of the posterior precautions: the NHS recovery page asks you not to bend your hip more than 90 degrees, which it describes as a right angle, and Leeds and Newcastle both ask the same. The angle is between your thigh and your trunk, so it is broken by a low seat or a deep sofa as easily as by reaching down to your feet, and leaning forward over the hip counts as well as lifting the knee. When you can stop is a question for your surgeon and not for us, and it is the same question as how long your precautions last. If you were never given this rule, you have not been missed out: not every team uses it.
How long after a hip replacement can I cross my legs?
Crossing your legs is on most posterior lists, and the end date comes from your team. Leeds asks you not to cross your legs or the midline of your body, Newcastle asks you to avoid crossing them in sitting and in lying, and the NHS recovery page says not to sit with your legs crossed. Newcastle's timeframe is 6 to 12 weeks depending on the consultant, and Leeds asks for six weeks or longer for some people. Crossing at the ankles while you sit, crossing at the knee and letting the top leg drape over the other in bed are three different amounts of the same movement. Leeds answers that question outright in the Hip School session it gives its own patients, which asks you to avoid crossing your legs at the knee or at the ankle, so take the wider reading unless your own team has told you something different.
Are the precautions different for an anterior hip replacement?
Yes, and often there are fewer of them or none. In a survey of American and Canadian hip and knee surgeons, those using a direct anterior approach were significantly less likely to prescribe either precautions or equipment (Carli and colleagues, 2018). Where a front approach does come with cautions, they tend to point the other way from the familiar ones: toward taking the leg back behind you and turning it outward rather than toward deep bending. What you are asked to do still comes from the team that operated, not from the name of the approach, so a front approach is not a reason to set aside a list you were given.
How do I find out which approach I had?
If you do not know which approach was used, the leaflet you came home with, your discharge letter and the ward that looked after you can all tell you, and the scar on its own cannot, because a scar on the side of the hip can belong to more than one approach. The NHS description of the operation only says that the hip is opened through one or more cuts at the back or the side, which is a fair measure of how much the general account leaves open. Your follow-up appointment is a good place to ask, and it is worth asking even if you feel you should already know.
References
- 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/
- NHS. How a hip replacement is done. Page last reviewed 6 March 2024. https://www.nhs.uk/tests-and-treatments/hip-replacement/how-a-hip-replacement-is-done/
- NHS. Complications of a hip replacement. Page last reviewed 6 March 2024. https://www.nhs.uk/tests-and-treatments/hip-replacement/complications-of-a-hip-replacement/
- 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/
- 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/
- Royal Orthopaedic Hospital NHS Foundation Trust. Orthopaedic surgery and anaemia. https://roh.nhs.uk/news-events/orthopaedic-surgery-and-anaemia
- 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/
- 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/
- The Newcastle upon Tyne Hospitals NHS Foundation Trust. Total hip replacement. Patient information. https://www.newcastle-hospitals.nhs.uk/resources/total-hip-replacement/
- 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/
- Smith TO, Jepson P, Beswick A, Sands G, Drummond A, Davis ET, Sackley CM. Assistive devices, hip precautions, environmental modifications and training to prevent dislocation and improve function after hip arthroplasty. Cochrane Database of Systematic Reviews. 2016;(7):CD010815. https://doi.org/10.1002/14651858.CD010815.pub2
- Korfitsen CB, Mikkelsen LR, Mikkelsen ML, et al. Hip precautions after posterior-approach total hip arthroplasty among patients with primary hip osteoarthritis do not influence early recovery: a systematic review and meta-analysis of randomized and non-randomized studies with 8,835 patients. Acta Orthopaedica. 2023;94:141-151. https://doi.org/10.2340/17453674.2023.11958
- Carli AV, Poitras S, Clohisy JC, Beaule PE. Variation in use of postoperative precautions and equipment following total hip arthroplasty: a survey of the AAHKS and CAS membership. Journal of Arthroplasty. 2018;33(10):3201-3205. https://doi.org/10.1016/j.arth.2018.05.043
- Jungwirth-Weinberger A, Schmidt-Braekling T, Rueckl K, Springer B, Boettner F. Anterior hip replacement: lower dislocation rates despite less restrictions? Archives of Orthopaedic and Trauma Surgery. 2022;142(10):2413-2417. https://doi.org/10.1007/s00402-021-03849-5
- Bido J, Meyers KN, Quevedo Gonzalez F, Zigan C, Wright TM, Rodriguez JA. Contribution of the medial iliofemoral ligament to hip stability after total hip arthroplasty through the direct anterior approach. Journal of Arthroplasty. 2024;39(9 Suppl 1):S266-S271. https://doi.org/10.1016/j.arth.2024.03.044
- 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/
- Ansari S, Singh SK, Regmi A, Goyal T, Kalia RB, Yadav RK, Suresh Gowda AK. Difference in muscle strength and functional outcome in direct lateral approach versus posterior approach in total hip arthroplasty: a prospective cohort study. Journal of the West African College of Surgeons. 2023;13(1):6-14. https://doi.org/10.4103/jwas.jwas_258_22
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.