Part of Total hip replacement rehab
Stairs after a hip replacement, getting in and out of a car, and the toilet
Warning signs, and when to get help
How do you do stairs after a hip replacement?
Stairs after a hip replacement are taken one step at a time, with a hand on a rail or banister, which OrthoInfo asks for every time and which is worth having fitted if your stairs have none, and with the foot order swapped between going up and coming down. Up, the leg that was not operated on moves first. Down, the walking aid goes to the lower step first, usually a crutch or your stick or cane by the time you are doing stairs, and then the operated leg follows it.
NHS Lanarkshire sets out the whole thing in six short steps. Going up: hand on the rail or banister where you have one, one step at a time, up to the bottom step first, then lead with the leg that did not have the operation and bring the operated leg and the sticks up to join it. Going down: rail again, one step at a time, both feet firmly on the stair, put the sticks down a stair and step the operated leg down, then step your other leg onto the same stair. Newcastle Hospitals describes the same pattern and repeats the instruction that is easiest to abandon when you are in a hurry: one step at a time, every step, in both directions.
The phrase you will hear on the ward is up with the good, down with the bad. It is a useful handle and a slightly misleading one: the leg it names is the leader, not the worker. Both orders exist to give the job to the non-operated leg: going up it pushes you up while the operated leg follows, and going down it lowers you under control while the operated leg reaches ahead for the next step. That is also why the aid goes down before you do, and why nothing in either sequence asks you to put both feet on the same step at the same moment and hop.
An ordinary stair asks less of the hip than a chair does, so the sequence above is much the same whichever approach your surgeon used. A tall step is a different matter, and OrthoInfo's exercise guide puts a cap on it: do not try to climb steps higher than the standard height, which it gives as 7 inches (about 18 cm), and always use a handrail for balance. Measure the odd deep step at a back door or a curb before you meet it in a hurry.
One thing the sequence above assumes, and which no page can assume for you, is how much weight your operated leg is allowed to take. Most people after a planned hip replacement are told to put as much weight through it as they can manage, and the stair pattern is written for them. Some are not. A stem fixed without cement, a bone graft, or wires or a plate around the top of the thigh bone are the sort of reasons a surgeon keeps a leg partly unloaded for a set number of weeks. Stairs are not a gentle way to find out which of those you are, because coming down the operated leg lands first and takes your weight while the other foot is still on the step above. Ask your surgical team or your physio what your limit is and when it changes, before the first flight rather than after it, and if you have been told to keep weight off that leg, do stairs only the way they showed you and only with the aid they gave you.
The car, the toilet and the chair are harder, because each of those is a question about how deep the hip bends and how far it turns, and that is precaution territory. Your surgeon and the hospital team set those limits. The classic back-approach lists are built around deep bending, crossing the leg over the middle of your body and twisting on it, a front approach is often given a different list or none at all, and the one number four of our sources agree on is the bend. The NHS gives it to everyone reading its hip replacement recovery page: do not bend your hip more than 90 degrees, a right angle. Leeds, Newcastle and Gateshead give the same 90 degrees inside their precaution lists, alongside not crossing your legs sitting or lying and not twisting on the leg. So treat 90 degrees as the working limit for a seat, a car and a toilet until your own team tells you otherwise.
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. Until you have that answer, take all three transfers the way the back-approach lists describe: a seat high enough that your knees finish lower than your hips, the operated leg out in front rather than across your body, and feet stepped round rather than twisted when you turn. None of those is a problem after a front approach either, so it is the safe default while you are waiting to be told, and it is not a substitute for being told.
There is one thing that default does not cover, and it matters more on this page than anywhere else. A hip reached from the front or from the side is usually least steady in the opposite direction from a hip reached from the back: the leg taken out behind you with the foot turned out, which is one position and not two. A back-approach list says nothing at all about it, so following that list does not make a front or side approach safe in its own risky direction. Every transfer on this page has a moment of it, and it is always the same moment, the turn you make once you are on your feet beside the car door, the toilet or the chair. So turn by taking small steps and moving both feet round, not by planting the operated foot and swinging your body over it, and ask your own team how far that leg may travel back. What the lists contain and how long they run is on hip precautions after a hip replacement.
Get the stairs watched before you need them. The NHS says a therapist will discuss managing daily activities with you before you go home, and a staircase is the item on that list most worth spending five minutes on in person. NICE asks for rehabilitation to start on the day of surgery where that is possible and within 24 hours of it, and for anyone carrying on alone afterward to be given clear goals and a point of contact, so there should be someone to ring when your own front steps turn out not to match the practice ones. Our stair climbing and step up pages cover the practice itself, and your physio or physical therapist will adjust how much of it you do.
One more reason to go at this slowly. 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.
Stairs with no rail at all are worth naming, because most advice assumes one. OrthoInfo asks for a handrail every time, and for secure handrails along all stairways at home, so a flight without one is a reason to have a rail fitted rather than a detail to work around. Gateshead Health does set out the same crutch sequence for stairs without a rail, so it can be done, but get your physio or physical therapist to watch you do it on a rail free flight before you do it alone.
Going down, which is the harder half
Everyone practices going up and then discovers that coming down is the half that frightens them. That is the right instinct. Going down, you are lowering your body weight on one leg with the floor further away than it looks, and a trip on the way down covers more stairs than a trip on the way up.
What makes the descent safer has nothing to do with strength. Get both feet firmly on the stair before you move anything. That is NHS Lanarkshire's wording, and it is the step people skip. Set the aid down on the lower step and let your hand come off it for a moment instead of carrying it along dangling. And keep your hands empty: no laundry basket, no mug, no phone, with the shopping going up in a bag over your shoulder or in two trips.
Dizziness belongs here and not in a list at the end. The top of a staircase is the worst place in the house to find out that standing up has made you lightheaded, and that is common enough after this operation to plan around. Stand, wait, and let it pass before you take the first step down. If it is new, does not settle within a minute or two, keeps happening or has already made you stumble, it needs advice the same day, and the warning signs at the foot of this page give the full wording.
Medicines are part of this and are worth naming while you are still on the landing. The NHS puts low blood pressure and the side effects of some medicines among the causes of falls, and asks you to speak to a doctor or pharmacist if you think yours could be affecting your balance. Newcastle Hospitals is specific about the painkillers: it tells its own patients that pain relief medication can bring on dizziness, feeling sleepy and sometimes mild confusion. So take the list to them and ask, rather than working it out yourself. Never stop or change a prescribed medicine on your own.
If stairs hurt somewhere other than the new hip, treat that as its own problem and not as slow progress. The other knee carrying the work for a few weeks is the usual reason, and knee pain on stairs covers it. If you are older, have fallen in the past year or feel unsteady on your feet, the stairs question is really a falls question, and balance and falls prevention is the program for it. 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 them: walking without a stick sets out how that decision is actually made, and walking with a cane is the technique itself, which is worth getting right on the flat before you take it to a staircase.
What if the only toilet is upstairs?
This is the question to raise before the operation, not on the morning you are discharged, and it is a common enough layout that the team will have met it many times before.
One route is to bring your life downstairs for a few weeks. OrthoInfo suggests setting up a temporary living space on one floor where that is possible, with equipment to match, and that is a decision for the occupational therapy team, not something to improvise. The other is to keep the upstairs toilet and plan the trip, which usually means a rail where the stairs need one, equipment on the toilet itself, and going up at a time of day when you are not tired. The NHS falls advice points at the hardware for both: consider fitting safety rails on steps, and grab rails in the bathroom.
Newcastle Hospitals says larger items such as toilet equipment are discussed at its telephone appointment before surgery, which tells you the conversation exists and has a slot. Ask what is supplied in your area, who fits it, and when it has to go back, because that differs by country and by service. A second walking aid to leave upstairs is worth asking about at the same time.
If the real problem is that you cannot manage the ordinary business of the day, say that in those words. NICE recommends that supervised rehabilitation, in a group or one to one, is offered to people who are having difficulty with daily activities after a joint replacement, who have an ongoing functional problem with specific needs, or who are not meeting their goals on their own. Those are the guideline's own grounds for being seen, so there is no need to play it down when you ask.
Getting in and out of a car
Sit down first, then bring your legs in. Reverse it to get out. Everything that goes wrong here comes from trying to do both at once, which turns a straightforward transfer into a twist on a loaded hip.
Set the car up before you get near it. Leeds asks you to travel in the front passenger seat and not to attempt the back seat, with the seat slid back as far as it will go and the backrest reclined to get you in. Leeds and Newcastle both ask you to park away from the curb, because standing in the road rather than up on the sidewalk or pavement raises the height of the seat relative to you, and height is the whole game. Which car also matters, and Leeds names the two to avoid if you have a choice: low sports cars and people carriers, because both are more likely to put you outside your precautions. OrthoInfo suggests firm pillows for your chairs, sofas and car that let you sit with your knees lower than your hips, so a cushion is the cheapest fix for a seat that is too low.
The move itself. Back up until you feel the seat behind your legs. Leeds describes extending the operated leg out in front of you and putting your hands on the seat behind you for support as you lower yourself down, then sliding your bottom back onto the seat, taking care not to raise your knee above your hip while you do it. Once you are sitting, Newcastle describes leaning back to bring both legs in, or one at a time. Leeds adds the part nobody plans for: you may need some help to lift the operated leg into the car. So arrange that before the day rather than finding it out in a hospital car park, and if you live alone, the person driving you is the person to ask.
Bring both legs round together and keep the knees apart rather than letting the operated knee roll inward, because deep bending at the same time as the leg turning in or crossing the body is the combination the precautions exist for. Two things about the rest of the journey are easy to get backward. The reclined backrest is for getting in, not for the drive: Leeds has you bring the seat back to a more upright position once you are sitting, with your knees no higher than your hips and the hip not bent past 90 degrees. And Leeds asks you to leave the operated leg straight out in front of you for the whole journey, rather than bending that knee up once you are settled. Getting out is the same film run backward: legs out first, then stand with the operated leg out in front of you and your walking aid to hand. Then move your feet to turn away from the car. Standing in an open car door is the easiest place on this whole page to leave the operated foot where it is and swing your body round it, and that turns the hip while the leg is behind you, which is the direction a hip reached from the front or the side is least steady against.
Long trips need their own thought, and this is where sitting after a hip replacement turns from a question about position into a question about time. The NHS asks you not to sit still for long periods, which helps with swelling, so a long drive wants a stop and a short walk in it, not three hours in one shape. A new calf swelling, warmth or tenderness after a long drive, or sudden breathlessness or chest pain, are in the warning signs below for exactly this reason.
Driving yourself is a separate question from riding as a passenger, and the two get mixed up constantly. Driving after a hip replacement has the answer, and nothing on this page is permission to drive.
Does the side that was operated on change the car?
The side changes nothing about the method. These instructions are written around the operated leg, not around a left or a right hip, so run them through your own body and the side sorts itself out: the operated leg is the one that stays out in front, goes in last and comes out first.
What the side genuinely changes is room, and that depends on where you live as much as on your hip. The front passenger seat is on the left in the UK, Australia and New Zealand and on the right in the United States and Canada, so the same operated hip can end up next to the door or next to the middle of the car. Next to the middle is the tighter of the two, because that leg has the console and the gear lever to clear, where the door side gives it open air. The answers are the same as above: the seat slid right back, the backrest reclined for the climb in, and a firm cushion to lift you.
Where it changes more than room is where it changes direction, since the swivel takes the operated leg either away from the middle of the car or across it. Crossing the midline is on most back-approach precaution lists, which is the one thing on this page where left and right can mean different amounts of the same restriction. Ask your own team how far the turn may go, and read your list on hip precautions rather than guessing from the leaflet your neighbor got.
The toilet, the seat height and how long you need the raised seat
The toilet is the transfer people do ten times a day and nobody rehearses. It is also the lowest seat in most homes, and that is why it gets equipment when the chair does not.
The NHS asks you not to sit down in a low chair or toilet seat, and notes that raised toilet seats are available. In the United States and Canada the same item is sold as an elevated toilet seat. Leeds goes further and gives the practical shape of it: your leg length decides whether you need one, and most people do, so expect a raised seat fitted at home, used for six weeks after the operation, and it is not advisable to fit it yourself afterward. That last one is a sensible instruction from a hospital that has seen people kneel on a bathroom floor to do it.
There is a height, and it is a measurement of you rather than a number that fits everybody. Leeds calls it your precautionary height, and defines it as the distance from the back of your knee crease to the floor, plus 2 inches (about 5 cm). Leeds says it is easier if someone measures it for you, and that is the honest version: reading a tape measure behind your own knee is awkward at the best of times and worse in the first fortnight. If you live alone, ask the occupational therapy or physiotherapy team to do it rather than improvising. At Leeds the heights are collected on a furniture heights form before the operation, and an occupational therapist assesses toilet transfers on the ward and issues a seat of the right height, so the measuring is already somebody's job.
Be clear about what that number is for, because it gets filed under comfort and it is not a comfort measure. The height is there to keep the hip out of a position, and the Cochrane review that looked at this equipment describes it in those words: raised toilet seats and chairs are provided, along with teaching to avoid positions of hip flexion beyond 90 degrees, or adduction or rotation past the midline (Smith and colleagues, 2016). A seat lower than your height puts the hip past its limit before you have done anything wrong, and the furthest it bends is the moment your weight leaves the seat and the moment it arrives, which is also the moment people reach down with one hand and let the operated knee roll inward. That is two of the three parts of the position a new hip comes out in, in a movement you make ten times a day. What the raised seat does not do is make a deep bend safe once you are sitting on it. The height buys you the angle; it does not change your limit.
Then measure the seats: have someone sit on the chair, or press the cushion down with your hand, and measure from the lowest point of the seat to the floor, because an uncompressed cushion flatters a chair by an inch or two (roughly 2 to 5 cm). Leeds asks you to do this for every seat you actually use, the dining chair and a stair lift seat included, and says a chair that comes out too low can be raised with extra cushions or folded blankets underneath the seat.
That is why an occupational therapist is the one who issues the seat, and why the test at the end of it is the same one wherever you are sitting. Leeds puts it plainly: your knees should always be lower than your hips, and should never be higher than your hips for six weeks after surgery. The heights also apply outside your own house, so a friend's armchair gets the same look.
How long you keep the equipment is a second question with two published answers. Leeds asks for six weeks on the raised seat. Newcastle approaches it from the other end and says loan equipment should not go back before your hip restrictions have ended, which it says can be up to 12 weeks. If your own team gave you a date, use theirs.
Hygiene is the question almost nobody prints, and it is a real problem when you cannot bend forward and cannot twist. Leeds is clear that you must not bend down to wash your feet or cut your toenails, which gives you a fair idea of how much reaching down is off the table. What works in clinic, as practice rather than as published advice: reach around behind you on the non-operated side instead of forward between your knees, which keeps the hip out of the deep bend and turns the operated leg outward rather than inward, away from the direction a hip reached from the back comes out in; behind you on the operated side is the version to avoid, because that twists the hip inward with the hip already bent to a right angle; sit tall rather than leaning; and set the paper and anything else you need within easy reach before you sit, so you are not twisting on the hip to find it. Long-handled aids for this exist and an occupational therapist can tell you what is available where you live. It is worth asking for by name rather than hoping it comes up.
How should you sit, and how do you get back up?
Sit high, sit firm, and sit somewhere with arms. Get up by moving your weight forward over your feet instead of hauling on something. That covers most of it, and the detail underneath is where your own precautions come in.
A low chair is one of the things the NHS asks you to avoid, and it warns specifically against a chair with no arms, because that is the one you will have trouble pulling yourself up from. Leeds describes the chair to look for as one with a firm, level seat that does not slope down at the back, arms and a high back, and rules out two kinds: no rocking or swivel chair, because neither is stable, and no using the recline action of a recliner or its built in footstool, which lifts your knees above your hips and takes you outside the precautions. OrthoInfo suggests firm cushions for chairs and sofas that let your knees stay lower than your hips. A deep sofa fails most of that at once, and in clinic it is a common reason for a call to the ward in the first fortnight. Leeds allows a sofa, but points out that a chair is far easier to stand up from because you can push on both arms.
Sitting down, Leeds asks you to feel behind you for the chair arms and take a step forward with the operated leg before you lower yourself. Standing up, it asks you to keep the operated leg straight out in front of you and take the weight through the other leg. Where your team allows the ordinary method instead, the forward lean that makes a rise possible, that version and the tension between the two are set out on the total hip replacement rehab program and practiced on sit to stand using armrests and sit to stand. Ask which version your team wants rather than choosing between them yourself.
One rule has no exceptions. Push down from fixed armrests, never up on a walking frame or walker, a radiator, a towel rail or a door handle. Each of those moves or comes off the wall, and every one of them has put somebody on the floor.
Time matters as much as position. The NHS says you can sit in a reclined position but asks you not to sit still for long periods, which is part of what settles the swelling in the leg and foot. Read that as resting back in a chair, not as working the lever on a recliner: Leeds asks its precaution patients not to use the recline action or the built in footstool, and the two statements are not in conflict once you separate the position from the machine. Spread short walks through the day instead of taking one long one. If you are mostly in the chair just now then seated and standing exercises for older adults gives you something to do in it, and the recovery timeline shows when the sitting usually stops being the problem.
The reaching problem: socks, shoes and the floor
The transfers get the attention and reaching is what actually catches people, because the floor is not optional. The NHS asks you not to bend down to touch your feet or ankles. Leeds asks you to dress the operated leg first and undress it last, and to get dressed sitting on the bed or a chair rather than standing up.
The equipment that solves this is unglamorous and it works. OrthoInfo names a dressing stick, a sock aid and a long-handled shoehorn for shoes and socks, a reacher so you can pick things up without bending the hip too far, and a long-handled sponge and a shower hose for washing. Newcastle adds that a pick-up stick does lower-body dressing as well as fetching things off the floor, that a long-handled shoehorn lets you put shoes on while staying inside your restrictions, and that these small items are usually bought locally or online, not supplied by the hospital.
The rule for anything you drop is to leave it or use the reacher. Nothing on your floor is worth a dislocation, and a dropped sock is how most broken precautions begin. Line your shoes up the night before, keep slip-on shoes with a firm back by the door, and put the things you use daily between hip and shoulder height before the operation. What else is on and off the list, and why, is on things to avoid after a hip replacement.
What to set up before you come home
Everything in this section is easier the week before surgery than the week after, and almost none of it needs a professional.
OrthoInfo gives the list that most hospitals work from: secure handrails along all stairways, safety bars or handrails in the shower or bath, a stable chair with a firm seat cushion that keeps your knees lower than your hips, a raised toilet seat, a stable shower bench or chair, the long-handled items above, firm pillows for chairs, sofas and the car, loose rugs and electrical cords taken out of the places you walk, and a temporary living space on one floor if that is possible. Work through it as a checklist, not a shopping list, since you may already have half of it.
A handful of questions are worth asking at your pre-operative appointment, and each has a short answer. Which approach is my hip being done through and what are my precautions. What height do my chair, bed and toilet need to be for me. Do I have stairs, and will someone check them with me before I go home. And who do I ring when something comes up that the leaflet does not cover.
NICE asks for people doing their own rehabilitation to be given clear goals and a point of contact, so that last question has an answer you are entitled to. Prehab before surgery covers the strength work to do in the same weeks, and why a hip replacement is needed is for anyone reading this while still deciding.
When a transfer has gone wrong and you need help
Most awkward moments are nothing. People drop into a chair that turns out to be deeper than it looked, or twist to reach the seatbelt, and nothing comes of it. The judgment to make afterward is whether the hip is as it was ten minutes ago.
A few things change that answer, and the warning signs below carry the full wording for each. Sudden severe pain in the hip or groin with a leg that will not move or take your weight, sometimes with a clunk or a pop. A leg that now looks shorter or turns in or out more than it did, even when the pain is mild, which is the one people sit on overnight and should not. A hip that clunks and feels as though it slipped out and went back, even if it settles immediately and the leg looks normal, which needs your surgical team the same day. And any fall or knock on the stairs, including a small one: if you cannot put weight on the leg or the hip is severely painful, that is an emergency department rather than a phone call, and if a smaller knock leaves the hip newly painful, bruised or swollen even though you can still walk on it, go back to your crutches or frame, keep your weight off that leg and get it checked the same day. 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. The NHS asks for emergency services for anyone who has fallen and cannot get up, and that is the reason it also asks you to wear a personal alarm or carry a mobile phone with you, which is worth doing in these weeks even if you never have before.
Then there are the ones with nothing to do with how you moved 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 entirely normal. A calf or thigh that is newly swollen, warm, tender or red needs advice the same day, and a long spell sitting in a car seat is one of the situations that brings it on.
One rule for afterward, whichever of those it was. Do not keep trying the transfer that went wrong. The same chair, the same car seat and the same twist will do the same thing again, and a hip that has already slipped or half slipped once is a hip your team wants to look at before you practice on it. Ring them, say exactly what you were doing when it happened, and use the other transfers in the meantime.
The slower ones, worth a call rather than a wait: dizziness on standing that is new or keeps happening, feeling faint with exercise, and hip pain, redness or swelling that is not settling or is getting worse. If you cannot tell which of these you are looking at, make the call anyway. Sorting that out is their job, and it is a short conversation. Problems after a hip replacement sets the whole set out with the speed each one needs and what to have ready when you ring.
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: 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: 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.
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.
Common questions
How do you do stairs after a hip replacement?
One step at a time, with a hand on a rail or banister, which OrthoInfo asks for every time, and with the foot order reversed between up and down. NHS Lanarkshire describes stepping up with the leg that did not have the operation and then bringing the operated leg and the sticks up to join it, and going down by putting the sticks down a stair, stepping the operated leg onto it, then bringing the other leg down to the same stair. Newcastle Hospitals asks for one step at a time in both directions. Get your physio or physical therapist to watch you do it before you rely on it at home.
Which leg goes first going up, and going down?
Up, the leg that was not operated on. Down, the operated leg, after the walking aid has gone down first. The old ward phrase for it is up with the good, down with the bad, and it is worth understanding rather than trusting, because it names the leg that leads and not the leg doing the work. Both orders put the non-operated leg in charge of the effort: going up it lifts you, and going down it lowers you under control while the operated leg reaches for the step below.
How do you get in and out of a car after a hip replacement?
Sit down first, then bring the legs in. The Leeds Teaching Hospitals leaflet asks you to travel in the front passenger seat rather than the back, with the seat slid back as far as it goes and the backrest reclined to get you in, and describes extending the operated leg out in front of you with your hands on the seat behind you for support. Leeds and Newcastle both ask the driver to park away from the curb, because that raises the height of the seat you are lowering yourself onto. Once you are sitting, Newcastle describes leaning back to bring both legs in, or one at a time, and Leeds brings the backrest to a more upright position for the drive, with the operated leg left straight out in front of you for the whole journey and the hip not bent past 90 degrees. OrthoInfo suggests a firm pillow in the car so you sit with your knees lower than your hips. Getting out, reverse it, and then turn by moving both feet rather than leaving the operated foot planted and swinging round it.
Does it matter which hip was replaced when getting into a car?
The method does not change, and no leaflet gives a separate one for a left or a right hip. What changes is the room. The instructions are written about the operated leg rather than about a side, so run them through your own: that is the leg that goes out in front and comes in without turning. Where you live decides which seat the front passenger seat is, so the operated hip may end up beside the door or beside the middle of the car, and the one next to the middle is the tighter of the two. If it is tight, that is what reclining the backrest to get in, sliding the seat right back and adding a firm cushion are for. Leeds also advises against low sports cars and people carriers, if you have a choice of car.
How long do you need a raised toilet seat?
Your own team sets this and the published answers differ. The Leeds leaflet asks for the raised toilet seat to be used for six weeks after the operation, and says that whether you need one at all depends on your leg length, and has an occupational therapist assess toilet transfers on the ward and issue you the seat of the right height. Newcastle Hospitals makes the related point about giving loan equipment back: it should not go back before your hip restrictions have ended, which it says can be up to 12 weeks. If you were given a date, that is your date. A raised toilet seat is called an elevated toilet seat in some countries, and they are the same thing.
How should you sit after a hip replacement?
High, firm and with arms, and not for hours at a stretch. Height is the part that is doing the safety work rather than the comfort work, because a seat below your own measurement bends the hip past its limit as you sit and as you stand. The NHS asks you not to sit down in a low chair or toilet seat, or in a chair without arms, since a chair without arms is the one you cannot get out of. Leeds describes a chair with a firm, level seat, arms and a high back. OrthoInfo suggests firm cushions for chairs, sofas and the car so your knees stay lower than your hips. The NHS also says you can sit in a reclined position but should avoid sitting still for long periods, which matters for the swelling in your leg and for your clot risk. Leeds is stricter about the furniture than the posture: no rocking or swivel chair, and no using the recline action of a recliner or its footstool, because that lifts your knees above your hips.
What if the only toilet is upstairs?
Say so before the operation rather than on the day you are discharged, because it changes what equipment is ordered and sometimes where you sleep for a few weeks. OrthoInfo suggests setting up a temporary living space on one floor where that is possible. Newcastle Hospitals says larger items such as toilet equipment are discussed at its telephone appointment, so there is a conversation to be had in advance. If managing your daily activities is the problem rather than the exercises, NICE says supervised rehabilitation should be offered to people who are having difficulty with them, which is worth quoting back to whoever reviews you.
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. 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/
- American Academy of Orthopaedic Surgeons. Total hip replacement. OrthoInfo. https://www.orthoinfo.org/en/treatment/total-hip-replacement/
- 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/
- NHS Lanarkshire. Stairs after a hip replacement. https://www.nhslanarkshire.scot.nhs.uk/services/adult-learning-disability-service/surgery/stairs-after-a-hip-replacement/
- Gateshead Health NHS Foundation Trust. Physiotherapy following hip replacement surgery. Patient information. https://www.gatesheadhealth.nhs.uk/resources/physiotherapy-following-hip-replacement-surgery/
- American Academy of Orthopaedic Surgeons. Total hip replacement exercise guide. OrthoInfo. https://www.orthoinfo.org/en/recovery/total-hip-replacement-exercise-guide/
- 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(7):CD010815. https://doi.org/10.1002/14651858.CD010815.pub2
- 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
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.