Is Physical Therapy Necessary After Hip Replacement?

Total hip replacement surgery sounds daunting — replacing an entire joint is a tall order. But hip replacement is also a potentially transformative procedure for those suffering from severe hip pain and mobility issues, typically resulting from arthritis or injury. The hip replacement procedure, also called total hip arthroplasty, involves removing damaged parts of the hip joint and replacing them with artificial components.

Total hip replacement surgery is only performed after all other reasonable attempts at non-surgical relief have been unsuccessful. the orthopedic surgeon’s goal is to offer patients a chance to regain a more active and pain-free lifestyle.

Hip replacement surgery is considered one of the safest and most reliable surgical treatments in any area of medicine, often providing patients with 20 or more years of pain-free mobility. Because of this, more than a half-million total hip replacement surgeries are done each year in the U.S.

However, full recovery from a hip replacement doesn’t just happen in the operating room. Hip replacement recovery extends into the crucial weeks and months of postoperative care, where physical therapy plays a pivotal role.

Physical therapy after total hip replacement surgery is not just a recommendation—it’s a cornerstone of successful recovery. It’s designed to help patients navigate through the healing process with guided exercises and therapies that restore movement, build strength, and facilitate pain management.

But is physical therapy truly necessary after a hip replacement? Can a hip replacement patient recover without it, and what risks might they face if they skip this step?

We’ll explore the undeniable benefits of physical therapy following—and even before—total hip replacement surgery, backed by expert opinions and patient experiences, to address these questions comprehensively. But first, let’s learn a little more about hip replacement surgery and what might lead a patient down the path toward it.

What Are the Common Causes of Hip Pain and Degeneration?

Several factors and conditions can cause pain and degeneration in the hip joint before hip replacement surgery is recommended Some common ailments that may cause a patient to suffer through hip pain and degeneration that often lead to hip replacement include:

• Osteoarthritis. This degenerative disease is the most common reason for hip replacement surgery. It occurs when the cushions between the bones of the hips erode over time, leading to pain and stiffness as bone begins to rub on bone. Patients who are overweight over long periods of time may develop earlier-age onset osteoarthritis, which may explain why obese patients tend to require total hip replacements an average of 10 years earlier than those of healthier weights.
• Rheumatoid Arthritis. This autoimmune disease causes inflammation in the lining of joints, including the hip joint, that can erode cartilage and occasionally underlying bone, resulting in deformity and dysfunction in the hip. Hip replacement surgery is typically needed.
• Traumatic Arthritis. Injuries to the hip, like those from a hip fracture or a severe sprain, can lead to degeneration of the joint surfaces and subsequently cause arthritis.
• Osteonecrosis. A condition, also known as avascular necrosis, that occurs when the ball portion of the hip joint doesn’t receive adequate blood supply. This can cause the bone to weaken and even collapse or deform. This condition affects the femoral head, the ball part of the hip’s ball-and-socket joint, which is located at the top of the thigh bone (femur).
• Post-Traumatic Deformity. When injuries to the hip joint are left to heal improperly, mechanic wear and tear can eventually become severe.
• Childhood Hip Disease. If not adequately treated during childhood, conditions like congenital dislocation or dysplasia of the hip can lead to abnormal joint surfaces and premature arthritis.

These conditions often result in significant amounts of pain, difficulties with mobility, and a reduced quality of life. This may lead sufferers to consider and opt for hip replacement surgery as a treatment to restore function and relieve discomfort.

When Might Total Hip Replacement Surgery Be the Best Solution?

Surgeries are typically the last resort treatment option, and hip replacement surgeries are no different. Before patients undergo surgery, they should first exhaust more conservative treatments that may be more impactful in the long term.

• Physical Therapy. Physical therapy can play an impactful role in hip pain relief and improving joint function. An individualized rehab therapy program can help strengthen the muscles around the hip joint, increase range of motion, and reduce stiffness. Interventions such as manual therapy, specific exercises, and guidance on proper movement patterns can help alleviate pain and prevent further joint damage. Regular sessions can also educate patients on how to use assistive devices like walkers or canes to reduce strain on the hip during daily activities.
• Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, are commonly used to reduce inflammation and pain. For more severe cases, stronger pain relievers, including opioids, may be prescribed for short-term use. Corticosteroid injections can provide temporary relief by reducing inflammation directly at the hip joint, although their long-term use is generally limited due to potential side effects.
• Lifestyle Changes. Altering daily activities through lifestyle changes can significantly impact hip pain management and overall bone and joint health. Maintaining a healthy weight can reduce stress on the hip joint, and low-impact exercises (i.e. swimming, cycling) can keep joints flexible and muscles strong. Also, adopting ergonomic practices, investing in supportive footwear, and sleeping on a quality mattress can help manage hip discomfort and pain relief and prevent further degeneration.

If, after exhausting these treatments, hip pain persists to the point of significantly impairing daily activities like walking, sitting for long periods, and resting comfortably, hip replacement surgery may be the best solution. This also holds true when imaging identifies visible changes in the joint structure, such as bone damage or deformities, which may indicate advanced joint disease.

Always consult with your physician, orthopedic surgeon, rehab therapist, and family when considering all the pros and cons of a new hip replacement.

What Does a Total Hip Replacement Surgery Involve?

A total hip replacement is a surgical procedure where a damaged or worn-out hip joint is replaced with an artificial joint, typically made from metal, ceramic, and very hard plastic. During this procedure, the entire hip joint is replaced with a hip implant, contrasting with partial hip replacement where only the ball part is replaced.

This hip replacement surgery is primarily performed to relieve pain and improve or fully restore mobility in patients where the hip joint has been severely impaired by arthritis, fracture, or other joint diseases. It’s a common and highly successful procedure that significantly enhances the quality of life for individuals suffering from chronic hip pain and functional limitations.

Total hip replacement can be performed through traditional or minimally invasive surgery techniques, with the latter involving smaller incisions and potentially offering benefits such as reduced pain and faster recovery.

Though hip replacement surgeries have become commonplace and often offer patients extraordinary results, it is still a major surgery. Today, many total hip arthroplasty patients require just a night or two in the hospital—some may even qualify for it as an outpatient procedure.  However, hip replacement surgery still comes with risks, including the risk of infections, blood clots, and potential hip dislocations.

Physical therapists play a critical role in preventing such issues from coming to fruition following hip replacement surgery. They also lead patients along the path to recovery and normalcy—from prior to hip replacement surgery rehabilitation to hospital acute therapy to ensuring patients are fully functional, mobile, and can get back to the activities they love, making a full recovery from hip replacement surgery.

Common Goals of Post-Surgical Physical Therapy

Recovery after total hip replacement surgery focuses on several key objectives to ensure the best possible outcome for the patient.

• Pain Management: Managing pain is a top priority immediately following total hip replacement surgery. Effective pain control allows patients to commence physical therapy sooner, which is critical for a successful recovery after a hip replacement.
• Restoring Mobility: Gradually increasing the range of motion in the hip joint is an important factor in returning to normalcy following hip replacement surgery. Physical therapy plays an integral role in helping patients achieve this, starting with basic activities like walking and slowly moving to more complex movements.
• Improving Strength: Strengthening the muscles around the new hip joint is crucial for stability and function. Exercises specifically designed to strengthen these muscles help support the new hip joint and reduce the strain during everyday activities.
• Preventing Complications: Post-operative care following hip replacement surgery includes measures to prevent complications such as those aforementioned infections, blood clots, and hip dislocation. Activities and exercises prescribed by a physical therapist aid in improving circulation and preventing blood clots, while also ensuring that the hip joint is used properly to avoid dislocation.
• Speeding Up Recovery: A structured rehabilitation program helps speed up the hip replacement recovery process, enabling patients to return to their everyday activities as quickly and safely as possible. Each patient’s recovery timeline will vary, but active involvement in physical therapy can significantly influence the speed and success of their recovery.
• Enhancing Overall Quality of Life: Ultimately, the goal of recovery from a hip replacement is to return the patient to a level of activity that they were accustomed to before hip pain limited their capabilities. For many, this means a return to recreational activities, work, or simply being able to perform daily tasks without pain.

These goals are essential for a successful recovery from total hip replacement surgery. Achieving them typically requires a combination of professional medical care, physical therapy, and active patient participation in their hip replacement recovery plan.

Stages of Physical Therapy Following Total Hip Replacement

Including acute care, rehabilitation after hip replacement surgery is structured into four phases, each designed to address different functional and recovery needs that incrementally progress the patient toward full functionality.

Here’s a breakdown of each phase, with examples of the typical physical therapy modalities used during treatment.

Phase 1: Acute Care

TIMING: Soon after hip replacement surgery

The acute care rehab therapy team at the hospital or surgery center plays a critical role in the initial recovery of a patient who has just undergone total hip replacement surgery. From the moment the patient is stable, physical therapists begin working to prevent complications while helping the patient begin regaining his or her mobility following the hip replacement.

From initial assessment to discharge planning, the focus of post-surgical rehab therapy is to set a foundation for the patient’s recovery, both physically and mentally, ensuring the hip implant is successful. It includes:

• Early Mobility. Within hours of hip replacement surgery or hip implant (including partial hip replacment), a physical therapist, or possibly an occupational therapist, will begin rehabilitation by helping the patient perform gentle movements that aid in recovery. As the patient heals, the therapist will help the patient with bed mobility (i.e. sitting up and turning from side to side), sitting and standing, and walking with the use of a walker or crutches. Occupational therapists may recommend special equipment like a raised toilet seat to aid in the patient’s early recovery and daily activities.
• Pain Management. The rehab therapist is also there to educate the patient on ways to manage their pain. This might mean using ice, various sitting and laying positions, or gentle manual therapy techniques that may also manage swelling. Therapists should work with patients on ways to prevent common complications, like blood clots and the early stages of pneumonia, through the use of exercises and devices.
• Strength and Range–of-Motion (ROM) Exercises. Following a total hip arthroplasty, rehab therapists will introduce simple exercises to strengthen the muscles around the hip without overloading the hip joint. To prevent stiffness and maintain flexibility, they will also guide patients through gentle ROM exercises.
• Education and Discharge Planning. Finally, the rehab therapy team will teach the patient how to safely perform daily activities like showering, dressing, using the bathroom, and more, as their hip heals. Therapists also provide patients with home exercises while instructing them on activities to avoid. Finally, physical therapists often help coordinate ongoing rehab treatments with home therapy teams, outpatient services, or private practice rehab therapists.

Phase 2: Pain Management & Gentle Exercises

TIMING: Typically for a few weeks after surgery

This phase of post-surgical physical therapy prioritizes managing pain and inflammation. Techniques such as ice application, electrical stimulation, and gentle manual therapy are often used to reduce discomfort.

The introduction of gentle exercises aims to prevent stiffness and improve circulation. These range-of-motion exercises are low-intensity and may include ankle pumps, leg slides, and gentle stretches. The goal is to maintain joint integrity while beginning the process of increasing mobility.

Physical therapists may also opt to implement passive ROM exercises. These are movements performed by the rehab therapist manually, or by using a device that moves the hip joint without any effort from the patient.

Phase 3: Increased Intensity, Focusing on Mobility and Function

TIMING: A few weeks to a few months post-surgery

As hip pain decreases, more dynamic exercises are introduced into the rehabilitation process which further improves ball and socket joint mobility and range of motion. Even a minimally invasive hip replacement can be painful. Activities may include walking, controlled stair climbing, and riding a stationary bike.

As pain levels improve and the patient becomes stronger, exercises become more challenging, helping to restore the normal function of the artificial hip. Eventually, the goal is for the patient to simulate and perform more challenging daily activities, such as getting in and out of the car.

During this phase, some patients elect to try aquatic therapy. Within the buoyancy of water, those recovering from total joint-replacement surgery can further improve mobility while applying less stress on their joints.

Phase 4: Strengthening and Returning to Normal Activities

TIMING: Several months post-surgery and ongoing

As patients begin to feel like themselves again, with little to no pain or mobility limitation, the focus of physical therapy shifts toward preventative efforts and getting the patient back to activities they enjoyed before being derailed by hip pain.

This phase after hip implants or in the hip replacement rehabilitation process introduces more rigorous activities aimed at strengthening the muscles around the hip and improving overall stability. This might include resistance training, more complex weight-bearing exercises, and even balance training to improve stability and prevent future falls.

Gradually, patients are encouraged to return to their regular daily activities, including recreational sports, but with necessary modifications. Depending on the goals of each patient, a physical therapist will tailor an individualized plan that strives to solidify her or his long-term success while doing the things they love.

All four of these phases are critical for the successful recovery of patients who have had total hip implants or hip replacement surgeries. Each phase builds upon the previous one, requiring active patient participation and often adjustments based on individual progress and feedback.

They are designed not only to manage pain and restore function with the new hip, but also to enhance the patient’s overall quality of life by enabling them to return to normal activities with confidence and minimal discomfort.

Can You Skip Physical Therapy After Total Hip Replacement Surgery?

Opting out of physical therapy after total hip replacement surgery can significantly impact the overall result of a patient’s recovery, and not for the better. Physical therapy is a crucial component of the post-surgery recovery plan, designed to help patients regain mobility, strength, and function in their new hip and throughout the kinetic chain.

Potential Consequences of Skipping PT

Some of the potential (and likely) consequences of skipping physical therapy after total hip replacement surgery include:

• Delayed Recovery. Without physical therapy, the recovery process will likely be slower. Rehabilitation helps expedite healing by encouraging movement and strengthening the muscles around the new joint, which are necessary for a timely recovery.
• Reduced Mobility and Range of Motion. Physical therapy plays a vital role in restoring mobility and flexibility. The joint may become stiff and scar tissue could form without proper rehabilitation, potentially leading to a permanent reduction in the range of motion. This stiffness can make it difficult to perform simple daily activities such as walking, bending, or sitting.
• Increased Pain and Discomfort. The interventions and exercises that physical therapy employs help patients manage pain and reduce discomfort during the healing process. Skipping therapy could lead to prolonged or increased pain, impacting quality of life and delay a return to normal activities.
• Higher Risk of Complications. Surgery increases the risk of several complications, as we’ve previously discussed. Rehab therapy helps mitigate these risks through targeted exercises that improve circulation, strengthen muscles to support the joint, and teach proper movement techniques to prevent dislocation.
• Muscle Weakness and Atrophy. Rehabilitation involves exercises that strengthen the muscles around the hip joint, leaving those muscles weakened or atrophied in the absence of this exercise. Weakened muscles can destabilize the joint and increase the risk of falls or injuries.
• Decreased Overall Function. Skipping physical therapy can lead to an overall decrease in musculoskeletal function, affecting overall quality of life. The inability to move freely and without pain impacts a patient’s independence and ability to work, take care of themselves, and engage in recreation.
• Long-Term Disability. In severe cases, the lack of rehabilitation can lead to long-term disabilities. The hip joint may not function properly, and the patient might never achieve the full benefits of the surgery (i.e. improved mobility and a pain-free existence).
• Need for Another Surgery. In some cases, inadequate rehabilitation following the initial surgery might lead to problems that make revision surgery necessary. This is especially likely if the joint becomes unstable or if the range of motion is severely restricted.

Needless to say, physical therapy is considered an essential part of recovery after total hip replacement surgery. It ensures that the patient can make the most out of the new joint (reducing pain and improving function, stability, and quality of life) and prevents serious negative outcomes (like long-term disability, permanently decreased mobility, and repeat surgery).

What is the Role of Prehabilitation for Total Hip Replacement Surgeries?

Often referred to simply as “prehab,” prehabilitation is a proactive approach to recovery where patients undergo a specific regimen of physical therapy to prepare them for an upcoming surgical procedure. It’s built around the theory (a well-supported theory) that the stronger a patient is before surgery, the stronger they will be after.

In the context of total hip replacement surgery, prehabilitation involves a series of exercises and treatments designed to strengthen the muscles around the hip, improve overall physical fitness, and educate the patient about the surgery and recovery process.

What does prehabilitation accomplish?

For patients who plan to have total hip replacement surgery, prehabilitation helps to accomplish six things.

1. Improve Surgical Outcomes:  Prehab focuses on strengthening the muscles around the hip joint, which can help support the new joint after surgery. Stronger muscles contribute to better stability and functionality post-surgery. Flexibility exercises are included as part of a prehabilitation plan to maintain or improve range of motion, which can speed up recovery times and improve the effectiveness of post-operative physical therapy.
2. Enhance Recovery Speed: By improving physical condition before surgery, patients can often reduce the length of their hospital stays and accelerate their return to normal activities. A body in better physical condition can recover more quickly and more effectively. Also, studies suggest that patients who undergo prehab may experience less pain after surgery, potentially reducing their reliance on potentially addictive pain medications.
3. Reduce the Risk of Complications: Keeping muscles active through prehab helps prevent atrophy and weakness, which can be significant when a joint is immobilized or used less frequently due to pain. Regular exercise before surgery can also improve blood flow, which is critical for healing and can help prevent complications such as blood clots.
4. Prepare Patients Mentally: Educating patients about what to expect during and after their hip replacements can reduce fears and anxiety, leading to a more positive mindset going into the procedure. Also, patients who engage in prehab often feel more in control of their recovery process, which can motivate them to actively participate in their post-operative rehabilitation.
5. Facilitate a Speedier Return to Normalcy: Through prehabilitation, patients with hip replacements learn about safe ways to move and positions to avoid post-surgery. This can facilitate a smoother and quicker return to daily activities.
6. Establish a Recovery Mindset: By starting a routine before surgery, patients are more likely to continue with their rehab regimen post-surgery as they understand its importance in the recovery process and are familiar with what to expect. Early interactions with healthcare professionals stimulate engagement with all supporting practitioners, including the orthopedic surgeon. This makes it easier for patients with hip replacements to understand advice and communicate their needs and concerns.

While not always part of the core rehabilitation plan for hip replacements, prehab is increasingly recognized as a vital part of the preparation process for total hip replacement surgery. By physically and mentally preparing patients, prehabilitation not only aims to improve surgical outcomes and speed up recovery, but also enhances the overall healthcare experience by empowering patients and reducing the stress associated with major surgery.

Physical Therapy Is Recommended after Hip Replacement Surgery

From prehab through the four stages of post-surgery rehabilitation, physical therapy is highly recommended after total hip replacement surgery. Physical therapy helps increase strength and mobility, allowing the patient to return to normal, pain-free daily activities. Skipping therapy can lead to potential post-surgical complications, decreased function, and even long-term disability or revision surgery. All told, physical therapy can greatly aid in the healing process after hip replacement surgery.