Post Hip Replacement Rehab

Not every hip replacement is the same. The surgical approach determines which precautions apply and what the rehab looks like in the first 6 weeks:

• Posterior approach: traditional and still common. Strict 6-week precautions — no hip flexion beyond 90 degrees, no adduction past midline, no internal rotation. No crossing legs, low chairs, deep squatting, sitting on the floor
• Anterior approach: increasingly popular. Fewer formal precautions; some surgeons allow no-restriction movement from day 1. Generally quicker return to walking
• Lateral approach: a compromise; abduction strength comes back more slowly

Your surgeon at KPJ Seremban Specialist Hospital, Columbia Asia Seremban or Mawar Medical Centre should give you a written post-op protocol with your specific restrictions. Bring it to the first physio visit — the physio needs to know the approach and any patient-specific limitations (osteoporosis, fracture fixation, cemented vs uncemented). workplace-injury insurance may cover cases arising from workplace incidents.

Phase 1 (week 0–2): inpatient physio at the hospital, then discharge. Home-visit physio 2–3× weekly. Pain and swelling management, bed mobility, sit-to-stand, walking with a walker around the house. Home visits RM 150–300.

Phase 2 (week 2–6): continued home or outpatient. Longer walks, step-practice, restoring basic gait, quadriceps and glute activation. Still inside the surgeon's precautions.

Phase 3 (week 6–12): clinic-based if travel is safe. Precautions typically lift around week 6 (posterior approach); real strengthening and gait work starts. Sessions RM 100–180.

Phase 4 (month 3–6): glute medius and single-leg work, community walking, stair confidence, return to most activities.

Phase 5 (month 6–12): maintenance — hip strength plateau, late gait refinement.

Expect 15–30 sessions total. The physio should re-measure range, strength and gait at key milestones and keep your surgeon looped in for anything unexpected.

Approximate targets (will depend on approach, comorbidities, age):

• Week 1: walking with a walker around the house, sit-to-stand independent
• Week 4: walking with a cane, stairs one-at-a-time, showering and dressing independent
• Week 6: cane often discarded, community walking returns, driving usually cleared if not on opioids
• Week 12: most patients report the hip feels 'part of them' again, walking feels natural
• Month 6: strength plateau reached, most sport and leisure activities possible (light hiking, swimming, cycling)
• Month 12: final refinement; some patients continue quarterly check-ins for strength

Most patients forget about the hip by 6–9 months — which is the main goal. If progress stalls (can't give up the cane by week 8, persistent limp, can't manage stairs by week 12), the physio should flag this to the surgeon at KPJ Seremban Specialist Hospital, Columbia Asia Seremban or Mawar Medical Centre.

Continue physio if pain and function are improving week-to-week, the wound has healed dry, and you're hitting the surgeon's milestones.

Go to A&E at Hospital Tuanku Ja'afar — not a physio — if any of these appear post-hip-replacement: sudden calf swelling and pain (possible DVT), sudden chest pain or shortness of breath (possible PE), fever above 38°C with wound redness, discharge or foul smell (possible infection), sudden inability to bear weight that was previously OK (possible dislocation or peri-prosthetic fracture — this is a surgical emergency for posterior-approach hips), severe thigh or groin pain at rest waking you nightly after previous improvement, or a 'pop' sensation in the hip with new instability. Dislocation in the first 6 weeks of a posterior-approach hip is time-critical — go straight to HTJ or the surgical hospital, not to physio.