The first 24 to 48 hours: starting gently, starting safely

After total hip replacement, early rehabilitation begins almost immediately. Your physiotherapist will usually see you on the ward within a day of surgery. The first goals are not about strength or distance; they are about safety, circulation and confidence. You will learn how to get in and out of bed without twisting the new hip, how to use your walking aid correctly, and how to do simple ankle and breathing exercises. These early movements help reduce the risk of blood clots, keep your muscles switched on, and ease stiffness.

Expect to sit out in a chair on day one, stand with support, and take a few steps. You may feel tired and a little unsure. That is entirely normal. Short, frequent bursts of activity are far better than one long, exhausting session. Your body has been through major surgery, so patience is part of the programme.

Walking practice: little and often beats long and tiring

Walking is the cornerstone of early hip replacement rehabilitation. Use your frame or crutches exactly as advised by your surgical team, and follow your specific weight-bearing status. Stand tall, look ahead, and take small, even steps. Aim for five to ten minutes, three or four times a day, increasing gradually as comfort allows. Avoid marching on the spot for long periods, and practise turning with small steps rather than pivoting on the operated leg.

• Keep your walking aid on the correct side and move it with the opposite leg.
• Take rest breaks before you feel exhausted, not after.
• Walk on flat, clear surfaces first, and remove loose rugs or cables.
• Wear supportive, non-slip shoes rather than slippers or bare feet.

When you feel steady, your physiotherapist may progress you to one crutch or a walking stick. Do not rush this stage. A smooth, confident walking pattern matters more than speed.

Early strengthening exercises that protect the hip

Gentle strengthening starts in the first few days after surgery. The aim is to wake up the muscles around the hip, not to exhaust them. Do these little and often, perhaps five to ten repetitions, several times a day.

• Ankle pumps: point and flex your feet slowly. This helps circulation and reduces swelling.
• Static quadriceps: tighten the muscle on the front of your thigh, press the back of your knee down into the bed, and hold for five seconds.
• Gluteal sets: squeeze your buttocks together, hold for five seconds, then relax.
• Heel slides: lying on your back, slide your heel towards your bottom, keeping within comfort and respecting any movement restrictions.
• Seated knee extension: sit upright and straighten your knee as much as comfortable, then lower slowly.
• Sit-to-stand: from a firm, high chair with arms, feet flat, lean forward and push through your feet to stand.

Stop if you feel a sharp pain, a catching sensation, or sudden giving way. Muscle ache afterwards is fine; joint pain that gets worse is a signal to ease back and speak to your physiotherapist.

Precautions to respect in the first six weeks

Your surgeon or physiotherapist will give you specific precautions, which can vary depending on the surgical approach used. Common rules include:

• Do not bend your hip past 90 degrees, so avoid low chairs and deep sofas.
• Do not cross your legs or turn your operated leg inward.
• Do not twist on the operated leg when standing or turning.
• Use a raised toilet seat and a firm chair with arms.
• Sleep on your back with a pillow between your knees, or as advised.
• Use a grabber to avoid reaching down for socks, shoes or items on the floor.

These rules are temporary and protect the new hip while soft tissues heal. As recovery progresses, your physiotherapist will guide you on when and how to relax them safely.

Managing swelling, pain and energy levels

Swelling around the hip and thigh is common after surgery. Elevate your leg when resting, apply ice for 15 to 20 minutes at a time, and wear compression stockings if prescribed. Take pain relief as advised, ideally 30 to 45 minutes before exercises, so you can move more comfortably. Pace yourself: plan a rest after activity, and build in a mid-afternoon lie-down if needed. A good day is not measured by how far you walk, but by how consistently you move and how well you recover afterwards.

When to ask for extra help

Contact your GP, hospital team or physiotherapist promptly if you notice new or worsening calf pain or swelling, chest pain, shortness of breath, a fever, redness or discharge from the wound, sudden severe hip pain, or an inability to put weight on the leg. These problems are not common, but they need checking. Otherwise, keep your follow-up appointments and continue your home exercises as instructed. Recovery after total hip replacement is a marathon, not a sprint. With steady, sensible early rehabilitation, you give your new hip the best chance to become a strong, reliable part of your daily life.