There are a lot of moving parts when it comes to recovery after surgery, especially a major one such as hip replacement. How should you prepare? What challenges should you expect? Will you need a caregiver?

All of this takes careful planning among your care team, you and your family members.  Johns Hopkins orthopaedic surgeon Savya Thakkar, M.D., an expert in minimally invasive and robotic-assisted total joint replacements, answers some common questions and shares tips about hip replacement recovery and rehabilitation.

When can I go home after a hip replacement?

“Most patients can start walking and can go home the day of the surgery,” says Thakkar. Most people don’t need bed rest. In fact, moving your new joint keeps it from becoming stiff.

If you have a preexisting condition (a heart or lung condition that needs monitoring), or if no one can give you a ride and help around the house right after the surgery, you might need to spend the night at the hospital. People who had complex surgeries or lack support at home may benefit from starting their recovery in an inpatient rehabilitation unit.

Will I need to use a walker at first?

Your care team, which includes your surgeon, therapists and primary care doctor, will evaluate the need for any assistive devices. To reduce falls, you might need a cane or a walker if you feel unbalanced walking on your own, but it’s generally not necessary to keep weight off the hip that went through surgery.

When will my hip incision heal?

“The incisions for a hip replacement surgery nowadays are very small and are closed up with absorbable sutures,” explains Thakkar. The incision is covered with a dressing and takes about six weeks to heal. During this time, it’s OK to shower, but to reduce the risk of infection, bathing and swimming should be put off until the wound fully heals.

How soon does rehabilitation therapy start after the hip surgery?

“Patients will have physical therapy before the hip replacement surgery, and then work with a physical therapist right after the surgery to reinforce exercises before they go home,” says Thakkar. Rehabilitation will continue a few days after the surgery, with visits with physical and occupational therapists two to three times per week, as well as home exercises.

Rehabilitation begins with getting used to regular movements and practicing daily activities, like getting out of bed or a chair, and progresses to practicing more difficult tasks, such as climbing stairs and getting in or out of the car.

Muscle strength plays a big role in being able to perform these and other tasks. This is why resistance training of hip muscles and knee muscles in the legs is a major component of rehabilitation.

What is considered a “normal” amount of pain after a hip replacement surgery?

Some swelling and initial pain at the joint are normal after hip replacement. To help reduce pain:

• Take time to rest between therapy sessions.
• Ice the leg and the incision site.
• Take anti-inflammatory medications, after consulting with your doctor, to help with these symptoms.

“Keeping the leg elevated above the heart when you lay down can also help the swelling to recede,” advises Thakkar.

It’s important to pay attention to your pain levels. If you feel like you are consistently at a 6 or more on a 1–10 pain scale, mention it to your doctor, because it could be a sign of infection or another complication. As you continue physical therapy, your pain levels should slowly decrease to about 1 or 2 in 12 weeks after the hip replacement.

How long does it take to recover after a hip replacement?

“On average, hip replacement recovery can take around two to four weeks, but everyone is different,” says Thakkar. It depends on a few factors, including how active you were before your surgery, your age, nutrition, preexisting conditions, and other health and lifestyle factors.

“Achieving a certain level of activity before you have the surgery can help you bounce back more quickly,” shares Thakkar. “We use a regimen called prerehabilitation, or prehab, to help patients get in a physical shape that will set them up for a successful recovery.”

Preparing for Hip Replacement Surgery | Q&A with Savya Thakkar, M.D.

- Watch on YouTube

Savya Thakkar, a hip and knee replacement specialist, talks about which conditions may require a hip replacement and what to expect before and after the surgery.

How soon can I return to regular activities after a hip replacement?

The goal of physical therapy is to get you back to your normal life, whether it’s going to work, playing with kids, or engaging in your favorite sport or hobby. Depending on the amount of physical activity a task requires, the amount of time it will take to be able to perform that task differs.

• Driving. If you had surgery on your right hip, it may take up to a month to be able to drive safely again. If it was your left hip, then you might be back in the driver’s seat in one or two weeks. Start in a parking lot and slowly move to rural roads, working your way up to the highway. Taking medications that may impair your coordination, such as opioids, might delay how soon you can go back to driving.
• Work. If you have a desk job with minimal activity, you can return to work in about two weeks. If your job requires heavy lifting or is otherwise tough on the hips, it is recommended to take off about six weeks to recover.
• Sports. For sports with minimal activity, such as golf, you can return when you feel comfortable. For high impact contact sports you should wait about six weeks to get back in the game. Before getting into a pool, you should also wait about six weeks until the incision completely heals.
• Sexual Activity. You can return to sexual activity whenever you feel comfortable.

What could slow down my recovery?

“As with any surgery, there is some risk of complications during and after a hip replacement, which may include infection at the incision site, bone fractures and hip dislocations,” explains Thakkar. If you notice a fever, drainage from the incision site, difficulty moving your hip or severe pain that is not relieved by your medication, contact your doctor immediately.

Taking rehabilitation at a comfortable pace and avoiding sudden, sharp movements can help prevent dislocations and falls that may delay the recovery.

How long will my hip replacement implant last?

Unlike older implants that were metal, modern hip prosthetics are made of a combination of metal, plastic and ceramic parts, so they are more durable and cause fewer issues. These implants can last 20 to 30 years, and the risk of failure and the need for repeat surgeries is low.

How long after replacing one hip should I wait to replace the other?

“If you suffer from severe arthritis in both hips, you could get both joints replaced at the same time (double hip replacement). This might actually be safer and lead to quicker recovery in some patients,” says Thakkar.

Having a double hip replacement reduces the risk of many complications that come along with anesthesia. Recovery is actually shorter but may require double the effort, because you would need to strengthen both legs at the same time. It may also be more challenging to get around the house initially, so you might need more support at home.

If you want to have two separate hip replacement surgeries, it is best to wait at least six weeks between the replacements to lower the risk of blood clots.