Phase I: Early Recovery and Mobilisation (0–6 Weeks)

Immobilisation:

• No brace routinely required

• Walking aids (crutches or frame) as needed

Precautions:

• Avoid hip flexion beyond 90°

• Avoid hip adduction past midline (no crossing legs)

• Avoid internal rotation of the hip

• Use precautions during sitting, toileting, dressing, and transfers

• Monitor wound healing and signs of infection

Therapy:

• Early mobilisation (day of surgery or day 1 postoperatively)

• Gait training with walking aids

• Range of motion within precautions

• Quadriceps and gluteal activation exercises

• Hip abductor strengthening (within safe range)

• Sit-to-stand and transfer training

• Swelling management (ice, elevation)

Criteria to Progress:

• Independent ambulation with aids

• Adherence to hip precautions

• Acceptable pain and swelling levels

• Safe transfers and basic functional activities

Phase II: Progressive Strengthening and Function (6–12 Weeks)

Precautions:

• Continue hip precautions as advised

• Avoid high-impact activities

• Avoid deep flexion or excessive internal rotation

Therapy:

• Wean from walking aids as gait normalises

• Strengthening exercises (gluteals, abductors, core)

• Closed chain strengthening and functional exercises

• Balance and proprioceptive training

• Stationary cycling and low-impact cardiovascular exercise

Criteria to Progress:

• Normal gait pattern

• Minimal swelling

• Improved strength and control

• Independence in daily activities

Phase III: Advanced Strengthening (12–16 Weeks)

Precautions:

• Avoid high-impact or pivoting activities

Therapy:

• Progressive strengthening including single-leg exercises

• Functional strengthening (stairs, step-downs)

• Advanced balance and proprioception

• Endurance training (cycling, walking programs)

Criteria to Progress:

• Good strength and stability

• No significant pain or swelling

• Confidence with functional tasks

Phase IV: Return to Function and Endurance (4–6 Months)

Precautions:

• Avoid high-impact activities unless specifically cleared

• Gradual return to higher-level activities

Therapy:

• Continued strengthening and endurance training

• Low-impact recreational activities (walking, cycling, swimming, golf)

• Functional and activity-specific training

• Criteria for Return to Activity

• Functional range of motion

• Good strength and balance

• No pain or swelling

General Recommendations

Work:

• Desk-based work may resume after 2–4 weeks.

• Manual labour is typically deferred until 3–6 months depending on job demands and recovery progression.

Driving:

• It is important that you are medically fit to return to driving and you feel safe to control the vehicle and take evasive action if needed.

• In general, for left hip surgeries in vehicles with automatic transmission, return to driving may be sooner.

Sports and Leisure:

• Low-impact activities may resume from 6–12 weeks.

• Activities such as cycling, swimming, and golf are encouraged.

• High-impact activities (running, jumping, contact sports) are generally discouraged following total hip replacement.

Thromboprophylaxis

All patients undergoing a hip replacement require postoperative thromboprophylaxis in accordance with current guidelines. The choice of agent and duration of treatment will be determined by A/Prof Ernstbrunner and his medical team based on the individual patient’s risk factors and comorbidities.

Disclaimer: This protocol is intended as a general rehabilitation guide only. Rehabilitation progression should always be individualised and may be modified by A/Prof Ernstbrunner and the treating rehabilitation team based on the patient’s clinical progress, surgical findings, and individual circumstances.