THR

THR = Total Hip Replacement. Physio after THR is about protecting the new joint, restoring mobility, rebuilding strength, and getting you back to walking normally without a limp. Protocols vary slightly depending on surgical approach - anterior, posterior, lateral - but the goals are the same.

1. *Early phase: 0-6 weeks post-op*

Goal is pain control, safe mobility, and preventing complications.

- *Weight bearing*: Usually weight bearing as tolerated immediately, sometimes with crutches/cane for balance. Check your surgeon’s protocol.

- *Hip precautions*: This depends on approach. Posterior approach = avoid hip flexion >90°, internal rotation, adduction across midline. Anterior approach = fewer precautions, but avoid extension + external rotation. Your physio will give you specific rules.

- *Ankle pumps and quad sets*: Start day 1 to reduce swelling and activate muscles.

- *Gait training*: Walk with proper pattern, heel-toe, equal step length. Don’t shuffle or limp - it creates bad habits.

- *Transfer training*: Getting in/out of bed, chair, toilet safely within precautions.

- *Breathing and circulation*: Deep breathing, ankle pumps to reduce DVT risk.

2. *Strength and mobility phase: 6-12 weeks*

Once incision is healed and precautions are easing:

- *Range of motion*: Gentle hip flexion, abduction, extension within safe limits. No aggressive stretching.

- *Glute and quad strengthening*: Bridges, clamshells, mini squats, step-ups. Glute medius is key for pelvic stability and stopping Trendelenburg gait.

- *Balance and proprioception*: Single-leg stance, weight shifts. Retrain the hip’s position sense.

- *Stationary bike*: Start at 6-8 weeks if cleared. Low resistance, high seat to avoid excessive flexion.

- *Stair training*: Step-to pattern first, then step-over as strength improves.

3. *Functional phase: 12 weeks-6 months*

Build endurance and return to daily activities.

- *Progressive strengthening*: Single-leg bridges, split squats, resisted hip abduction/adduction.

- *Walking endurance*: Gradually increase distance, aim for 30-45 min continuous walking without limp.

- *Functional drills*: Sit-to-stand from lower surfaces, getting in/out of car, uneven surfaces.

- *Low-impact exercise*: Swimming, cycling, elliptical. Avoid high-impact for 6-12 months.

4. *What to avoid*

- *Dislocation risks*: Respect your precautions for 6-12 weeks. Dislocation is rare after 6 weeks but devastating when it happens.

- *High-impact activities*: Running, jumping, contact sports are usually off limits long-term. It wears the prosthesis faster.

- *Prolonged sitting in low chairs*: Makes it hard to stand up and stresses the hip.

5. *Key outcomes to hit*

- Full hip extension - without it you’ll walk with a limp

- Glute medius strength good enough for single-leg stance 30s

- Walk without assistive device and without pain

- Climb stairs reciprocally

Timeline

- Return to daily activities: 4-6 weeks

- Drive a car: 4-6 weeks if right leg, sooner if left and automatic

- Return to low-impact sport/golf: 3-6 months

- Full recovery: 6-12 months. The bone and soft tissue keep remodeling for a year.

Anterior vs posterior approach differences

- *Anterior*: Faster early recovery, fewer precautions, but watch for hip flexor tenderness and lateral thigh numbness.

- *Posterior*: More precautions early, but lower risk of hip flexor issues. Higher dislocation risk early if precautions are broken.

THR has one of the best success rates in orthopedics. Most people get 90%+ pain relief and return to walking normally. The limiting factor is usually soft tissue strength and gait retraining, not the joint itself.

Was yours anterior or posterior approach, and are you pre-op or post-op? That changes which precautions and exercises we prioritize.

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