If total hip replacement has been recommended, it helps to know exactly what will happen. This guide walks through the full arc of the procedure: getting ready in the weeks before surgery, the day of surgery itself, the hospital stay, and the weeks and months of recovery that follow.
This is Blog 3 of 4 in our Total Hip Replacement cluster. The earlier articles cover the basics of the surgery and the causes and diagnosis that lead to it. The final article covers patient FAQs and outcomes data.
Before Surgery: Getting Ready
Preparation starts weeks before the procedure. The better the prep, the smoother the recovery usually is.
Medical Clearance and Testing
Most patients go through a pre-operative evaluation that may include:
- A full physical exam
- Blood work and basic lab tests
- An electrocardiogram (ECG) to check heart rhythm
- Chest X-ray if needed
- A review of all current medications, supplements, and vitamins
- Dental checks, since dental infections can raise the risk of joint infection
- Skin checks for any rashes, sores, or infections near the surgery site
The surgeon and anesthesia team use these results to plan a safer procedure and spot any issues that might need attention before surgery.
Medication Review
Patients are typically asked to:
- Pause certain medications, such as blood thinners and some anti-inflammatory drugs, in the days before surgery
- Continue important medications, like blood pressure pills, with specific instructions
- Avoid alcohol and smoking in the weeks leading up to surgery (smoking significantly raises the risk of infection and slow healing)
Always follow the exact instructions given by the surgical team. Some medications must be stopped gradually rather than abruptly.
Prehab
“Prehab” means getting the body stronger before surgery. A few weeks of prehab can meaningfully improve recovery. Common elements include:
- Strengthening the muscles around the hip, core, and upper body (important for using a walker later)
- Improving flexibility and range of motion
- Practicing deep breathing and gentle cardio to support surgical recovery
- If needed, losing a small amount of weight to reduce strain on the new joint
Preparing the Home
Recovery is easier in a space set up for it. Before surgery:
- Clear walking paths of throw rugs, cords, and clutter
- Install grab bars in the bathroom and a raised toilet seat if recommended
- Consider a shower chair
- Arrange a comfortable sleeping area on the ground floor if stairs will be hard
- Stock up on easy-to-prepare meals
- Gather tools with long handles (reacher, sock aid, long-handled shoe horn) to avoid bending
- Line up support from family, friends, or paid help for the first one to two weeks
The Day of Surgery
Most hip replacements are done in a hospital or a surgery center that specializes in joint replacement.
Anesthesia
Two main options are common:
- General anesthesia puts the patient fully asleep.
- Spinal or regional anesthesia numbs the lower body while the patient stays awake or lightly sedated.
Many surgical teams prefer spinal or regional anesthesia for hip replacement because it can reduce nausea and help with early mobility. The anesthesiologist and surgeon decide together based on the patient’s health and preferences.
The Procedure in Plain Terms
Once the patient is asleep or numb, the surgeon:
- Makes an incision to reach the hip joint. The location depends on the surgical approach chosen (anterior, posterior, or lateral, as introduced in Blog 1).
- Removes the damaged femoral head (the ball at the top of the thighbone).
- Prepares the acetabulum (the socket in the pelvis) and fits the new cup.
- Prepares the top of the femur and inserts the stem of the implant.
- Attaches the new ball to the stem.
- Tests the joint for stability and correct alignment.
- Closes the incision with sutures or staples.
The surgery itself usually takes one to two hours, though total time in the operating room is longer because of preparation and recovery from anesthesia.
Comparing Surgical Approaches
All three approaches replace the same parts of the joint. The main differences are which muscles are moved or cut and how the incision is oriented.
- Anterior approach. The surgeon reaches the joint from the front, working between muscles rather than cutting them in some cases. Many patients experience a faster early recovery, though long-term outcomes are similar across approaches.
- Posterior approach. The most common approach historically. It gives the surgeon excellent visibility and access. Some posterior-approach patients are asked to follow specific hip precautions for several weeks.
- Lateral approach. Reaches the joint from the side. Less common today but still used in some cases.
The American Academy of Orthopaedic Surgeons notes that minimally invasive variants of these approaches use smaller incisions and aim for less tissue disruption, but long-term outcomes are generally similar to traditional approaches. The best approach is the one the surgeon performs frequently and with confidence.
In the Hospital
Most patients stay in the hospital for one to two days. Some patients qualify for outpatient surgery and go home the same day.
During the hospital stay, patients typically:
- Receive IV fluids and pain medication
- Start moving within a few hours of surgery, often standing and taking a few steps with help
- Begin physical therapy the same day or the next day
- Receive medication to prevent blood clots
- Learn how to use a walker and navigate to the bathroom safely
Before going home, patients usually need to demonstrate that they can walk short distances with assistance, manage stairs if their home has any, and understand their medications and any precautions.
The First Weeks at Home
Early recovery is a mix of carefully moving, resting, and starting structured rehabilitation.
Pain Management
Pain is highest in the first days and eases steadily. Pain management often includes a mix of medications tailored to each patient. Non-opioid options, ice, and careful positioning help reduce the need for stronger drugs. Most patients move away from strong pain medications within the first few weeks.
Incision Care
The incision usually heals well within a few weeks. Keeping it clean, dry, and protected reduces infection risk. The surgical team provides specific bathing, dressing-change, and wound-inspection instructions.
Preventing Blood Clots
Blood clots are one of the more serious risks after hip replacement. Prevention steps usually include:
- A blood-thinning medication for a set period
- Compression stockings or leg sleeves
- Ankle pumps and frequent leg movement
- Early walking
Warning signs to report immediately include calf pain or swelling, sudden shortness of breath, and chest pain.
Mobility and Assistive Devices
Most patients use a walker for the first one to three weeks, then transition to a cane. Each patient’s timeline is individual. Physical therapists advise when to step down to less support.
Rehabilitation and Physical Therapy
Rehab is the most important part of recovery. Skipping or rushing it is one of the most common avoidable mistakes.
According to the American Academy of Orthopaedic Surgeons, rehabilitation generally moves through a few phases:
Early Phase (First Few Weeks)
Exercises start in the recovery room. Common early exercises include:
- Ankle pumps (flexing and pointing the foot)
- Quadriceps sets (tightening the thigh muscle)
- Buttock contractions
- Gentle knee bends
- Straight leg raises
These are typically done several times a day to encourage circulation, strengthen key muscles, and prevent stiffness.
Standing and Walking Phase
Once a patient is stable on their feet, standing exercises are added:
- Knee raises while standing
- Hip abduction (moving the leg gently out to the side)
- Hip extensions (moving the leg gently backward)
- Progressive walking with a walker, then a cane
Walking is emphasized as one of the most important recovery activities. Short, frequent walks are better than long, tiring sessions.
Advanced Phase (4 to 6 Weeks and Beyond)
Once strength and balance are returning, rehab usually adds:
- Resistance training with elastic bands
- Stationary cycling (often starting with backward pedaling before forward)
- Longer walking sessions
- More specific hip-strengthening exercises
Full recovery takes months, not weeks. Many patients feel meaningfully better by six to twelve weeks, but complete muscle reconditioning can take six months to a year.
Hip Precautions: What to Avoid During Recovery
Depending on the surgical approach used, the surgeon may ask the patient to follow specific hip precautions for about six to eight weeks. Common precautions include:
- Do not cross the operated leg over the other
- Do not bend the hip past 90 degrees (such as leaning forward deeply in a chair)
- Do not rotate the leg inward or outward excessively
- Keep the operated leg pointed forward when sitting or standing
- Avoid low, soft chairs and couches in the early weeks
Patients who have an anterior approach may have fewer precautions. The surgical team explains what applies in each case.
Stages of Returning to Daily Life
Return-to-activity follows a general sequence rather than fixed dates. Most patients progress roughly in this order:
- Assisted walking with a walker or crutches in the first one to three weeks
- Independent walking and light household activity as strength and balance return
- Gradual return to driving only after strong pain medications are stopped and the surgeon has cleared it
- Low-impact exercise (walking, swimming, stationary cycling) once the incision has healed
- Return to work at a pace that depends on the physical demands of the job
- Travel, especially flights longer than a few hours, only after surgeon clearance because of blood clot risk
Each milestone is individual. The surgical team and physical therapist adjust the plan based on progress. Specific timelines for common questions (such as driving, flying, returning to work, and playing sports) are covered in our FAQ article.
Possible Complications and How to Reduce the Risk
Most hip replacements go smoothly, but every surgery has risks. Possible complications include:
- Blood clots (deep vein thrombosis, pulmonary embolism)
- Infection (at the incision or deep in the joint)
- Dislocation of the new hip, especially early after surgery
- Implant loosening or wear over many years
- Leg length differences that usually resolve but occasionally persist
- Nerve or blood vessel injury (uncommon)
Risk is reduced by careful surgical technique, blood-clot prevention, good wound care, following hip precautions, and completing physical therapy. Seek prompt medical attention if warning signs appear after surgery. A full list of warning signs that require contacting the surgical team is in our FAQ article.
Long-Term Care and Follow-Up
After the initial recovery period, most patients have periodic follow-up visits to check the implant and review activity level. Over many years:
- Annual dental cleanings and any dental or surgical procedures should be mentioned to the orthopedic team because of infection risk.
- Low-impact exercise helps maintain strength and protect the implant.
- If new pain or a feeling of instability develops years later, an orthopedic visit is warranted.
A modern hip implant is built to last many years. Long-term outcomes, implant survival rates, and how often revision surgery is needed are covered in the FAQ and statistics article (Blog 4).
Common Procedure-Stage Questions
How long does the surgery itself take?
The hip replacement procedure typically takes one to two hours, although total time in the operating room including preparation and recovery from anesthesia is usually longer.
Will I need to go to a rehab facility after surgery?
Not always. Many patients go directly home with outpatient physical therapy. Some patients, especially those who live alone or have mobility challenges, may benefit from a short stay at a rehabilitation facility. The surgical team helps decide what is safest.
What does a typical recovery arc look like?
Most patients notice real improvements within six to twelve weeks, and ongoing gains continue for several months. Complete muscle and strength recovery often takes six to twelve months, though timelines are individual.
Disclaimer: This article is for general informational and educational purposes only. It is not intended as medical advice, diagnosis, or treatment. Always talk with a qualified healthcare professional for guidance about your individual situation. The information presented here does not replace a consultation with a licensed medical provider.
