Hip replacement surgery - how to prepare and what rehabilitation looks like?

Hip replacement (also known as endoprosthesis replacement) is a surgical procedure that involves replacing damaged parts of the hip joint with an artificial prosthesis. The procedure restores joint function, reduces pain, and improves the patient’s quality of life.

Endoprosthetics is most often performed on people affected by osteoarthritis or after injuries. It is a routine, commonly performed procedure. The operation usually lasts from 1 to 3 hours, and the patient spends 3 to 7 days in the hospital.

In Poland, hip replacement surgery is performed much more often in women than in men. In 2017, the average age of patients undergoing this surgery was approximately 68.5 years, and the most common reason for undergoing surgery was osteoarthritis.

The procedure can be categorized based on its complexity:

• total hip replacement, during which all joint surfaces are replaced. This solution is used in cases of advanced changes affecting the entire joint;
• partial hip replacement, during which only one compartment of the joint is replaced. This is a less invasive procedure, also associated with a shorter recovery period, but it can only be performed in specific cases.

Hip replacements can also differ based on the type of prosthesis used:

• cemented hip replacement, which uses an implant fixed to the bone with bone cement. This type of prosthesis is used in older patients whose bones are in poorer condition. It ensures immediate stability of the implant, but also creates a risk of the cement loosening at a later stage;
• cementless hip replacement, which uses an artificial joint made of materials that allow for osseointegration, i.e., bone ingrowth into the porous surface of the implant. This type of prosthesis requires good bone quality, which is why it is more commonly used in younger patients. The procedure involves a longer healing time, but also potentially provides more lasting results.

The final choice of technique and prosthesis is made by the surgeon based on the patient’s individual condition.

A hip prosthesis is recommended when conservative treatment no longer provides sufficient relief.

Other indications include:

• advanced hip osteoarthritis,
• pain that interferes with daily functioning,
• stiffness and limited range of motion.

Only the surgeon can make the final decision about eligibility for surgery. Each case is evaluated individually. Specialists assess the patient’s overall condition and potential risks during surgery and rehabilitation.

Contraindications may include:

• active infection,
• advanced respiratory or cardiac failure,
• cancer,
• severe osteoporosis.

Although rare, complications can include wound or prosthesis infection, deep vein thrombosis, pulmonary embolism, prosthesis loosening, or arthrofibrosis. The overall risk is low.

Preparation typically includes:

• orthopedic consultation,
• lab tests (e.g., blood count, clotting time),
• imaging (X-ray or MRI),
• general health assessment to evaluate risks and rule out contraindications,
• anesthesiology consultation (choosing regional or general anesthesia).

Before the operation, it is also important to take care of your physical condition. If you are overweight, reduce your body weight and limit or completely refrain from drinking alcohol and smoking cigarettes, as all these factors affect the time it takes for your body to recover and heal.

Prehabilitation, i.e., multidirectional preparation of the patient for surgical treatment, conducted under the supervision of an experienced physiotherapist, will help to achieve these goals. Even before the operation, it is worth starting activities that will support later regeneration. Centers such as NAMI Medical Resort and Clinic have a team that can prepare the patient to better tolerate the procedure and facilitate rehabilitation after surgery. The best results are achieved through comprehensive support for the body, including light physical activity, specialized treatments, and even a proper diet.

After surgery, the patient must undergo rehabilitation to regain their fitness. However, work with a physical therapist should begin even before the operation itself. This is part of prehabilitation, i.e., preparing the body for surgery, thanks to which the patient can better tolerate the procedure itself, reduce the risk of complications, and then return to fitness faster, more efficiently, and more easily.

Consultations and work with a specialist contribute to improved mobility, increased muscle strength, and pain reduction. Each of these factors influences the subsequent recovery process.

As soon as the patient learns that they have been qualified for surgery, they should look for a place or specialist who will help them prepare their body for the operation in a comprehensive manner. At the NAMI Medical Resort and Clinic, patients can count on the care of an interdisciplinary team, access to specialized equipment, and even meals that support regeneration.

During a pre-operative visit, a physiotherapist will assess the patient’s functional status, decide on the appropriate form of therapy (manual, kinesitherapy, or physical therapy), and develop an exercise plan.

After hip replacement surgery mobility is limited, patients rely on crutches or a walker. Therefore, the home environment should be arranged to ensure safety and prevent falls. A proper setup also reduces strain on the operated leg.

Alternatively, patients may choose to undergo both prehabilitation and postoperative rehabilitation in a medical facility such as NAMI, where they receive coordinated, multidisciplinary care, specialized equipment access, and recovery-supporting meals. NAMI offers a dedicated orthopedic medical program designed for patients both before and after surgery.

Home preparation tips:

• Remove tripping hazards (rugs, cables),
• Ensure easy access to lighting (e.g., lamps near the bed or sofa),
• Use a high chair or armchair to avoid low seating,
• Use a rolling table to move items without bending,
• Place frequently used items within easy reach,
• Install grab bars near the toilet and shower,
• Use non-slip mats.

Rehabilitation begins in the hospital, on the first day after surgery. The patient lies or sits on the bed and performs appropriate exercises together with physiotherapists working in the orthopedic ward. Thanks to these activities, immobilization is prevented and anticoagulation is achieved in the early postoperative phase.

The aim is for the patient to start sitting, standing, and moving as soon as possible. The physiotherapist teaches the patient how to use crutches and shows them how to walk on flat surfaces and stairs and how to use the toilet independently. This allows the patient to function independently at home and begin home or outpatient rehabilitation at a selected center.

It is a good idea for the patient to choose a place for further rehabilitation before the operation – preferably during prehabilitation, i.e., preparation for the procedure. Starting this process with knowledge of what rehabilitation looks like and who will be conducting it increases safety and readiness to work on returning to full strength. Places such as the NAMI Medical Resort and Clinic are fully prepared to accept patients after orthopedic procedures and are ready to provide comprehensive care that brings the best results.

Immediately after surgery, take special care not to dislocate the prosthesis. Do not bend your hip beyond a right angle. Also avoid combinations of adduction, internal rotation, and flexion movements.

• In practice, this means that you cannot sit too low, whether on a chair, sofa, bed, or toilet. It may be helpful to sit on an additional hard cushion, blanket, or special pad.
• Do not bend over. When you want to pick something up or put on your shoes, use a special grabber and a longer shoehorn.
• Do not cross your legs or knees. Do not put your leg over your other leg.
• Do not turn the operated leg inward. Place your foot so that it is pointing forward or slightly outward, but not inward.

The stitches are usually removed 10-14 days after the surgery. Until then, the dressings must be changed.

Rehabilitation after hip replacement can be divided into several stages. Usually, the first stage is the period from surgery to discharge from the hospital. The next 6 weeks are the early stage, while the subacute stage lasts up to 12 weeks after surgery. After this time, most patients who have undergone hip replacement surgery regain full independence and fitness, which allows them to function well in everyday life. Crutches are usually discontinued 3-4 weeks after surgery.

After discharge from the hospital, great emphasis is placed on improving muscle strength and increasing range of motion. To this end, the patient mainly performs strengthening and stretching exercises. Cardiovascular fitness should also be taken care of. At first, the patient is limited to moving around on crutches, but later it is worth using, for example, a stationary bike, elliptical trainer, or treadmill.

As before the operation, it is worth taking care to strengthen the whole body after the procedure. A holistic approach brings the best results. Gentle movement, adapted to the patient’s capabilities, care for regeneration, physical therapy treatments, and a nutritious diet will support the process of regaining strength.

It is possible to return to sports with an endoprosthesis. However, patients should avoid high-intensity activities and contact sports, as these can lead to wear and tear on the implant, which in turn necessitates reoperation.

However, studies show that the level of advancement in a given sport and the patient’s level of fitness before the procedure are factors that help decide whether to return to demanding disciplines such as skiing, horse riding, or running.

At NAMI, we understand that professional physiotherapy before and after surgery is key to restoring function and comfort. Our orthopedic physiotherapists support patients at every stage, tailoring therapy to their individual needs.

Our orthopedic medical program includes diagnostics, manual therapy, physical therapy, rehabilitation exercises, and health education. We use advanced rehabilitation equipment and modern therapeutic technologies to support the healing process.

NAMI Medical Resort and Clinic exclusively offers medical programs.

1. Salter, Donald M; Su, Sui-Lung; Lee, Herng-Sheng, International Journal of Medical Sciences: “Epidemiology and genetics of osteoarthritis” (2014).
2. Gajda, M.; Pac, A.; Gryglewska, B.; Gajda, P.; Różańska, A.; Wójkowska-Mach, J. Patients Undergoing Hip or Knee Arthroplasty in Poland Based on National Data—Challenge for Healthcare in Aging Society. Healthcare 2021.
3. Ibrahim MS, Alazzawi S, Nizam I, Haddad FS. An evidence-based review of enhanced recovery interventions in knee replacement surgery. Ann R Coll Surg Engl. 2013 Sep;95(6):386-9. doi: 10.1308/003588413X13629960046435. PMID: 24025284; PMCID: PMC4188283.
4. Choi, YJ., Seo, DK., Lee, K. et al. Results of total knee arthroplasty for painless, stiff knees. Knee Surg & Relat Res 32, 61 (2020). https://doi.org/10.1186/s43019-020-00081-0.