A Total Hip Arthroplasty (THA), commonly known as a hip replacement, removes a damaged hip joint and replaces it with an artificial implant. The four-week mark represents a significant point in recovery, where a patient transitions from basic healing to functional independence. While generalized guidelines exist, the exact progression, including how far you should be walking, must be personalized and determined by your orthopedic surgeon and physical therapist. Adhering closely to their specific instructions is necessary for a safe and successful recovery.
The Initial Recovery Phase (Weeks 1-4)
The first month of recovery focuses on foundational healing and regaining basic mobility. Early mobilization begins almost immediately, with patients encouraged to stand and take a few steps using an assistive device, often a walker, within 24 hours of surgery. This early movement helps reduce the risk of complications such as blood clots and pneumonia.
During the first week, the goal is short transfers and walks, such as to the bathroom or across a room, using the walker for full support. As surgical pain and swelling subside, the focus shifts to functional walking within the home. By weeks two and three, many patients are walking more frequently and are actively engaged in prescribed physical therapy exercises to strengthen muscles and improve range of motion.
The transition from the hospital to home requires adapting to daily life while maintaining strict adherence to hip precautions and wound care. By the end of the fourth week, pain is generally better controlled, and the incision is typically well-healed. This progress sets the stage for increasing activity levels and potentially reducing the reliance on walking aids.
Walking Distance and Activity at Four Weeks
At the four-week milestone, the focus shifts from “how far” to “how often” and “how correctly.” The goal is not to achieve a single maximum distance but to increase endurance safely through frequent, short bouts of walking. Most physical therapy protocols recommend walking for periods of 10 to 15 minutes, several times a day.
In terms of distance, this often translates to walking around the block or covering a few hundred yards on a flat surface. It is more important to focus on maintaining a proper, non-limping gait, using a heel-toe pattern, than it is to push for distance. Walking should be a restorative exercise at this stage.
Many patients transition from a walker or two crutches to a single cane or crutch by this time, or may be cleared to walk unassisted indoors. The assistive device should be held in the hand opposite the operated hip to shift weight and promote a symmetrical walking pattern. If you find yourself limping without the aid, continue using it until your strength and gait normalize.
Non-Walking Activities and Restrictions
While walking increases, strict hip precautions remain in place for most patients, particularly those who underwent a traditional posterior approach. These precautions prevent the new hip joint from dislocating. This includes avoiding bending the hip past a 90-degree angle, requiring the use of a raised toilet seat and avoiding low chairs.
Other restrictions involve not crossing the legs or ankles and avoiding twisting the operated leg inward or outward, as these movements stress the new joint components. Tools like sock aids and long-handled reachers help manage tasks like putting on shoes and socks while respecting the bending restriction.
Many surgeons clear a patient to resume driving between the two- and four-week mark, provided they are no longer taking prescription opioid pain medication. Driving eligibility also depends on which hip was replaced, as the right leg operates the gas and brake pedals. Regarding stairs, patients should use the “up with the good, down with the bad” technique, always using a handrail for stability.
Recognizing Overexertion and When to Consult a Doctor
The line between beneficial activity and overexertion can be subtle at four weeks post-surgery. Normal signs of recovery include general muscle soreness and mild, temporary swelling that is relieved by elevation and ice. Signs of pushing recovery too far include a significant increase in pain lasting more than a few hours after activity, or noticeable, persistent swelling in the leg.
If you experience specific, sharp, or sudden pain in the hip or groin, or hear an audible clicking or popping sound from the joint, seek immediate medical advice. These symptoms could indicate an issue with the implant or a potential dislocation.
Certain symptoms require immediate consultation with your medical team, as they may signal a serious complication. These warning signs include a fever, increased redness or warmth around the incision site, or excessive drainage from the wound, which can indicate an infection. Unrelieved or severe swelling, tenderness, or pain in the calf may signal a blood clot and should be addressed promptly.