A total hip replacement (THR) is a procedure where a damaged hip joint is replaced with an artificial implant. For many people considering this surgery, the fear of prolonged bed rest is a major concern. Modern orthopedic care has decisively moved away from the idea that patients must remain immobile for an extended time after a THR. Current recovery protocols prioritize safe, early mobilization and active physical therapy, starting almost immediately after the operation.
The Shift Away from Extended Bed Rest
The traditional recovery model involved several days of strict bed rest, but this approach has been largely abandoned due to a better understanding of post-surgical healing. Contemporary protocols, often part of an Enhanced Recovery After Surgery (ERAS) pathway, prioritize getting the patient moving quickly to reduce the risks associated with immobility.
Lying in bed for too long significantly increases the risk of deep vein thrombosis (DVT), which is the formation of blood clots in the legs. Early movement stimulates circulation and prevents these clots from forming. Extended bed rest also contributes to muscle atrophy, where muscle tissue wastes away, making long-term recovery and regaining strength more difficult. Furthermore, early mobilization helps reduce the risk of pulmonary complications, such as pneumonia, by encouraging deeper breathing.
Immediate Post-Surgical Mobilization (The First Week)
The timeline for getting out of bed after a total hip replacement is typically measured in hours, not days. Many patients are encouraged to sit up, stand, or take a few steps with assistance on the same day of surgery, often within four to six hours. This immediate action is a core component of the ERAS protocol, supported by multimodal pain management.
The day following the operation, physical therapy sessions begin. Patients start walking short distances in the hospital room or hallway using a walker or crutches, practicing transfers, and learning how to navigate stairs. The typical hospital stay for a THR is now very short, often only one to three days, due to this rapid mobilization.
Discharge criteria center on the patient’s ability to safely manage basic mobility tasks at home, such as getting in and out of bed and performing basic self-care. While strict bed rest is minimal, movement remains restricted and controlled, guided by physical therapists and the surgeon. The goal is to get the patient home safely and quickly to continue rehabilitation.
Long-Term Restrictions and Activity Milestones
After leaving the hospital, the recovery focus shifts to regaining strength and full functionality, a process that can take six months to a year. For the first six to twelve weeks, patients must adhere to specific “hip precautions” to protect the new joint from dislocation. These precautions typically involve avoiding bending the hip past 90 degrees, refraining from crossing the legs, and avoiding excessive inward rotation of the leg.
Return to Driving and Work
The return to driving is usually permitted once the patient is off narcotic pain medication and can perform an emergency stop without hesitation. For a left hip replacement in an automatic car, this may be as early as two to four weeks. However, for a right hip replacement, it often takes four to eight weeks. Returning to work varies significantly: those with sedentary jobs might return in two to four weeks, while those with physically demanding jobs may need up to twelve weeks.
Activity Levels
Low-impact activities, such as light household chores, walking for exercise, and swimming, are typically safe to resume after the initial six to twelve-week precaution period. Activities involving impact, like running, jumping, or contact sports, are generally discouraged long-term. This is done to prevent premature wear on the artificial joint. The overall timeline for feeling fully recovered and returning to most normal activities is often around six months, though the new hip will continue to heal for up to a full year.