Hip Replacement: What You Need to Know

Hip replacement surgery is one of the most successful and commonly performed orthopaedic procedures today. Whether caused by arthritis, injury, or wear and tear over time, chronic hip pain and reduced mobility can significantly impact quality of life. This article explores what to expect before, during, and after hip replacement — with a particular focus on how manual therapy can play a powerful role in supporting recovery, improving mobility, and reducing post-operative complications.

We’ll cover:

• Who typically needs a hip replacement and why
• The difference between partial and total hip replacement
• The various surgical approaches and how they affect surrounding muscles
• What to expect during recovery and rehabilitation
• The role of manual therapy in pain modulation, scar tissue healing, and nervous system support
• Common post-operative issues like Trendelenburg gait and blood clots
• And why kidney health, walking, and nutrition are essential components of holistic recovery

Whether you're preparing for surgery yourself or supporting someone through it, this guide is designed to give you both practical insights and a deeper understanding of how to recover well.

Hip Replacement – Why and for Whom?

Hip replacement surgery, or hip arthroplasty, is commonly performed to relieve persistent hip pain and restore mobility when conservative treatments no longer work. It's most often needed in cases of:

• Osteoarthritis
  
• Rheumatoid arthritis
  
• Hip fractures (especially in older adults)
  
• Avascular necrosis
  
• Developmental dysplasia or structural issues

Signs You Might Need Hip Replacement:

• Loss of range of motion
  
• Pain in the hip joint or groin
  
• Pain radiating down the thigh
  
• Worsening back pain
  
• A leg that feels shorter (due to cartilage loss)
  
• Stiffness in the hip
• Difficulty with everyday tasks like putting on socks or getting in/out of a car
  

The goal of hip replacement is to increase range of motion and decrease inflammation and pain, so you can return to an active and independent life.

Preparing for Surgery: Set Yourself Up for a Better Recovery

You can optimise your health before surgery:

• Nutrition - Think anti-inflammatory diet, increase fibres from vegetables and fruit, increase protein and focus on healthy fat. Eliminate added sugars, milk, plant-milks, low quality oils and gluten. Focus on hydration too.
• Vitamin D: Supports bone healing and immune function
  
• Vitamin E: Antioxidant that reduces post-op inflammation and oxidative stress
  
• Up you levels of Albumin: A marker of nutritional status; low levels are linked to poor healing
  
• Check in with weight and adipose tissue distribution 
• Manage Diabetes (if you have)
• Prehabilitation - Improve strength, cardio and mobility before the surgery.

Rehabilitation Focus:

Gluteal Muscle Group (Buttock Muscles)
Often referred to as the glutes, this group includes:
Gluteus maximus – the largest muscle, responsible for hip extension (e.g. standing up from a chair)

Gluteus medius and minimus – stabilise the pelvis when walking and standing on one leg
These muscles are essential for walking, balance, and posture. Weakness here is a common cause of hip pain and abnormal gait patterns (like Trendelenburg).

Quadriceps Muscle Group (Front Thigh Muscles)
Located on the front of the thigh, the quadriceps are:
Four powerful muscles (vastus lateralis, vastus medialis, vastus intermedius, and rectus femoris)
Responsible for knee extension and stabilising the leg when walking, squatting, or standing

Strong quads help protect the knee joint and support the hip during movement and recovery.

Pelvic Girdle (Pelvis and Core Stabiliser Region)
The pelvic girdle is the ring-like structure that connects your spine to your legs. It includes:

• The hip bones (ilium, ischium, pubis)
  
• The sacrum
  
• Supporting muscles like the pelvic floor, deep core, and hip stabilisers
  

This region forms the foundation of your body’s movement and posture. A strong pelvic girdle is crucial for balance, walking, lifting, and protecting your spine and internal organs.

Aim to walk, do resistance training or functional exercises before surgery

Manage Modifiable Risks

• Keep blood sugar stable (if diabetic)
  
• Lose excess weight if needed
  
• Address vitamin/mineral deficiencies
  
• Build resilience before the big day

Types of Hip Replacement

Total Hip Replacement (THR / Total Hip Arthroplasty) Replaces both:

• Femoral head
  
• Acetabulum (hip socket)
  

Partial Hip Replacement (Hemiarthroplasty) Replaces:

• Only the femoral head
  

Socket is left intact
Often used for hip fractures in older adults

Cemented vs Uncemented Implants

If bone quality is strong, the implant is press-fit into the bone and integrates naturally
If bone is weaker, bone cement is used to anchor the prosthesis securely

Modern Surgical Advances

• Today’s hip replacements last longer (often 20+ years)
  
• Lower blood loss, shorter surgeries, and minimally invasive options reduce risks
  
• Computer-assisted navigation improves positioning accuracy
  
• Outcomes are more consistent, even in older patients

Surgical Approaches & Muscle Groups Affected

Posterior Approach

• Oldest and most commonly used
• Muscles affected: Gluteus maximus, short external rotators
• Don't: Deep squats or forward bending early on
• Slightly higher early dislocation risk
  

Anterior Approach (Direct Anterior) - A newer technique (developed in 1947, gaining popularity recently)

• Muscle-sparing: No major muscles or tendons are cut
• Less post-op pain, quicker early recovery
• Avoid straight leg raises early on
• Numbness on the outside of the thigh is common due to nerve stretch, usually improves within 3 months

Lateral Approach

• Involves cutting or detaching part of the gluteus medius tendon
• Important for hip stability and gait
• Slight risk of temporary weakness and Trendelenburg gait
  

Anterolateral Approach

• Between gluteus medius and tensor fascia latae
• Affects part of glute med/min
• Balanced approach with a lower dislocation risk

Recovery and Rehabilitation - What To Expect

• Most people stand and walk on the same day as surgery
  
• Progressively increase distance and activity levels
  
• Some swelling, soreness, tightness and bruising are completely normal
  
• Numbness on the outer thigh is common and usually resolves before 3 months
  

Timeline:

• 0–6 weeks: Focus on walking, circulation, and gentle movement
  
• Around 3 months: ~80% of recovery is usually complete
  
• Full healing can take up to 12 months
  

Key Muscles to Rebuild:

• Gluteus medius and maximus
  
• Quadriceps
  
• Pelvic stabilisers (e.g. iliopsoas, deep rotators)
  
• Calves and feet to support gait and balance
  
• Walking is the foundation — but activating glutes and quads is essential for stability, posture, and joint protection.

Manual Therapy After Hip Replacement

Manual therapy is a hands-on approach used by trained professionals to assess and treat dysfunctions in joints, muscles, fascia, and the nervous system. After a hip replacement, manual therapy plays a critical role in recovery and is often overlooked in standard rehabilitation protocols.

What Manual Therapy Can Do After Hip Replacement

• Mobilise scar tissue and fascia to prevent adhesions and improve tissue glide
  
• Release tension and stiffness in surrounding joints (e.g., lumbar spine, SI joint, knee, contralateral hip)
  
• Improve blood flow and lymphatic drainage, supporting circulation and reducing swelling
  
• Restore posture and alignment, especially if compensatory patterns developed pre-surgery
  
• Enhance joint range of motion by gently mobilising restricted areas
  
• Re-activate deep stabilising muscles, particularly the glutes, pelvic floor, and hip rotators
  
• Improving Vascularisation for Healing
  

Manual therapy techniques such as soft tissue mobilisation and myofascial release help to:

• Loosen tight tissues around the hip
  
• Encourage vascularisation — bringing oxygen and nutrients to the area
  
• Stimulate tissue regrowth and repair through improved circulation
  
• This is essential for full healing of both the surgical site and compensated structures.

Manual Therapy and the Nervous System

Manual therapy doesn’t just work on muscles — it also modulates how your brain perceives pain.

Gate Control Theory
The skin and connective tissues contain mechanoreceptors — nerve endings that detect pressure and stretch. Manual stimulation of these receptors sends non-painful sensory input to the spinal cord. This input can "close the gate" to pain signals travelling to the brain. The result: A reduction in pain perception, muscle tension, and stress

DNIC (Diffuse Noxious Inhibitory Control)
DNIC is a mechanism where the nervous system modulates pain by using one sensory input to inhibit another. When you receive manual therapy, it activates pathways in the brainstem that inhibit pain signals. Think of it as your brain deciding, "this new input is more important, let’s turn down the volume on the pain". This is part of your body’s natural pain-control system, and manual therapy enhances this effect.

Why It’s Worth Seeing a Manual Therapist

If you have access, seeing a skilled manual therapist after hip replacement can:

• Optimise recovery
  
• Improve comfort, gait, and confidence
  
• Reduce reliance on medication
  
• Support both the physical and neurological aspects of healing

Scar Tissue After Hip Replacement

Healing Timeline:

• Inflammatory phase (0–7 days)
  
• Proliferation phase (1–6 weeks)
  
• Remodelling phase (6–12 months)
  

Optimise Scar Healing:

• Keep wound clean and dry early on
  
• Begin gentle massage once closed
  
• Red light therapy (660nm/850nm) to reduce inflammation and stimulate tissue repair
  
• Support healing with vitamin C, zinc, and protein
  
• Manual therapists can help release adhesions and support nerve regeneration

Read more about Scar Tissue Recovery Here

Common Complications to Watch For

Trendelenburg Gait
Caused by weakness in gluteus medius
Pelvis drops when standing on the surgical leg
Rehab focuses on glute activation and posture

Deep Vein Thrombosis (DVT)
Blood clots in the legs post-surgery

Prevention

• Early mobilisation
  
• Elevated legs for periods
• Manual Therapy 
• Breathing and arm movement if confined to bed
  
• Hydration
  
• Compression garments and/or anticoagulants if prescribed
  
  

Why I Always Mention Kidney Health After Surgery

In many of my articles on surgery, operations, or recovery, you’ll notice I often highlight the kidneys — and there’s a very important reason for this.

The kidneys are vital to survival and recovery. They are not just "waste filters" — they are one of the most hardworking and complex organs in your body, performing several essential functions every second of the day:

What the Kidneys Do:

• Filter your blood: Around 180 litres per day! Removing waste, toxins, and excess fluid
  
• Balance electrolytes: Regulate levels of sodium, potassium, magnesium, and calcium — all critical for nerve conduction, muscle contraction, and heart rhythm
  
• Regulate blood pressure via the renin-angiotensin system
  
• Produce hormones involved in red blood cell production and bone metabolism
  
• Help maintain the acid–base balance in your body

Recap: Why You Should Care About Kidney Health in Rehab

If you're recovering from surgery, dealing with inflammation, or trying to optimise your healthspan:

• Look after your kidneys through hydration, movement, and reducing medication load where possible.
• Ensure electrolyte balance (especially if sweating, fasting, or on medications)
  Recognise that movement is medicine, not just for joints — but also for your vital organs.

Sodium, Potassium & the Nervous System: Why Kidneys Matter So Much

Your nervous system and muscles rely heavily on two minerals:

Sodium (Na⁺)
Helps generate nerve impulses and initiate muscle contraction
Potassium (K⁺)
Helps cells repolarise after a nerve signal or muscle contraction
. Essential for heart rhythm and muscle relaxation

The balance between sodium and potassium inside and outside your cells is what allows every heartbeat, muscle movement, and nerve signal to function properly.

• Without this balance, you may experience:
  
• Confusion or brain fog
  
• Muscle cramps or weakness
  
• Irregular heartbeat
  
• Fatigue or paralysis
  
• In severe cases, sudden death
  

And who maintains this balance? The kidneys.

They regulate how much sodium and potassium is retained or excretedbased on what your body needs.

Why Walking Stimulates Kidney Health

Your intuition is spot on. Walking does far more than just move your legs:

• Activates the calf muscle pump → improves blood and lymph flow through the abdomen and pelvis. 
• Walking creates thrymic moves of the psoas muscles that through fascia contact, mechanically stimulates  kidneys and may help mobilise the fascia and improve fluid dynamics in the area.stimulating kidney and increasing kidney health.
• Walking gently massages the organs through diaphragmatic movement and spine/pelvis motion
  
• Increases renal blood flow, enhancing filtration
  
• Reduces inflammation and improves insulin sensitivity, indirectly supporting the kidneys
• Activates the parasympathetic nervous system (rest-and-digest), which supports kidney repair and detoxification
  

If you have any questions regarding your hip surgery or need a manual therapy session Book your time here