How to Actually Rehab A Total Hip Replacement (Step-by-Step Guide for Physical Therapists)
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In today's video we go over, How to Actually Rehab A Total Hip Replacement (Step-by-Step Guide for Physical Therapists) - FPF Show Episode 196:
Total hip replacement outcomes are generally good—but many patients are left with persistent weakness, gait deviations, and no clear plan for returning to higher-level activities like strength training, running, and sport.
In this video, I provide physical therapists with an evidence-informed, step-by-step framework for total hip replacement rehabilitation. We’ll discuss what the research says about supervised physical therapy after total hip arthroplasty, which patients may need more than a basic home program, and how to progress rehabilitation beyond simply restoring independence.
You’ll learn how to progress patients through:
• Early mobility, gait training, and postoperative precautions
• Hip mobility, strength, balance, and single-leg control
• Squat, hinge, step-up, lunge, and deadlift progressions
• Return to heavier strength training and recreational activity
• Plyometrics, running, agility, and return-to-sport testing
The goal isn’t just to help patients walk again—it’s to restore the strength, capacity, and confidence required to return to the activities they care about.
Always consider surgeon-specific precautions, surgical approach, healing status, medical history, and individual patient goals.
TIMESTAMPS
00:00 Intro
00:30 Why Physical Therapists Matter After Total Hip Replacement
02:05 Does Every Total Hip Replacement Patient Need Physical Therapy?
08:05 Why Athletes Need More Than Standard THA Rehab
12:00 The Best Rehab Framework After Total Hip Replacement
13:47 Phase 1 (0–3 Days): Early Post-Op Rehabilitation
15:37 Early Exercises After Total Hip Replacement
16:34 Criteria to Progress Beyond Phase 1
22:15 Phase 2 (1–6 Weeks): Restore Mobility & Strength
23:22 Hip Mobility Exercises
24:53 Squat, Hinge & Single-Leg Progressions
27:05 Phase 2 Progression Criteria
29:03 Strength Testing After Total Hip Replacement
31:00 Phase 3 (6–12 Weeks): Advanced Strength Training
32:38 Progressing Single-Leg Strength & Core Training
33:30 Criteria to Begin Running & Sport
39:03 Phase 4 (3–6+ Months): Return to Sport
41:25 Return-to-Running Progression
43:42 Plyometric & Agility Progressions
45:17 Return-to-Sport Testing After THA
48:21 Final Takeaways
Hip built like a tank,
- Dan Pope DPT,OCS,CSCS
Show Notes / Relevant Articles:
- FPF Mini Course - 7 Reasons Why Injuries Happen in the Gym and What to do About it
- What Physical Therapists NEED to Know About Hamstring Strain Injuries
- Patellofemoral Pain MASTER Class
- What Physical Therapists Need to Know About Adult Hip Dysplasia
- What Physical Therapists Need to Know About Femoral Acetabular Impingement Syndrome
- Femoral Acetabular Impingement Treatment WITHOUT Surgery! [Physical Therapist's Guide]
Want to earn some CEUs for physical therapists, physical therapy assistants & ATCs for watching this content? Click HERE to sign up for FPF "Insiders Academy" for just a dollar. You can earn CEUs for watching this content. Plus, you'll gain access to over 14 MASTER courses, 50+ cheat sheets, 100+ webinars, e-books and complete guides. You'll also get private access to the "Insiders Academy" community where you can have all of your questions answered by me.
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Thank you!
Dan Pope DPT, OCS, CSCS
References:
Formal Physical Therapy After Total Hip Arthroplasty Is Not Required: A Randomized Controlled Trial. The Journal of Bone and Joint Surgery. American Volume. 2017. Austin MS, Urbani BT, Fleischman AN, et al.RCT
Evaluation of Exercise Interventions and Outcomes After Hip Arthroplasty: A Systematic Review and Meta-analysis. JAMA Network Open. 2021. Saueressig T, Owen PJ, Zebisch J, Herbst M, Belavy DL.SR
Effects of Supervised Exercise Compared to Non-Supervised Exercise Early After Total Hip Replacement on Patient-Reported Function, Pain, Health-Related Quality of Life and Performance-Based Function - A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Clinical Rehabilitation. 2019. Hansen S, Aaboe J, Mechlenburg I, Overgaard S, Mikkelsen LR.SR
Rehabilitation for Total Hip Arthroplasty: A Systematic Review. American Journal of Physical Medicine & Rehabilitation. 2023. Konnyu KJ, Pinto D, Cao W, et al.SR
Clinical and Cost-Effectiveness of Physiotherapy Interventions Following Total Hip Replacement: A Systematic Review and Meta-Analysis. Rheumatology International. 2020. Fatoye F, Wright JM, Yeowell G, Gebrye T.SR
Randomised Controlled Trial to Evaluate a Physiotherapy-Led Functional Exercise Programme After Total Hip Replacement. Physiotherapy. 2017. Monaghan B, Cunningham P, Harrington P, et al.RCT
Rehabilitation After Total Hip Arthroplasty: A Systematic Review of Controlled Trials on Physical Exercise Programs. European Journal of Physical and Rehabilitation Medicine. 2009. Di Monaco M, Vallero F, Tappero R, Cavanna A.SR
Timing of Rehabilitation on Length of Stay and Cost in Patients With Hip or Knee Joint Arthroplasty: A Systematic Review With Meta-Analysis. PloS One. 2016. Masaracchio M, Hanney WJ, Liu X, Kolber M, Kirker K.SR
The Therapeutic Validity and Effectiveness of Physiotherapeutic Exercise Following Total Hip Arthroplasty for Osteoarthritis: A Systematic Review. PloS One. 2017. Wijnen A, Bouma SE, Seeber GH, et al.SR
Activity Recommendations After Total Hip and Total Knee Arthroplasty. The Journal of Bone and Joint Surgery. American Volume. 2021. Fortier LM, Rockov ZA, Chen AF, Rajaee SS.Review
Mass General THA Protocol: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.massgeneral.org/assets/mgh/pdf/orthopaedics/sports-medicine/physical-therapy/rehabilitation-protocol-for-total-hip-arthroplasty.pdf