From Research to Practice: Rehab Post-Hip Arthroplasty

Meet Sarah – yoga mat, garden gloves, and a brand new hip.

Sarah is 68. She drinks her coffee black, swears by Yin Yoga, and spends most weekends elbow-deep in her community garden. Six weeks ago, she had a total hip replacement on her right side after years of so-called ‘bone-on-bone’ osteoarthritis finally caught up with her.

When she walked into my clinic, she looked pretty good on paper. No walking aids, surgical scar healing well, pain around 3/10 most of the time. But the minute she tried stepping onto the treatment table, I could see it – the hesitation, the guarded movement, the stiffness that hadn’t yet caught up to her confidence.

More than anything, she just wanted to feel like herself again. Not “recovered,” but capable-of getting up from the ground without effort, stepping back into yoga without worrying about dislocating her hip, and pulling weeds without a postural crisis.

And that’s when I knew this wasn’t going to be about ticking off milestones. This was about bridging the gap between surgery and the life she wanted to return to-without over-medicalizing the process.

As always, my approach was guided by Physio Network’s extensive library of Research Reviews, check them out HERE.

The early days – gentle nudges, not protocols

At six weeks post-op, we weren’t jumping into anything wild. Sarah was already walking comfortably around the house and had started venturing outside for short strolls. What she needed was reassurance that she was safe to move-and a clear path forward that didn’t feel like a hospital discharge checklist.

We kept things simple:

• A few drills to remind her glutes and core they had a job to do (think: gentle bridges and supported step-ups).
• Light mobility work focused on hip extension and rotation-just enough to feel like her hip was part of her again.
• And maybe most importantly, a chat about what she could actually do. Based on a Physio Network review of Fortier et al. (2021), it turns out the list of approved activities post-THA are longer than most patients think. Walking, swimming, yoga (with some modifications), even cycling – all within reach sooner than expected if you load gradually and monitor tolerance.

No bootcamp. No five-day-a-week rehab plan. Just a nudge forward every week or two, backed by reassurance and the occasional well-placed analogy. (Her favorite: “You’re not fragile- you’re just freshly tuned up.”)

Weeks 8-16: When strength meets confidence

Around the two-month mark, Sarah had hit a bit of a plateau. Her pain was minimal, but the stairs still felt like Everest. She avoided sitting on the floor. And she wasn’t convinced her right hip was trustworthy enough for yoga.

Enter phase two – not just strength, but power. A Physio Network review on power training in older adults post-THA (Chui et al., 2022) was a game-changer here. It turns out that how fast you move matters, especially for things like fall prevention and functional independence.

So we got a little creative:

• Speedy sit-to-stands (think “explode up, slow down”).
• Light resistance step-ups with a focus on tempo.
• And balance drills with distraction – like standing on one leg while naming her favorite garden plants (she’s partial to marigolds, by the way).

We didn’t meet every week- just enough to tweak her program, track progress, and talk through the inevitable “is this normal?” moments.

By week 16, Sarah was moving differently. Her gait had smoothed out. She could get up from the floor with only a bit of hesitation. And one day, unprompted, she said: “I walked across the park to meet a friend and didn’t even think about my hip.”

That’s when I knew we were heading somewhere meaningful.

The final push – from reps to real life

By five months post-op, rehab looked a lot less like rehab.

Sarah had returned to her beginner-level yoga class, with a few modifications for extreme poses. We’d talked through the key movement risks post-THA: deep hip flexion, excessive rotation, twisting on one leg- and how to move within her new range safely, not avoid movement altogether.

In the garden, she was lifting pots again, albeit with a wide stance and a better hip hinge than before surgery. She started noticing her right side didn’t “give out” when pivoting or carrying things. She’d made peace with the scar, the slower days, the new pace of things.

And I was seeing her maybe once every three to four weeks at this point, more for guidance and tuning than anything hands-on. After six months, we said our goodbyes. She was ready.

Final thoughts – what I learned from Sarah

Every post-THA patient comes in with more than just a new joint. They come with a story, a lifestyle they’re eager to return to, and a whole lot of questions that Google doesn’t answer well.

Here’s what working with Sarah taught me:

1. You don’t need a rigid protocol: The research is clear, progressive strength and power training helps. But how you deliver that matters. Layer it into their life, not just your EMR notes.
2. Power isn’t just for athletes: Older adults, especially post-op, benefit enormously from moving with intent and speed, when done safely and thoughtfully.
3. Meaning matters more than metrics: We measured strength and mobility, sure. But it was the first pain-free gardening session and her quiet return to yoga that told me we were on track.
4. Space out the sessions: Most of our work happened with a two- or three-week gap. Sometimes longer. She had a plan, she had trust, and that gave her agency, not dependence.

Wrapping up

If your post-THA rehab feels like a checklist, zoom out. Who’s the person in front of you? What do they want from their hip- not just in a clinical sense, but in their everyday life?

Back your decisions with evidence for which subscribing to the Physio Network Research Reviews is a great start, but don’t forget the human stuff. The messy, meaningful stuff.

In the end, rehab isn’t just about rebuilding strength, it’s about reclaiming the moments that make life yours again.

If you want to know more, read Dr Anthony Teoli’s full Research Review on activity recommendations post-hip or knee arthroplasty HERE, or check out Physio Network’s full library of Research Reviews HERE.