How to Rebuild Strength After Hip Replacement
- Tom Morgan, Chartered Physiotherapist
- Aug 9
- 3 min read
Hip replacement can remove the painful joint surfaces, but it does not instantly restore the muscle strength lost through arthritis, reduced activity and surgery.
Rebuilding strength is a gradual process. The best programmes move from basic activation to functional exercises, then to progressive resistance that is challenging enough to create further adaptation.
Which muscles become weak?
The gluteal muscles are a major focus because they control the hip and pelvis during walking. The quadriceps, hamstrings, calves and trunk muscles also contribute to everyday mobility.
Start with gluteal activation
Early gluteal squeezes and supported hip abduction help re-establish muscle activation. They may feel basic, but they create the foundation for later walking and single-leg control.
Use sit-to-stand as a functional strength exercise
Sit-to-stand trains the quadriceps, gluteals and trunk in a movement you use every day. Start with a higher firm chair or arm support if needed, then reduce assistance as strength improves.
Progress hip abductor strength
Standing hip abduction, clam shells and later band walks or cable work can progressively challenge the outer hip muscles.
Good technique matters: leaning the trunk to lift the leg higher reduces the demand on the muscle you are trying to train.
Want the full hip replacement recovery plan?
Add step-ups and squats
Step-ups train the same basic pattern needed for stairs and kerbs. Squats develop coordinated hip and knee strength.
Begin with a manageable range and stable support, then progress height, depth or resistance.
Move towards gym resistance
From around six to eight weeks, suitable patients may introduce light leg press work. Later progressions can include hip thrusts, Romanian deadlifts and more demanding single-leg exercises.
Use progressive overload
If an exercise always feels easy, it may no longer be providing enough stimulus. Progress can come from additional resistance, more range, more repetitions or a harder movement variation.
Do not increase everything at once.
Train both legs
The operated side deserves attention, but avoiding the non-operated leg is not helpful. Train both sides and use the stronger side as a useful reference rather than something to compete with every session.
Strength takes longer than pain relief
A hip can feel dramatically better before the muscles are fully restored. Meaningful gains can continue well beyond six months with consistent training, so it is not too late to improve if you feel behind.
When should you seek further advice?
Recovery is rarely a perfectly straight line, but new or rapidly worsening symptoms should not simply be pushed through. Contact your surgical team, GP or physiotherapist if pain, swelling, movement or function is moving in the wrong direction rather than gradually improving. Seek urgent medical attention for symptoms such as sudden breathlessness or chest pain, marked one-sided calf swelling, a hot increasingly red joint with fever, sudden loss of function, or other symptoms your surgical team has told you require urgent review.
Want the full hip replacement recovery plan?
This article provides general information and does not replace advice from your own surgeon, physiotherapist or medical team. Recovery varies between individuals and any specific restrictions or weight-bearing instructions from your surgical team should take priority.
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