Most information about hip replacement stops at the operation. Patients hear about the scar, the crutches and the day they go home, yet the questions Dr Arj Imbuldeniya, Consultant Orthopaedic Hip and Knee Surgeon at Cromwell Hospital, hears most often in clinic are about the weeks that follow and the sensations nobody warned them to expect. None of the things below usually means anything has gone wrong, and knowing about them in advance can take much of the worry away.
In this guide, Dr Imbuldeniya walks through the first few days after surgery, the first six weeks of recovery, how to get your home ready, and when to call us. Your own team will tailor the advice to you, because recovery differs between surgical approaches and between individuals, but these are the questions he hears most often.
The first few days
Most people walk on the day of surgery or the day after, with a frame or crutches at first, and physiotherapy starts straight away. The leg can feel strangely heavy, almost as though it belongs to someone else, and for the first week or two you may need your hands, a strap or a leg lifter to get it into bed. This is swelling, together with the muscles around the hip temporarily switching off after surgery; it is not nerve damage, and it improves as the swelling settles.
A few days after the operation, bruising often appears well down the thigh, sometimes as far as the knee or ankle. It can look dramatic, but it is simply old blood drifting downwards with gravity. Some people also pass urine far more often for a day or two as the body clears the fluids given during surgery, and the stronger painkillers make constipation very common, so a gentle laxative from the first day helps.
Weeks one to six
Swelling usually peaks in the first week or two and can take several weeks to settle fully; gentle walking, and lying with the leg raised for short spells through the day, both help. Sudden, sharp, electric zings around the scar or down the thigh are common around the second or third week, as the tiny skin nerves cut during surgery recover, and a patch of numbness beside the scar is also common and usually shrinks over the following months.
Many people feel that the operated leg is now longer. Occasionally it is, by a small amount, but far more often the feeling comes from years of arthritis, during which the body tilted the pelvis and tightened muscles to protect the painful hip, and it takes time to adjust to a hip that now sits properly. Please do not buy a shoe raise without speaking to us first, because for most people the feeling settles over the first few months. A soft click as you stand up can be a tendon moving over the new hip, and if it is painless it is usually nothing to worry about.
Sleep is often poor for the first few weeks, and many people hit a low patch towards the end of the first or second week, when the adrenaline has gone, the stronger painkillers are being reduced and progress feels slow. It is very common, it does not mean the operation has failed, and it lifts as you get moving again.
Getting your home ready
Before surgery, clear the routes between your bed, your chair and the bathroom of loose rugs and trailing cables, and put night lights in the hallway and bathroom. A firm, fairly high chair with arms, where your hips sit a little above your knees, is far easier to get out of than a low sofa or a heavy recliner, and you do not need expensive specialist furniture. A raised toilet seat, a shower stool or bath board, a long-handled sponge, a grabber and a leg lifter all make the first fortnight easier.
For the journey home, a car with a higher seat is easier than a low saloon: sit down backwards first, then swing your legs in. Your team will tell you which movement restrictions, if any, apply to you, as these differ between approaches, and many of my Röttinger patients have few or none.
Driving, work and travel
Most people can drive again at around four to six weeks, once they are off the stronger painkillers and can do an emergency stop safely, and it is worth checking with your insurer. People with desk jobs often return within a few weeks, while physical jobs usually need longer.
If you are planning to fly in the first few months, ask us first, because the risk of blood clots is higher after surgery.
When to call us
You will be given medicine to lower the risk of blood clots, and it is important to finish the full course. Contact us straight away if you notice pain, swelling or tenderness in the calf, redness, heat or leakage from the wound, or a high temperature, or if you suddenly develop severe pain and the leg looks shorter or turned outwards, which can mean the hip has dislocated.
Chest pain or breathlessness needs an urgent call to 999.
The longer view
Most of the improvement in pain and walking comes in the first three months, and gains continue for up to a year. Biology first does not stop when an operation is needed.
Arriving stronger, with blood sugar well controlled, any anaemia treated and smoking stopped, makes surgery safer and recovery smoother, so I look at these things with my patients well before the day of the operation.
Recovery at Cromwell Hospital
I see patients and operate at Cromwell Hospital, where assessment, imaging, surgery and rehabilitation support all happen within one hospital. Many of my patients have the Röttinger approach, which goes between the muscles rather than through them, and many suitable patients are walking on the day of surgery.
About the author
Dr Arj Imbuldeniya is a Consultant Knee and Hip Surgeon with over 25 years' experience, and the founder of OrthoLongevity - a biology-first, surgery-last approach to joint health that integrates orthopaedic surgery, regenerative medicine, longevity thinking, and biological risk profiling.
Most joint pain does not require surgery. Up to 90% of his patients avoid an operation altogether - through precise diagnosis, targeted regenerative treatments, and personalised programmes addressing the full picture: tissue biology, inflammatory load, movement quality, posture, gait, nutrition, sleep, and stress. Those who do require surgery are biologically and mechanically optimised beforehand, and supported through joined-up rehabilitation afterwards.
