PT Resources

Total Hip Replacement

Total Hip Replacement Protocol (cementless)

General Precautions:

  • TDWB for first few weeks (per physician)
  • Internal rotation to 0° only (1-12 weeks post-op)
  • Adduction to 0° only (1-12 weeks post-op)
  • Hip flexion to 90° only (1-12 weeks post-op)
Post -op

0-4 Weeks

Goals: Safe and independent use of crutches or walker. Independent with knowledge and maintenance of hip precautions. Daily performance of home exercise program. All exercises to be repeated 25x, 2-3 x/day. When wound completely healed, begin scar tissue massage. Exercises:

  • 1. Quad sets- tighten knee muscles of outstretched leg by pushing the back of the knee into the bed, hold 5 seconds.
  • 2. Gluteal sets- squeeze buttocks together, hold 5 seconds.
  • 3. Heel slides- bend knee sliding knee towards buttocks, then slide heel back away from body.
  • 4. Hip abduction & adduction- lay on back, slide straight leg out to side and back in, careful not to cross midline.
  • 5. Short arc quads- put 6 inch towel roll under knee. Straighten lower leg until knee is fully extended and hold for 5 seconds. Then relax and slowly bend knee back to original position.
  • 6. Long arc quads- seated, let legs bend to 90°, straighten lower leg until knee fully extended. Then relax and slowly bend knee down to original position.

4-8 Weeks

Goals: With physician approval, increase weight bearing by 25%/week until 100% weight bearing. Utilize cane as soon as able and safe. Maintain general hip precautions. Exercises:

  • 1. Stationary bike adjusted to not exceed 90° hip flexion. (When approved by MD)
  • 2. Prone hip extension.
  • 3. Mini squats.
  • 4. Bridges.
  • 5. SLR. (flexion & abduction)
  • 6. Hip rotation (NO IR, ER to 30°)
  • 7. Calf raises.
  • 8. Standing hip abduction.
  • 9. Standing hip extension.
  • 10. Marching.

8-12 Weeks

Goals: Ambulation without device. Ascend and descend stairs in a step over step fashion. Exercises:
Aquatic Program

  • 1. Shallow water walking waist deep.
  • 2. SLR in waist deep water (buoyancy assisted and resisted).
  • 3. Hip abduction.
  • 4. Hip extension.
  • 5. Hip flexion to 90°.
  • 6. Knee flexion & extension.
  • 7. Deep well exercises (bicycle, cross country ski)


  • Golf when off 2 crutches and steady, approximately 3-4 months.
  • ρ chip and putt approx. 3 months.
  • ρ driving approx. 4 months.
  • ρ cart recommended for first 6 months

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