Total Hip Replacement Physiotherapy in Singapore

Hip replacement rehabilitation at a glance

What makes hip replacement rehabilitation different?

After a hip replacement the early questions are about stability and walking. The new joint can dislocate in the first weeks if it is forced into certain positions, the muscles that were cut or stretched need time to recover, and a limp is common until the muscles at the side of the hip are strong again. Rehabilitation therefore combines protection, walking retraining and gradual strengthening.

Strength is the long game. A systematic review found that exercise directed by a physiotherapist after discharge improves hip abductor strength, gait speed and cadence (review), which is why the exercises carry on long after the wound has healed.

For the general stages of recovery after surgery, and the signs that need urgent help, see our post-surgery physiotherapy page. Here we stay with the hip.

Do you need hip precautions after a hip replacement?

It depends on your surgeon and the surgical approach, and the evidence suggests the rules matter less than once thought. NHS leaflets range from no movement restrictions to precautions for 12 weeks, and reviews of posterior-approach replacements found about 2% of people dislocated whether or not they followed precautions. Until your surgeon says otherwise, follow the rules you were given.

The leaflets are from Tan Tock Seng Hospital, Lancashire, Gateshead, Royal Wolverhampton, St George's and University Hospitals Birmingham. Singapore General Hospital's enhanced recovery programme uses the direct anterior approach (SGH).

What the evidence shows

A systematic review of 6,900 patients found dislocation in 2.2% of people given precautions and 2.0% of those given none after a posterior approach. A second review of 9,599 hips found a relative risk of 0.98 with minimal or no restrictions, although the evidence was of low quality. The most recent review of 8,835 patients concluded that current evidence does not support routinely prescribing precautions after a posterior approach for osteoarthritis.

Dislocation needs urgent treatment, so surgeons differ in how cautious they are. That decision is theirs, and we work within it.

How the approach changes what we watch

Complications differ by approach, as a Canadian Journal of Surgery review sets out. Ask your surgeon which approach you had.

If your surgeon has set precautions

• Sit in a high, firm chair, with your hips higher than your knees (Spencer leaflet).
• Dress the operated leg first and undress it last, using a helping hand and a sock aid if you need them.
• Sleep on your back, or on the non-operated side with a pillow between your knees.
• Turn in small steps rather than twisting on the operated leg.

Hip replacement in the first two weeks: from hospital to home in Singapore

Hip replacement stays in Singapore have shortened. A typical stay was four to five days, and Singapore General Hospital's enhanced recovery programme now lets some patients go home within 23 hours (HealthXchange). At Tan Tock Seng Hospital a physiotherapist sees you on the day of surgery or the day after to get you standing and walking (TTSH).

SGH arranges home visits by physiotherapists and community nurses in the first two weeks. Between those contacts, your own exercises do most of the work.

What the first two weeks involve

• Walk short distances often with your frame or crutches, and follow the weight-bearing instructions you were given.
• Do your exercises three times a day: ankle pumps, thigh squeezes, heel slides and lying hip abduction, within your precautions.
• Use an ice pack, wrapped in a towel, for swelling, and expect some swelling in the leg (SGH).
• Take stairs one step at a time: up with the un-operated leg, down with the operated leg and your crutches (Gateshead NHS).
• Ask before you leave hospital how and when to move to one stick.

We can see you at home in these weeks, where a 45-minute visit costs $320, or at the clinic once travel is comfortable. The post-surgery page sets out how to choose between home, clinic and online sessions.

Hip replacement recovery: walking, strength and activity targets by week

A common pattern is a frame or two crutches at first, one stick as the limp settles, and no aid somewhere between four and twelve weeks, with strength and walking pattern improving for months after that. Your surgeon's instructions and your own progress set the real timetable.

The ranges draw on NHS leaflets from St George's, Gateshead, Royal Wolverhampton and University Hospitals Birmingham. Walking aids are usually needed for about four to eight weeks, and sometimes up to twelve.

Why do you limp after a hip replacement, and when does it go?

A limp is common because the muscles at the side of the hip, the abductors, are often weak, sore or were cut during surgery, and a weak side lets the pelvis drop when you stand on that leg. It usually improves as strength returns, and NHS leaflets advise keeping the stick until you can walk without a limp. A limp that lingers needs a proper look at strength, pain, stride length and leg length.

A systematic review found that exercises directed by a physiotherapist after discharge improve hip abductor strength, gait speed and cadence, and that they appear to work about as well unsupervised at home as supervised in a clinic.

Does the operated leg feel longer?

Many people feel that one leg is a different length after a hip replacement. In a postal survey of people five to eight years after surgery, about a third perceived a difference, and those who did had poorer function (Wylde and others, 2009). Of those who perceived a difference, 31% used a shoe raise.

Some of the difference is apparent rather than real, caused by the pelvis tilting while the hip muscles are tight, and it often settles as movement and strength return (self-reported leg length study). If a difference bothers you or lasts beyond a few months, tell your surgeon, because it can be measured on an X-ray.

Can you sit cross-legged, squat or pray on the floor after a hip replacement?

Sometimes, but not early, and not for everyone. In a Thai study of 240 people with a posterior-approach replacement, 21.7% could sit on the floor six months later, and the strongest predictor was whether they could before surgery. Ask your surgeon before you try, because the rules depend on your approach.

The first three rows come from a small 2023 conference study of eight healthy people. The last two come from the Thai study, which cites earlier measurements.

In that study, patients followed precautions for six weeks and had no restrictions afterwards. Those who could sit on the floor before surgery had about ten times the odds of managing it afterwards (Nawatthakul and others, 2022). The tasks that bend the hip most are the ones precautions target: low seats, shoes, toilets and getting into bed.

We check your hip movement, tell you what is realistic for your hip and plan around it: a raised toilet seat, a sock aid, a chair for meals and prayer while precautions apply, and graded floor-sitting practice when your surgeon agrees. If you sit on the floor to pray or eat, mention it to your surgeon before surgery so that the approach and the rules can be discussed.

How much physiotherapy do you need after a hip replacement?

Trials suggest that for most people a good home exercise programme does about as well as supervised physiotherapy. A meta-analysis of seven trials and 389 people found that supervised exercise was not significantly better than home-based exercise for function, pain or quality of life after hip replacement (Hansen and others, 2019).

A second review of seven trials and 398 people found only a small short-term advantage for supervised physiotherapy in self-reported outcomes, and suggested that routine supervised physiotherapy may not give a clinically significant benefit.

Supervised sessions help most if

• You are still limping, or still need two aids, well after the early weeks.
• You cannot do the exercises without pain, or you are unsure which movements break your precautions.
• Your hip muscles feel weak: you cannot balance on the operated leg without the pelvis dropping.
• You live alone, face stairs at home or have had both hips replaced.
• You have goals that need a lot of hip movement, such as prayer on the floor, gardening, dancing or golf.

If you are walking well and keeping up your programme, one visit to review it may be all you need. No referral is usually needed before your first visit with us.

Getting back to activities after a hip replacement

Walking, swimming, cycling and golf are encouraged after a hip replacement once your surgeon agrees, and dancing is usually allowed. Surgeons generally advise against running, jumping sports and contact sports.

That advice comes from a 2018 review and a survey of Dutch orthopaedic surgeons, and it reflects surgeon opinion more than trials. Badminton and tennis are a conversation with your surgeon rather than a rule. Gardening and other floor-level tasks need the same care as floor sitting, so ask before you go back to them.

How we run hip replacement rehabilitation at Benchmark Physio

We start from your operation note, agree which rules apply to you, and rebuild the walk and the muscles around the hip in steps.

Frequently asked questions about hip replacement rehabilitation

Related services

• Post-surgery physiotherapy
• Hip pain
• Home physiotherapy
• Online physiotherapy
• Lower back pain

Sources

The ranges and figures on this page come from the studies, hospital leaflets and guidance below. Protocols differ between surgeons and hospitals, so your own instructions take priority. Last reviewed October 2026.

1. Crompton J and others. Do hip precautions after posterior-approach total hip arthroplasty affect dislocation rates? A systematic review of 7 studies with 6,900 patients. Acta Orthopaedica, 2020
2. Reimert J and others. Are hip movement precautions effective in preventing prosthesis dislocation post total hip arthroplasty? A systematic review and meta-analysis. Disability and Rehabilitation, 2022
3. Hip precautions after posterior-approach total hip arthroplasty for primary hip osteoarthritis: a systematic review and meta-analysis of 8,835 patients. Acta Orthopaedica
4. Surgical approach in primary total hip arthroplasty: anatomy, technique and clinical outcomes. Canadian Journal of Surgery, 2015
5. Nawatthakul A and others. The ability and factors related with floor sitting after total hip arthroplasty with a posterolateral approach. Orthopedic Reviews, 2022
6. Sah A and Chinimilli P. Hip motion during activities of daily living. ISAKOS Congress 2023, conference abstract
7. Physiotherapist-directed rehabilitation exercises in the outpatient or home setting improve strength, gait speed and cadence after elective total hip replacement: a systematic review
8. Hansen S and others. 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
9. Unsupervised home exercises versus formal physical therapy after primary total hip arthroplasty: a systematic review
10. Wylde V and others. Prevalence and functional impact of patient-perceived leg length discrepancy after hip replacement. International Orthopaedics, 2009
11. Influence of self-reported leg length discrepancy on function and satisfaction 6 years after total hip replacement
12. Evans JT and others. How long does a hip replacement last? The Lancet, 2019 (NIHR summary)
13. Oljaca A and others. Current knowledge in orthopaedic surgery on recommending sport activities after total hip and knee replacement. Acta Orthopaedica Belgica, 2018
14. Sport advice given by Dutch orthopaedic surgeons to patients after a total hip arthroplasty or total knee arthroplasty
15. Physiotherapy advice and exercises following total hip replacement. Lancashire Teaching Hospitals NHS Foundation Trust
16. Physiotherapy following hip replacement surgery. Gateshead Health NHS Foundation Trust
17. Exercise and guidance following hip replacement surgery. Royal Wolverhampton NHS Trust
18. Total hip and knee replacement post-operative leaflet. St George's University Hospitals NHS Foundation Trust
19. Guidance following your hip replacement. University Hospitals Birmingham NHS Foundation Trust
20. Total hip replacement physiotherapy leaflet. Spencer Private Hospitals
21. SGH cuts hospital stay for total hip replacement patients from days to hours with enhanced recovery programme. HealthXchange, 2020
22. Elective total hip replacement. Tan Tock Seng Hospital patient guide
23. After surgery care for total hip replacement (direct anterior approach). Singapore General Hospital