Training After Total Hip Replacement

Training
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Hi, I’m curious if any TR users have come back to training after major leg surgeries, and if so, what that process has been like?

I am 42 and I have a total hip replacement (ceramic socket and ball replacement) scheduled next month. I’ve been riding and training through the pain of osteoarthritis for several years (the bi-product of BMXing and skateboarding my entire life), but the opportunity has come to have all that pain removed and my range of movement increased.

It’s hard to gage accurate recovery times as the procedure is usually given to much older people who have been sedentary for quite some time due to the pain. I’m going into the surgery pretty fit and have an indoor trainer set up for my recovery, plus all the knowledge I’ve gained from managing the condition with exercise (on and off bike) and diet.

I’m also pretty stubborn.

Any information about any of your experiences would be greatly appreciated!

All the best,

Rhys

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I don’t have any specific details, but a riding buddy had his hip replaced about 10 (?) years ago at a similar age. Obviously there was a lot of rehab that went into it, but he got back to riding full time eventually, but I don’t recall the exact time frame.

He did give up running, however (he was a triathlete and a very stand-alone runner).

My best suggestion is to hit the PT as prescribed and treat it like it is your training. But there is no reason you shouldn’t be able to return to your previous level of activity….and be pain free.

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A friend of mine broke his femoral neck some years ago. He was back on his bike within weeks, long before he could retire his crutches. Not quite the same but still… Consult your doctor, but I’ll be surprised if they won’t be supportive of getting back on your bike as soon as possible.

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Yep. Like other responders so far, I don’t have personal experience as I haven’t had a hip replacement but know several people who have. I can say it worked out really well for them. One was back to very active mtbing and rock climbing within a year. Both said they had wished they had done it sooner.

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I had both hips replaced in 2018, and the only question I’ve ever had is why didn’t I do it sooner… You’re doing the right thing going into the surgery fit: that’ll make a big difference in how fast you recover. Other things to prepare:

  • Depending on whether you get an anterior surgery or the traditional approach from the back, you may have some movement restrictions for a few weeks. II prepped the furniture with risers so I wouldn’t have to bend my legs past 90º to get up and down, but if you have an anterior approach you won’t have to worry about that. (I chose the back approach because it was easier on the surgeon. Last thing I wanted was to make his work harder.)
  • Get ice and big ice bag. You’ll need it.

As for surgery and recovery:

  • The surgery is surprisingly easy. They’ve got pain control pretty much down. The worst discomfort might be nausea the first day, particularly when you stand and move - that’s probably the anesthetic wearing off.
  • The first week you’ll have a few days when you feel pretty sore. I iced a ton and saved the pain meds for night time to help me sleep - I shifted from the prescribed narcotics to NSAIDS as soon as I could since I didn’t care for the pain med side effects, but there were a few days when they were pretty nice to have. Things started to normalize around days 9-10.
  • PT: I found it disappointing. They primarily want to improve the support muscles around the hip to protect it, but if you’ve been training up to surgery, they’re in pretty good shape already - much better than the vast majority of the people they’ll see. (One PT told me he had trouble believing I’d had surgery at all.)
  • Walking was by far my favorite exercise for recovery. I found a local outdoor shopping center and walked in the mornings and evenings when there were fewer people to bump into with my walker. Transitioning to a cane (sometime near the end of the 2nd week I think?) helped.
  • Moods. Recovery felt frustratingly slow at times, and it was hard not to feel impatient and try to rush things, especially week 2-5 when the rate of improvement slowed. It’s easy to get frustrated with how slow progress seems at times - I remember it seemed like it took forever to ditch the cane. In retrospect, it’ll seem like a blur.
  • The trainer: you’ll probably be on it sooner than later - check with your surgeon when you get your staples out (around 2 weeks).

There’s also a site called Bonesmart where people who’ve had THR post their experiences that I found enormously helpful in terms of what’s normal and what’s not.

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Wow, thank you so much! I really appreciate all the replies, but this one in particular has been really helpful. Thank you for being so generous with your time and words.

I believe i am having the anterior surgery (will double-check tomorrow), and I was told by my surgeon that I’d leave on crutches the same day of the operation!

I’ve also been dealing with the pain with daily flexibility stretches and multiple hip strengthening sessions per week, as well as riding pretty seriously for a number of years. Hopefully this gives me a head start with recovery.

Ultimately, until recently, the joy of being out on my bike outweighed the discomfort, but I was told I could get a full range of motion back and live pain-free… and that seemed too good to pass up.

I’m pretty excited to see how fit I can get without the pain of the arthritis, just the pain of actual riding. I’ll keep you posted!

Thanks again,

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I had a total right a few years ago. The recovery was pretty easy, That evening, post-op, I was walking the floors of the hospital, high on pain killers, and having a great time. Got home, had dinner, passed out, and by 3am the pain killers wore off and the cramping intense pain set in. Narcotics couldn’t touch it. (Post op, the surgeon came in and mentioned to my wife that ‘he’s going to have a hard recovery, I didn’t realize how muscular he is’. (He told me to not stop riding pre-op, so I kept doing Zwift Academy, and killing rides)

After all that, and bored out of my mind, I hopped on the trainer within 3 days (But don’t use clipless pedals!! The force to unclip was unnerving, see DISLOCATE HIP), doing easy low resistance work, and basically ‘spinning’, no set workout or plan, increasing the resistance a little each day. I was surprised that there wasn’t any pain in the hip at all, but the muscles were still traumatized. Occasionally getting comfortable on the saddle took some time and tended to limit the time I was able to ride. I was also instructed what not to do for stretching and posture, and to watch for modes of infection too.

I was also strongly advised to not ride outdoors for the next 6 to 9 months, but started ripping on the trainer and felt great. My first followup, the surgeon asked me if I was ‘already on the bike’, and looked at my wife. She looked at me, and I said that I was, but was ‘being good’. He chuckled and said that he figured I was, that ‘people like you don’t like to stay off the bike’, and that he really hoped I was ‘being good’. I know enough physicians and they said to be very careful that I don’t dislocate that new hip, and ominously said ‘remember that first night? It’ll be even worse!’.

I joked last week that I should probably get the other one done before the shit hits the fan, and the wife wasn’t exactly happy/laughing.

I had a congenital problem and it was just getting worse over the years, and biking wasn’t helping it. I had the first pre-op appointment and went to Dizzy World for vaca, and had some issues with hip pain. We got back, and an MRI revealed the extent of the degeneration. The wife started crying and apologized over and over for ‘dragging your hip all over Orlando’. I guess it was pretty bad…

So glad I got it done. The nerve pain I had due to nerve impingement syndrome gradually disappeared, and it feels great. You won’t miss the arthritis pain a bit. Ride on!

Also even though it’s titanium, TSA freaks out and I have to go through the scanner every time I fly. I’ve thought of just saying no to the query of any artificial joints.

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Are you me? :rofl:

I had my right hip replaced last September 19th due to avascular necrosis. Im also 42, grew up racing BMX (MTB now), and went in to the procedure very fit.

The first couple days after surgery kinda sucked, but after that it was a very consistently progressive recovery process. Best decision I ever made.

I was off crutches at 2 weeks and lightly pedaling on the trainer for 10 mins a day. I steadily increased the trainer time until I was able to do 2 hours, which was the middle of November. And then I started a mid volume masters plan (8-10 hrs) and have been training consistently since. Hip feels great.

I have had some glute soreness at times but I think that has more to do with skiing than anything else.

You won’t regret it!

EDIT: Regarding PT – I feel similar to the poster above. I was pretty disappointed with it. Everything was very very easy and didnt really seem to be doing much. Probably because most of the people they see for hips are elderly. I found walking and stretching to be the most beneficial at the beginning.

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Thank you so much!! Hadn’t even thought about the pedals! Looks like I’ll be digging my old Shimano DX flat pedals out!!!

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Thank you!

So the gist of it is… in the short-term things are going to be pretty rough afterwards, but this is something that could potentially be transformative in the long term? Sounds like a Trainer Road VO2 Max session!

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Just had a double titanium hip replacements (lateral approach 18 weeks apart). The 2nd one being 15 weeks ago.

I was allowed back on a turbo spinning very easily each time at 4 weeks, using flat pedals for a week. The first session each time I had to start with 10 minutes back pedalling… harder than anticipated.
At 8 week each time I started picking up training but keeping to 1 hour maximum. I mainly did endurance sessions but more recently VO2 work up to 1 minute reps (I’ve lost s lot of fitness during the last 18 months).
Be ready to be very tired from recovering & training and boost your protein intake to help.
Currently (week 15 post 2nd op), I have been riding Peak District (UK) gravel up to 40 miles gradually building up the ascent and narlyness.
Started lifting again including squats & leg press week 13 after 2nd operation
In 6 weeks time I plan to do my first 10 mile TT in 18 months… aim is sub 30 minutes (evens).

General advice.
Stay ahead of the pain especially in weeks 1-3. Take the pain killers before you need them don’t try to be brave.
Do the physio exercises especially the hip abduction work it will make a huge difference to how you walk.
Keep up the walking afterwards but don’t go too mad too soon and set yourself back for a couple of days.
Don’t be too keen to ditch the crutches early, they help with balance,
Make sure you have someone to help you at home as even simple things require a bit of planning without.

Good luck.

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Yeah, I forgot to mention – its pretty easy to over do it at the beginning since for me everything felt so good. But its deceiving. I went back to work at 2 weeks and definitely did too much and ended up back on the couch for 2 days.

Its all about balancing being up and moving and taking plenty of time to be off your feet as well.

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I lowered my saddle and used a pair of Merrill slipper/shoes. Worked great for the week or two I was just spinning along. I don’t have flats though, but great idea, just lower the saddle. I did get some discomfort around the glutes and the new hip, so I cremed that up and lowered the saddle and it worked great.

I never did crutches, they issued a walker, and a cane, that I used the walker for one day (great use of money) and the cane for a couple weeks, and they wanted me walking as soon and as much as possible, hence that day post-op, I felt great (narcotics are amazing) and figured I’d walk all over the place.

Elderly Yeah, I got a lot of attention from the female nurses. The surgeon actually kind of apologized for it saying that ‘the men we usually see think getting up for the remote is exercise’. The one young nurse that came in to shave/prep my leg did The Whole Leg and Glutes, waist to foot, front and back. My wife sat there with a weird look on her face. Afterward, I asked her, and she burst out laughing: ‘She was enjoying it!!’, I was shocked and faked anger over her ‘allowing’ that woman to abuse me, and she said that it was harmless and she really was into doing it. I said that I felt ‘dirty’, and she laughed again. I huffed ‘Well at least she could have done the other one too!’ and got a frown and a laugh: ‘You would deny her opportunity to fondle your leg?’. I lost that conversation.

Even in the office, I was somewhat of an oddity.

One last thing: I asked the surgeon if the new hip came with a mileage warranty, and he didn’t laugh. ‘Be careful with that because a redo will be harder to do and harder to recover from’. Then, after running into my wife in the hospital said ‘He asked me if it had a mileage warranty, and I wasn’t laughing. How much doe she ride?’ and then supposedly said ‘I figured he’d be a problem. I hope I’m still here when he needs a revision’. He’s a really great guy, and does great work. I hope I was able to loosen up his bead side manner…

On PT: It was offered, but I didn’t really need it. I did have ‘occupational therapy’ both pre-op, and that night post-op covering what to and not to do. Walking, stepping up, getting in/out of a chair, getting in/out of bed. All things that I didn’t realize could complicate things. I worked on stretching (very carefully) and keeping the meat moving. Stretching is a big danger early in rehab as it’s just those muscles that hold the new joint together. Some stretches could easily pop the ball out of the cup and getting it back takes a lot of anesthetic, muscle relaxers, and surgery. It’s not at all comfortable to have it happen, or have it put back in place. OUCH!! That fear kept me inline, surprisingly…

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i had an anterior hip replacement end of oct 2024 at the age of 56.

pain: initially my pain was out of control and i had to have the narcotics prescription changed to better control the pain. do not hesitate to call and get meds changed if needed. keeping the pain medications exactly on schedule was important to me or the pain was rampant.

pt: i did not like the physical therapist much. i had a hard time with the pt exercises and was behind schedule pt exercise progression. the main exercise they want you to do is walking, an exercise that i initially found painful, slow, and depressing. it just took me longer to heal. people vary. my mother’s 76 year old husband did not need to take narcotics at all and was up and walking much quicker than i was.

walking: switched from walker to cane at 2 weeks after surgery on insistence from pt. i was able to walk inside with limp without cane at 6 weeks. i able to get rid of cane altogether at 9 weeks after surgery.

work: went back to work at 9 weeks after surgery. i do not have a desk job.

biking: got on trainer at 3 weeks after surgery, but only used one leg. i placed the surgery leg on a box. at this point i did not have range of motion in surgery leg to make full pedaling circle. i did short sessions, one legged with low power (28-40 watts). (i am female)

6 weeks after surgery, i was able to use trainer with both legs, but power was still low (around 40-50 watts). i quickly progressed doing a lot of high zone 1 and low zone 2 over the next 3 weeks, doing about 9-13 hours a week on the trainer. i rode outside at 9 weeks out. at that point, i was still unable to stand while cycling, but otherwise, i was fine outside. i am riding tempo and endurance well now, but i lack top end.

lifting: i went back to the gym 4 weeks after the surgery. i have a bus stop ¼ of a block from me and this bus was able to take me directly to the gym. the gym is only about ⅔ of a mile away, but i was unable to walk that distance for a couple of more weeks. i did not do any leg exercises. i was very happy to be able to get to the gym.

quad injury: the anterior surgery cuts into the quad, injuring it. i still do not have full quad flexion back, which is causing knee pain. i am still not able to do leg exercises well in the gym due to the lack of normal range of motion and knee pain. the flexion keeps getting better and i hope that it will get back to normal eventually.

depression: i found the whole process very depressing, being in pain, not being able to move when normally very active, and pain medications are all depressing.

hip pain: the hip and leg pain caused by the arthritis were gone the day after the surgery. i had been walking with cane or walking sticks for about 10 months prior to the surgery and i am now walking pretty normally. i am still stiff in the morning. prior to the surgery my activities were very hampered by the fact that i found walking more than ½ mile very difficult. i can now walk 3 miles easily with no pain. i could probably walk more, but i have been focused on cycling.

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My surgeon did it laterally, and said that was ‘the best’ in his opinion. One other surgeon did anterior surgery and supposedly had more returns to the ER or his practice. A lot of that is likely conjecture and rumors. :person_shrugging:

Like the prostatectomy: some swore single port was better, and others went with multiport, some favored catheters removed at 1 week, others favored 30 days, or longer. In the end, it has to be done, and we just hope for the best. (He did a great job actually)

We all need to be better educated medical consumers, but also no surgery is completely free of possible complications. I’m sorry for your experience. Hopefully there is enough positive to offset the negative.

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ps: at 4 months out, i am riding well. my knee on the surgery leg is still tender at times, but that is not inhibiting my riding. i did a 4hr 44 min ride on monday, trainer workouts on Thursday and saturday, and 3.5 hour ride on sunday. i can stand while cycling, but not as strongly as before due to knee tenderness. my right to left ration by double sided power meter is better than it has been in years.

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THANK YOU to everyone who replied. This has been so very helpful. Here’s to the recovery!!!

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I’m having my right hip done on Tuesday (2 days from now), anterior approach - I just don’t know what to expect post op really! Everyone’s experiences seem so individual. I’m 43, pretty fit although this past year my hip has really started to affect how I ride. My ftp is like 30 watts less than normal, for a woman of my size 30 watts is a great deal too. I also have hip dysplasia and am hypermobile so I’m definitely scared of dislocating the new hip. But it’s going to be very hard for me to not overdo it during the recovery period I imagine. My surgeon really stressed that the bone needs to set in and heal around the implant properly in the first 3 months and after that I can “really beat it up” lol. So we’ll see, I’ll give y’all an update soon I guess!

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Yes, keep me updated!!! I’m de to have mine on the 22nd!

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I had just commuted into work when I was knocked off my bike while going round an island. The car driver simply didn’t stop at the island and ran into me.

Sat in the hospital bed three days later and currently 8 hrs post op.

Now I have an adversity to drugs and held out for the first 30 hrs on paracetamol. I wanted to use the morphine as a last resort rather than a first stop. This was a total idiot move on myside. We have a couple of nurses in my family, one retired , my mom and one practising, my niece . Both of whom suggested get the good stuff down your neck when offered.

Rehab starts later today and I’m looking forward to starting the journey back to recovery. Gutted I’ll miss my Mallorca cycling holiday but feeling rather lucky to still be here .

For those of a certain age, hopefully you’ll remember the old desk Sargent in Hill Street Blues” and his words of wisdom “ let’s be careful out there”.

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