Quick Questions and Answers
When can I start hydrotherapy after a hip replacement?
At AquaPhysio, we can often start hydrotherapy from around 2 weeks after surgery, provided your wound is fully healed, there are no complications and your consultant's protocol allow it.
Why am I still limping after my hip replacement?
There are several reasons, but one of the most common is weakness in the gluteal muscles, particularly those responsible for keeping your pelvis level when you stand on one leg. You may also have developed a limp before surgery that has become a habit.
How does hydrotherapy help me walk better?
The water supports some of your body weight, allowing you to practise walking with less load through your hip. We can work on your walking pattern, muscle strength, balance and confidence before progressing these activities on land.
Should I keep using my crutches if I'm still limping?
Yes, if you still need them to walk well. It's often better to use a walking aid for a little longer and maintain a good walking pattern than to discard it too early and develop a significant limp. Your physiotherapist can advise when you're ready to reduce your support.
How long does it take to walk normally after a hip replacement?
Many patients are walking more comfortably within 6 to 12 weeks, but this varies considerably. If you've had significant muscle weakness or a limp for years before surgery, rebuilding your strength and walking pattern can take several months.
You've Had Your Hip Replaced. Why Isn't Walking Normal Yet?
For many patients, having a hip replacement is something they've been looking forward to for a long time. They've been struggling with pain, finding walking increasingly difficult and perhaps giving up activities they really enjoy. It might be walking the dog, playing golf, gardening, going shopping or simply being able to go on holiday without worrying about how far they'll need to walk.
Following surgery, patients are usually encouraged to get up and start walking very quickly, often on the same day or the following morning. This is great, and early mobilisation is an important part of recovery.
The difficulty comes when patients expect that because they can walk, they should be walking normally.
We regularly see patients who are pleased with their new hip but are frustrated because they're still limping, feel unsteady or find themselves getting tired after relatively short distances.
The questions we get asked include:
- Why am I still limping when my hip pain has gone?
- Why does my operated leg feel so weak?
- When can I stop using my crutches?
- Why do I lean to one side when I walk?
- How far should I be walking each day?
- When can I get back to walking my dog?
- Will hydrotherapy help me walk normally again?
These are all very common concerns, and understanding why they're happening is an important part of your recovery. If you're still in the very early stages, we've also written about The First Week After a Hip Replacement: What to Expect, including early movement, managing swelling and preparing for rehabilitation.
Your Hip Has Been Replaced, but What About Your Muscles?
Before your hip replacement, you may have been living with pain for months or even years. During that time, you've probably changed the way you walk, stand and move without even realising it.
You might have started taking shorter steps, leaning away from your painful hip or putting more weight through your other leg. Over time, the muscles around your hip can become weaker because they're not being used as effectively as they should be.
One of the most important muscle groups is your gluteal muscles.
Your gluteals do much more than help you stand up or climb stairs. They play a really important role in controlling your pelvis and keeping you stable when you walk.
Every time you take a step, there's a moment when you're standing on just one leg. At that point, the muscles around your hip need to work hard to keep your pelvis level and stop your body dropping or leaning to one side.
If those muscles aren't strong enough, your walking pattern changes.
You might notice your body swaying from side to side or find yourself leaning over your operated hip every time you put weight through it. We call this a Trendelenburg-type walking pattern, although patients usually describe it much more simply as limping or waddling.
Replacing the hip joint doesn't automatically restore the strength and control of the muscles around it. That's something we need to work on.
Why Walking More Isn't Always the Answer
One of the things we often hear from patients is that they've been told to walk as much as possible after their hip replacement. Walking is important, and we certainly want patients to be active, but there's a difference between walking more and walking better.
If you're walking with a significant limp because your muscles are weak, simply increasing your walking distance isn't necessarily going to correct the problem.
You might manage a longer walk, but you could be reinforcing the same compensations with every step. For example, imagine you're walking the dog and after 10 minutes your hip muscles become tired. You start leaning to one side, your steps become shorter and you're putting more weight through your other leg. Continuing for another 20 minutes might increase the distance you've covered, but it isn't necessarily helping you develop a better walking pattern.
This is why we look at both the quality and quantity of walking. We want you to gradually increase your distance, but we also want you to maintain good control as you do it. Sometimes that means walking shorter distances more frequently, continuing to use a stick or crutch, or spending more time strengthening the muscles that support your hip.
Why We Use Hydrotherapy After a Hip Replacement
At AquaPhysio, we see the pool as a really useful part of early hip replacement rehabilitation, particularly for patients who are struggling with walking.
The reason is quite simple. On land, your muscles have to support your body weight every time you take a step. In the pool, the water supports some of that weight for you.
By changing the depth of the water, we can change how much weight you're putting through your legs. In approximately waist-deep water, effective weight-bearing can be reduced by around 50%, although this varies depending on your body position and how you're moving.
This means we can practise walking and strengthening exercises at a level that may be more comfortable and achievable than on land.
Our specialist hydrotherapy pool is kept at approximately 34°C, which many patients find particularly helpful when they're feeling stiff and sore after surgery.
One of the questions we're often asked is how soon patients can get into the pool following surgery. At AquaPhysio, we can often start from around 2 weeks, provided the wound has fully healed and your consultant is happy for you to begin.
We've explained this in more detail in our article I've Had My Hip Replaced. When Can I Safely Have Hydrotherapy?, which looks at when it's safe to start and what we need to consider before getting you into the water.
There are three things we're particularly interested in when helping someone return to walking.
1. Getting You Walking Without a Limp
When someone first comes into the pool following a hip replacement, one of the first things we look at is how they're walking.
Are they taking equal steps? Are they putting weight through both legs? Are they leaning to one side? Are they able to stand upright rather than bending forwards?
We can use the water to reduce the load through the operated leg and give patients the opportunity to practise a more normal walking pattern.
This might involve walking forwards, backwards and sideways, working on step length and practising transferring weight from one leg to the other.
We can also adjust the water depth as patients become stronger, gradually increasing how much weight they're taking. The aim is to improve walking in the pool and then transfer that improvement onto land.
2. Strengthening the Gluteal Muscles
If there's one group of muscles, I really want patients to understand following a hip replacement, it's the gluteal. In particular, the gluteus Medius plays a major role in controlling your pelvis when you're standing on one leg.
Think about walking. Every step involves lifting one foot off the ground and balancing on the other leg.If the muscles around your hip aren't strong enough to control that movement, your body will find ways to compensate.
In the pool, we can work on these muscles using exercises such as sideways walking, controlled hip movements, weight transfers and supported single-leg standing. The water allows us to adjust the amount of support while still challenging the muscles. As patients improve, we gradually increase the difficulty and start asking the muscles to do more.Of course, the pool isn't the only place we need to strengthen your gluteals. We also need to build this into your land-based exercises so that you're strong enough to manage everyday activities.
3. Improving Balance and Confidence
Something we see quite regularly after hip replacement surgery is that patients are nervous about putting their full weight through their operated leg.
This is understandable, particularly if they've spent a long-time avoiding weight through that hip because of pain.
Some patients also worry about falling or damaging their new joint. In the pool, we can practise standing on one leg, stepping in different directions and controlling movement with the support of the water. We can also use the gentle resistance of the water to challenge balance as patients become more confident.
This is particularly useful for someone whose goal is to get back to walking outdoors, where the ground isn't always flat and predictable. Walking along a pavement is one thing. Walking across grass, stepping off a kerb or managing uneven ground while holding a dog's lead requires much more balance and control.
We need to prepare patients for these everyday challenges.
What Does Hip Replacement Hydrotherapy Actually Involve?
We don't use exactly the same programme for everyone.
We need to know when you had your surgery, what surgical approach was used, whether you have any movement or weight-bearing restrictions and how you're currently managing.
We also want to understand what your walking was like before surgery. Someone who was walking several miles a day until shortly before their operation may progress differently from someone who has been struggling to walk for several years.
We particularly like using hydrotherapy during the early weeks following a hip replacement because this is when patients are often struggling with muscle weakness, confidence and walking patterns. Starting rehabilitation at the right time can help us work on these problems before they become more established.
We've written more about the benefits of early rehabilitation in Why Hydrotherapy at 2–4 Weeks Post-Hip Replacement Is a Game Changer, including why we believe the pool can be such a useful part of recovery.
The Early Weeks: Approximately Weeks 2 to 6
For suitable patients, we can often introduce hydrotherapy from around 2 weeks after surgery once the wound is fully healed and pool rehabilitation has been cleared.
At this stage, we focus on gentle movement, walking patterns, muscle activation and building confidence.
We might work on:
- Walking forwards, backwards and sideways.
- Controlled weight transfers onto the operated leg.
- Gentle hip movements within your permitted range.
- Activating the gluteal and thigh muscles.
- Supported balance exercises.
- Practising standing and stepping with good control.
We're not trying to make you do as much as possible in one session. We're looking at what you're able to do well and how we can gradually progress it.
Weeks 6 to 12: Building Strength and Walking Endurance
As your recovery progresses, we start asking more of the muscles around your hip.
This is often when patients are becoming more independent and thinking about getting back to longer walks and everyday activities.
We can begin increasing the difficulty of exercises by changing the water depth, introducing more challenging balance work and strengthening the hip muscles through a greater range of movement where appropriate. We might also practise stepping up and down, controlled single-leg standing and exercises that challenge your pelvic control.
The important thing is that we're working towards what you need to do on land.
If your goal is to walk the dog for 30 minutes, we need to make sure your hip muscles have the strength and endurance to support that activity without you developing a limp as you become tired.
Why Is Standing on One Leg So Important?
This is one of the key things we look at during hip replacement rehabilitation. You might be able to stand comfortably on both legs, but what happens when you lift one foot off the ground?
Does your pelvis stay level? Do you lean your body to one side? Do you immediately need to hold on? Are you confident putting your full weight through the operated leg? These are important questions because every step you take involves a period of standing on one leg.
If you can't control your pelvis during single-leg standing, it can be difficult to maintain a good walking pattern.
At AquaPhysio, we can start practising this with the support of the water. We can then gradually reduce that support and progress to more challenging exercises as your strength and confidence improve.
We're not just interested in whether you can balance for 10 or 20 seconds. We want to know how well you're controlling the movement and whether you can maintain that control as you become tired. This is what helps us prepare you for walking further, climbing stairs and getting back to the activities you enjoy.
When Can I Get Back to Walking My Dog?
I wanted to include this because it's such a common goal for our patients.
For many people, getting back to walking their dog represents a return to normal life. It's not necessarily about walking five miles or doing something particularly athletic. It's about being able to get out of the house, enjoy some fresh air and do something they've always done.
However, walking a dog can be more demanding than walking around your home. You might need to manage uneven pavements, grass, kerbs and sudden changes of direction. If your dog pulls on the lead, you also need enough strength and balance to react.
We want to make sure you're ready for those challenges. Initially, that might mean shorter walks on flat ground, perhaps with someone else managing the dog.
As your walking improves, we can gradually increase the distance and introduce more challenging surfaces. There isn't one particular week when everyone will be ready. It depends on your strength, balance, walking pattern and how confident you feel.
Our goal is to help you get back to walking your dog without having to think about every step you take.
Should I Stop Using My Crutches as Soon as Possible?
This is another question we get asked regularly.
Patients are often really keen to get rid of their crutches because they see it as a sign that they're recovering well. Of course, becoming independent of walking aids is an important milestone, but we don't want to rush it.
If you still have a significant limp without your crutches, it may be better to continue using some support while you strengthen your hip and improve your walking pattern. A stick or crutch can help reduce the demand on weak hip muscles and allow you to walk with better control.
We would much rather see someone walking well with one stick than walking badly without it. As your strength improves, your physiotherapist can help you gradually reduce the support you're using.
The Pool Is Only Part of Your Recovery
Something we're very clear about at AquaPhysio is that hydrotherapy isn't the whole answer.
It's a really valuable part of rehabilitation, particularly when patients are struggling with pain, weakness or walking patterns on land.
However, as your recovery progresses, you need to be doing more and more on land.
Your muscles need to become strong enough to support your full body weight. You need to improve your balance, increase your walking endurance and practise the activities you want to return to. That's why we work closely with orthopaedic consultants and land-based physiotherapists.
We also have our sister clinics, Wimbledon Physiotherapy & Sports Injury Clinic and Epsom & Ewell Physiotherapy & Sports Injury Clinic, where patients can continue their strengthening and rehabilitation.
There's no point doing lots of good work in the pool if we don't then progress that movement and strength onto land. Equally, there's no point struggling through exercises on land when the pool could provide an environment where you can move more comfortably and work on your walking pattern.
It's about using the right environment at the right time.
What If You're Several Months After Surgery and Still Limping?
It's not unusual for us to see patients who are three, four or even six months after their hip replacement and still aren't happy with their walking.
They may have very little pain in the new joint but still feel weak, unsteady or frustrated that they can't walk as far as they'd like. Sometimes they've been walking with a limp for so long that it has become their normal way of moving. Other times, the gluteal muscles simply haven't regained the strength needed to control the pelvis properly.
The important thing is to understand why you're limping. Not every limp is caused by muscle weakness. Persistent pain, leg-length differences, nerve problems or other postoperative complications may need further assessment.
Once we've established what's contributing to the problem, we can put together a programme to address it. Hydrotherapy can still be really useful at this stage, particularly if you're finding certain strengthening or balance exercises difficult on land.
It's certainly not too late to work on improving your walking.
Frequently Asked Questions About Walking After a Hip Replacement
Why am I still limping 6 weeks after my hip replacement?
There are several possible reasons, including weakness in the gluteal muscles, reduced balance, pain, swelling or walking habits developed before surgery. Six weeks is still relatively early in recovery, but it's important to identify what's causing the limp so your rehabilitation can address it.
How long should I walk each day after a hip replacement?
There isn't one distance that's right for everyone. We generally recommend gradually increasing your walking based on your symptoms, strength and walking quality. Several shorter walks may be more useful than one long walk that leaves you tired and limping.
When can I start hydrotherapy after a total hip replacement?
At AquaPhysio, suitable patients can often start from around 2 weeks after surgery, provided the wound is fully healed, there are no complications and your treating team has cleared you for pool rehabilitation.
Why are my gluteal muscles so important after hip replacement surgery?
Your gluteal muscles help control your pelvis and stabilise your hip when you walk, stand on one leg and climb stairs. If they're weak, you may lean to one side or develop a limp. Strengthening these muscles is an important part of recovery.
Will hydrotherapy help me stop limping?
Hydrotherapy can be very useful for improving walking patterns, muscle strength and balance. The water supports some of your body weight, allowing you to practise movements
with less load. However, we also need to identify why you're limping and progress your exercises onto land.
Should I continue using a walking stick if I still limp?
If a walking stick helps you maintain a better walking pattern, it may be sensible to continue using it while your strength improves. Your physiotherapist can assess when you're ready to reduce your support.
Is it normal to feel tired when walking after a hip replacement?
Yes, particularly during the early stages. Your body is recovering from major surgery, and your muscles may have been weak before the operation. Walking endurance generally improves as your strength and fitness return, but persistent or worsening fatigue should be discussed with your healthcare team.
What if I'm still limping 6 months after surgery?
It's worth having your walking pattern, hip strength and balance assessed. There may be ongoing muscle weakness or compensatory movement patterns that can be improved with rehabilitation. Persistent pain or an unexplained limp should also be reviewed to rule out other causes.
Do I need a referral to attend AquaPhysio?
You can contact us directly to arrange an assessment. We'll ask about your surgery, any restrictions you've been given and what you're hoping to achieve from rehabilitation.
Had a Hip Replacement and Want to Get Back to Walking Well? Let's Talk.
If you've recently had a hip replacement, are still relying on crutches or are several months into recovery and wondering why you're still limping, please get in touch.
At AquaPhysio, we regularly help patients following hip replacement surgery, and we understand how important it is to regain your independence.
We want you to understand what your muscles need to do, why certain exercises matter and how we're going to help you progress.
Our specialist hydrotherapy centre in Lower Morden welcomes patients from Wimbledon, Sutton, Epsom, Ewell, New Malden and across Surrey and South West London.
Whether your goal is walking comfortably around the house, getting back to the shops, enjoying longer walks or taking your dog out again, we'd be delighted to help you through your recovery.
Having a new hip is the first part of the journey. Getting your strength, walking and confidence back is the next. You can also find more information about our hydrotherapy programme for hip replacement recovery, including how we help patients before and after surgery. Get in touch with AquaPhysio and let's see how we can help you move forward.
Please remember that rehabilitation following hip replacement surgery varies depending on your surgical approach, individual recovery and any restrictions provided by your consultant. Hydrotherapy should only begin once your wound has healed and you have been cleared for pool rehabilitation.