Total Joint Replacement — Total Hip Arthroplasty (All Approaches)

University Hospitals · Timothy Alesnik, PT; Lisa Berko, PT; Julie Drew, PT; Andrew Helber, PT…

Weight-Bearing

Weight bearing as tolerated (WBAT) with assistive device as needed from day 0; walker initially, progressing to cane to no device as balance/LE control allow; TED hose bilateral LE x4wks (not at night)

Key Restrictions

Anterior/anterolateral/direct lateral approach: no hip extension past 20 deg, no ER past 50 deg, caution with active abduction wks 0-6; posterior approach: no hip flexion past 90 deg, no active IR or adduction past neutral, avoid combining these motions; general: no crossing legs (ankle crossing OK), avoid floor-height lifts, keep hips above knees when sitting, avoid twisting while WB on involved side; standard precautions maintained through wk 12 (may vary by surgeon, especially anterior approach)

Timeline & Phases

Phase I (day 0-3): protect healing tissue, bed mobility/transfers, ambulate 50-100ft, stair/car transfer training, independent HEP; Phase II (day 3-6wks): D/C assistive device as balance allows, restore ROM within precautions, normalize gait, DVT prevention (out of bed every 90min); Phase III (6-12wks): pain-free ADLs, gluteal/abductor/pelvic strengthening, community ambulation up to 1 mile; Phase IV (12wks+): return to recreational activity, closed-chain strengthening, low-to-moderate-impact progression, physician clearance for moderate-impact activities

Notes

Global hip precautions patient handout (Appendix A); functional testing appendix (B): Return-to-Driving Step Test (pass >=13 steps), Forward Step-Down Test, Timed Up and Go (goal <=12 sec), 30-second Sit to Stand; outcome measures: LEFS, TUG, 30-second chair stand; return-to-driving typical timeline L side 3wks, R side 4-6wks (MD clearance, off narcotics, passing step test); discharge (athletic): >90% strength vs. uninvolved LE; extensive references

Surgeon / Author

Timothy Alesnik, PT; Lisa Berko, PT; Julie Drew, PT; Andrew Helber, PT; Elizabeth Rockwood, PT; Edward Wasner, PT; Mario Gastaldo, PT (reviewed January 2025 by Mario Gastaldo, PT, Julie Drew, PT, Danielle Ross, PT, Lauren Frawley, PT; physician review February 2025: Dr. Cohen-Levy and the physician group at the Center for Orthopedics)

Published

2025-02