A hip or knee replacement is one of the most successful surgical procedures in modern medicine, and the right exercise programme is what turns a good operation into a great outcome. Whether you are preparing for surgery, recovering in those first weeks, or months down the line looking to get back to full fitness, this guide walks you through every stage. The evidence is clear: people who exercise appropriately after joint replacement recover faster, experience less pain, and enjoy better long-term function than those who rest and wait.
Why Exercise Matters After Joint Replacement
Your new joint is designed to move. In fact, it needs movement to function properly. After hip or knee replacement, appropriate exercise helps in several critical ways:
- Prevents stiffness: Scar tissue can form quickly around a new joint, limiting range of motion if you do not move regularly
- Rebuilds muscle strength: Muscles weaken before surgery (due to pain and reduced activity) and during recovery, but respond well to progressive exercise
- Reduces swelling: Gentle movement promotes blood flow and lymphatic drainage, helping manage post-surgical swelling
- Speeds recovery: NHS research shows that patients who follow structured exercise programmes return to daily activities significantly faster
- Improves long-term outcomes: Active patients report better joint function, less pain, and greater satisfaction 5-10 years after surgery
The National Institute for Health and Care Excellence (NICE) recommends structured rehabilitation exercise as a core part of joint replacement recovery. Your surgical team will provide initial guidance, and this article helps you understand what to expect at each stage.
Understanding Your Recovery Timeline
Every recovery is different, but most people follow a broadly similar pattern. Understanding what to expect helps you stay motivated and avoid pushing too hard or holding back unnecessarily.
Week 1-2: Early Recovery
Your physiotherapist will start you on gentle exercises within hours or days of surgery. These focus on ankle pumps (to prevent blood clots), gentle knee bends or hip movements, and getting safely in and out of bed and chairs. Walking with aids begins immediately.
Week 2-6: Building Foundation
Exercises become more purposeful. You will work on increasing range of motion, rebuilding basic strength, and improving your walking pattern. Most people transition from a frame to crutches or a stick during this period. Pain gradually decreases, though some days will feel better than others.
Week 6-12: Progressive Strengthening
This is where real progress happens. Your surgical team will likely clear you for more challenging exercises. Walking distances increase, stairs become easier, and you may begin exercises like supported squats, step-ups, and resistance band work. Many people return to driving around week 6-8 (check with your surgeon).
Month 3-6: Return to Activity
Most people feel substantially recovered by 3 months, though full recovery continues for up to a year. You can progress to more varied exercise, including swimming (once the wound is fully healed), cycling, and gym-based work. This is an excellent time to join a structured programme like Redefine for guided, progressive exercise.
6 Months and Beyond: Long-Term Fitness
Your new joint is designed to last 15-25 years with appropriate care. Regular exercise is one of the best things you can do to protect it. Activities like walking, swimming, cycling, and strength training are all excellent. High-impact sports (running, jumping) are generally best avoided to protect the joint surfaces.
Post-Replacement Exercise Progression
This progressive routine covers the key exercises that support recovery. Start gently and increase as your confidence and strength grow. Your physiotherapist or GP can help you decide when you are ready to progress between stages. Allow around 20 minutes for the full routine.
Step 1: Ankle Pumps and Circles (2 minutes)
Lying or sitting with your legs extended, pump your feet up and down by pointing your toes away from you and then pulling them towards you. Do 10-15 pumps. Then circle your ankles 5 times in each direction. This exercise promotes circulation and can begin on day one after surgery.
Step 2: Seated Knee Extensions (3 minutes)
Sit in a sturdy chair with your feet flat on the floor. Slowly straighten your operated leg, hold for 5 seconds, then lower with control. Aim for 10 repetitions. This rebuilds the quadriceps muscle, which is essential for walking, stairs, and getting out of chairs. If straightening fully is difficult at first, straighten as far as comfortable.
Step 3: Standing Hip Abduction (3 minutes)
Hold a worktop or sturdy chair for balance. Stand on your non-operated leg and slowly lift your operated leg out to the side, keeping your body upright. Hold for 3 seconds and lower slowly. Aim for 10 repetitions each side. For knee replacement patients, this strengthens the hip muscles that support knee alignment. For hip replacement patients, this rebuilds the outer hip muscles essential for walking without a limp.
Step 4: Supported Mini-Squats (4 minutes)
Stand behind a sturdy chair, holding the backrest. Bend both knees to lower yourself a short distance - imagine sitting back slightly. Keep your weight evenly distributed through both legs. Hold for 3 seconds and rise slowly. Start with a shallow bend and deepen gradually over weeks. Aim for 8-12 repetitions. This is a fundamental exercise for rebuilding functional strength.
Step 5: Step-Ups (4 minutes)
Using a bottom stair or a sturdy step, step up with your operated leg, bring the other foot up to join it, then step back down leading with the non-operated leg. Hold the banister or rail for safety. Aim for 8-10 repetitions each leg. Begin this exercise when your physiotherapist or surgical team confirms you are ready - typically from week 6 onwards. Step-ups are excellent for rebuilding the strength needed for stairs and uneven ground.
Step 6: Stationary Cycling (4 minutes)
Once cleared by your surgical team (usually from week 6-8), a stationary exercise bike is excellent for rebuilding range of motion and cardiovascular fitness without impact. Start with no resistance and pedal gently for 5 minutes, building to 15-20 minutes over several weeks. Adjust the seat height so your knee does not bend past 90 degrees at the bottom of the pedal stroke.
For more comprehensive recovery guidance, see our complete post-surgery exercise guide which covers preparation, hospital stay, and returning to daily activities.
What to Avoid After Joint Replacement
While exercise is essential, certain movements and activities need care, particularly in the first 3 months. Your surgical team will provide specific precautions based on your procedure.
After Hip Replacement
- Crossing your legs: This can risk dislocation in the early weeks, particularly with posterior approach surgery
- Bending past 90 degrees at the hip: Avoid deep squatting, sitting in very low chairs, or bending to pick things up without assistance
- Twisting on your operated leg: Turn your whole body rather than pivoting
- High-impact activities: Running and jumping place excessive stress on the new joint
After Knee Replacement
- Kneeling on the operated knee: Many people find this uncomfortable, though it is not usually harmful once healed
- Deep squats: Avoid bending the knee beyond what is comfortable; forced deep flexion is not necessary
- High-impact sports: Running, jumping, and contact sports are best avoided
- Excessive stair climbing early on: Use stairs as needed, but do not use them as exercise in the first few weeks
These restrictions ease over time. By 3-6 months, most everyday activities are unrestricted. Your surgical team is the best guide for when to progress. For information about exercising with other health conditions, see our guide to exercise with health conditions.
Long-Term Fitness with a Joint Replacement
Once fully recovered, your exercise options are broader than many people expect. Activities that are generally excellent for people with joint replacements include:
- Walking: The single best exercise for long-term joint health - aim for 30 minutes most days
- Swimming and water exercise: Zero impact, excellent for cardiovascular fitness and muscle strength
- Cycling: Low-impact and great for maintaining range of motion
- Strength training: Essential for protecting your joint; focus on muscles around the hip and knee
- Yoga and Pilates: Modified versions improve flexibility, balance, and core strength
- Golf, bowls, and doubles tennis: Lower-impact sports that most surgeons support
Versus Arthritis recommends staying active for life after joint replacement. Regular exercise not only protects your new joint but also reduces the risk of needing surgery on other joints. Staying strong and mobile is the best investment you can make in your long-term quality of life.
When to Seek Medical Advice
Most recovery is straightforward, but contact your surgical team or GP if you experience:
- Increasing pain that is not improving with time, especially if the joint feels hot or swollen
- Sudden onset of severe pain or inability to bear weight
- Signs of infection: redness, warmth, discharge from the wound, or fever
- A feeling that the joint is unstable, clicking, or giving way
- Calf pain, swelling, or redness (which could indicate a blood clot)
These symptoms are uncommon but important to address promptly. Do not wait for a routine appointment if you are concerned.
Frequently Asked Questions
How soon can I exercise after a hip or knee replacement?
You will begin gentle exercises within hours or days of surgery, guided by your physiotherapist. These start with simple ankle pumps and progress to walking with aids. Most people can begin more structured exercise from around week 2-4, with progressive strengthening from week 6 onwards. Your surgical team will guide the timeline based on your specific procedure and recovery.
Will my replacement joint wear out faster if I exercise?
Modern joint replacements are designed to withstand decades of normal activity. Low-impact exercise (walking, cycling, swimming, strength training) does not accelerate wear. In fact, keeping the muscles around the joint strong actually protects it. High-impact activities like running are best avoided as they place greater stress on the joint surfaces, but most other activities are encouraged.
When can I return to sport after joint replacement?
This depends on the sport. Low-impact activities like swimming, cycling, and golf can often resume from 3-6 months. Walking and hiking typically resume within a few months. High-impact sports like running and contact sports are generally not recommended. Your surgeon can advise on specific activities based on your joint type and recovery.
Is it normal to still have some discomfort months after surgery?
Some residual discomfort, particularly with new activities or at the end of a busy day, is normal for up to a year after surgery. This does not mean anything is wrong. However, if pain is worsening rather than improving, is severe, or is affecting your sleep, speak with your surgical team. Most people find that exercise actually reduces long-term discomfort by strengthening the muscles that support the new joint.
References
- NHS. Hip replacement - recovery. nhs.uk
- NHS. Knee replacement - recovery. nhs.uk
- NICE. Joint replacement (primary): hip, knee and shoulder. nice.org.uk
- Versus Arthritis. Joint replacement. versusarthritis.org
