Your Hip Replacement Is Scheduled. Here Is What to Do With the Next Six Weeks

The date is on the calendar. Check in at 5:30 a.m., surgery at 7:00, home the same day if everything goes clean. You have the pre-op packet, the list of what you can and cannot eat the night before, and a loose plan to take it easy until then.

That last part is what I want to talk about.

A man came into the West Front St office last October. Sixty-four, new hip scheduled for the week after deer season, and he had already told his son not to count on him for the woodpile that year. He had read the date on the calendar as permission to stop. Stop the morning loop on the TART. Stop the garden. Stop the stairs. Stop everything, because why keep beating up a joint that is coming out anyway.

I understand that logic completely. I also think it is the most expensive decision people make in this process, and nobody warns them.

Here is what does not get said at the surgical consult. The surgeon replaces the joint. Nobody replaces the muscle.

The surgery fixes the bearing surface, not the engine

A hip replacement is a mechanical repair. The worn joint comes out, a new one goes in, and the grinding, catching, arthritic pain that has been waking you at 3 a.m. is gone. It is one of the most reliable operations in medicine and I am not going to talk you out of it.

But think about what has happened to that leg over the last two or three years. You limped. You stopped pushing off on that side. You took the stairs one at a time, leading with the good leg. You quit the second half of the walk.

And it was never only the hip that changed. When you stopped pushing off, your foot stopped rolling all the way through. Your pelvis stopped rotating. The other leg picked up work it had never been asked to do, and your low back started supplying range the hip used to give you for free. Change one link and every link above it changes.

Muscle takes its instructions from what you ask of it. Ask it for very little over two years and it will honor that request precisely.

None of that gets fixed by anesthesia.

You wake up from surgery with a beautiful new joint and the same weak glute you went in with. Which is why some people are back on the Leelanau trails by spring and some people are still using a cane in July.

What the research actually found

In 2025 a research group published an overview of the prehabilitation literature in the Journal of Orthopaedic and Sports Physical Therapy. Not one study. A review of the reviews, pulling together 19 randomized trials covering 1,110 hip replacement patients, plus a larger pool of knee patients.

The people who did structured exercise before surgery came out ahead on strength, on measured function (things like how fast they could get out of a chair, not just how they said they felt), on quality of life, and on complication rates. The authors were straight about the limits: most of the benefit showed up inside the first six months and the underlying evidence ranged from moderate quality down to poor. This is not a miracle. It is a head start.

A separate 2022 review looking only at hip replacement found something worth sitting with. Patients who got exercise did better. Patients who got education alone, the folder and the video and the class, showed no meaningful improvement in postoperative function over usual care.

Knowing what to do is not the same as doing it. Your hip does not read.

The part that surprised me

There is a 2014 study in the Journal of Bone and Joint Surgery that used Medicare claims data from nearly 4,700 hip and knee replacements. The researchers looked at what happened in the 90 days after surgery, specifically whether patients ended up needing a skilled nursing facility, home health, or an inpatient rehab stay.

Among patients who had physical therapy before surgery, 54.2% needed some form of post-acute care. Among patients who had none, it was 79.7%. After the researchers adjusted for age, health conditions, and the specifics of the procedure, preoperative PT was linked to a 29% drop in post-acute care use and about $871 less in total episode cost.

Now, honest caveat. That is claims data, not a randomized trial. People who show up for preop PT may be healthier or better organized to begin with, and no statistical adjustment fully scrubs that out. I would not hang a policy on it.

But I would hang six weeks of your life on it.

What to do about it

Before any of the specifics, one question. What is the first thing you want back after this is over? Not a year from now. The first month. Getting out of a low chair without planning it. Walking to the end of the road and turning around under your own steam.

Whatever the answer is, that is what these six weeks are for.

None of this needs a gym membership or a program that eats your week. It needs load on the right muscles, often enough to matter.

• Sit-to-stands from a kitchen chair, no hands, as slow going down as coming up. Two sets to near-fatigue, four or five days a week.
• Single-leg balance at the counter, one finger down for safety. Thirty seconds each side. Then try it while you brush your teeth. If the surgical side is a disaster compared to the other, you just found the deficit.
• Step-ups on the bottom stair. Up with the surgical leg, down with control, not a thud. Start with eight and build.
• Arms. Nobody thinks about this and everybody needs it, because you are going to push out of chairs, off the toilet, and out of the car with your arms for two weeks. A gallon of milk in each hand counts.
• Set the house up now, while you are not sore. Cords off the floor. A chair with arms where you will actually sit. The stuff you use daily moved from the low cabinet up to the counter.

One thing I would skip: pushing into sharp, deep groin pain to "keep it moving." Work in the range you have. You are building capacity, not proving a point.

And if something new shows up, calf swelling and warmth, a fever, numbness that was not there before, that is a phone call to your surgeon's office, not something to train through.

The bottom line

Six weeks is enough time to change how your leg behaves. It is not enough time to change anything if it goes by while you sit and wait for the date.

I know what part of you is thinking. The hip hurts, you have been told it is worn out, and every instinct says protect it until somebody fixes it. That instinct is not stupid. It is the reason you are still functioning at all. It is also the reason your glute is where it is right now. Both of those are true in the same leg.

You might read all of this and decide to rest anyway. That is your call. It is your body and your calendar and I am not going to argue with you about it.

But if you would rather spend these weeks working, you have more time than you think. Six weeks is a long stretch in the life of a muscle.

If you have a hip replacement on the calendar, or you are still deciding whether you want one, come in and let us look at how you move first. The first visit is a free 20-minute movement assessment. Twenty minutes, in clinic, a real look at what your hip and everything above and below it are doing. No charge, no insurance, no pressure to book anything after, and no call from us next week asking if you decided. Call the West Front St office at (231) 944-6541.

You can also get a free copy of my book on hip replacement recovery at thesuperiortherapy.com.