The three-week mark following a total hip replacement represents a significant transition from the immediate post-operative healing phase to the beginning of functional recovery. While acute pain should be subsiding, the body is now engaged in rebuilding strength and adapting to the new joint mechanics. Recovery is highly individualized, depending on factors like age, overall health, and the surgical approach used, but certain milestones are common. The focus shifts from wound management toward increasing mobility and independence through dedicated physical therapy. Understanding what is normal helps manage expectations and supports a successful progression toward full recovery.
Expected Physical Abilities and Recovery Benchmarks
By three weeks, many individuals notice substantial improvement in functional mobility compared to the first week post-surgery. The surgical incision should be dry and well-closed; staples or sutures are often removed around 10 to 14 days, leaving a healing scar that no longer requires frequent dressing changes. This stage often marks a shift in reliance on assistive devices.
You may be transitioning from a walker or crutches to a single cane, or possibly walking short distances without an aid, though this varies widely. Daily activities, such as dressing, showering, and moving around the home, should feel significantly easier and require less assistance. This increased independence is a key benchmark of the third week.
It is normal to experience “good days and bad days” during this period. Increased activity one day might lead to more soreness and stiffness the next, indicating the body is still healing and adapting. Recognizing this fluctuation is important, as pushing too hard can cause temporary setbacks in discomfort and swelling. Continued, mindful movement is encouraged, but strenuous or high-impact tasks must still be avoided.
Managing Pain, Swelling, and Sleep Quality
At the three-week point, the sharp, intense pain felt immediately after surgery should have largely diminished. The remaining discomfort is typically a dull ache, muscle soreness, or stiffness, particularly after exercise or periods of rest. This is a normal response as surrounding muscles and soft tissues heal from surgical trauma and begin to strengthen.
Many people are weaning off prescription narcotic pain relievers and transitioning to over-the-counter options like acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs), if approved by their surgeon. Taking these non-opioid medications about an hour before physical therapy or before bed can optimize comfort and engagement in recovery. Following the prescribed weaning schedule is crucial to manage pain effectively while minimizing dependency.
Residual swelling in the ankle, lower leg, and around the hip is common and may persist for several months. To manage this, frequent elevation of the leg above heart level and consistent application of ice packs for 15 to 20 minutes are recommended, especially after activity. Sleep disruption is common, often due to discomfort or required restrictive positioning. Sleeping on your back with a pillow between your legs, or on the non-operative side with two pillows between the knees and ankles, helps maintain proper hip alignment and improve sleep quality.
Rehabilitation Exercises and Activities
Rehabilitation at three weeks focuses on increasing the hip’s range of motion, improving gait mechanics, and strengthening the musculature surrounding the new joint. Consistency in performing the prescribed home exercise program is more important than intensity, with many surgeons recommending dedicated exercise sessions multiple times a day. The primary goal is to activate and strengthen the gluteal muscles, which stabilize the hip and ensure the longevity of the implant.
Low-impact exercises often include heel slides to gently regain knee and hip flexion, quadriceps sets to improve thigh muscle activation, and light standing balance exercises while holding onto a stable surface. Standing hip extensions and abductions, where the leg is moved backward or out to the side, are introduced to build strength in the gluteus maximus and medius. These controlled movements help normalize the walking pattern and build endurance.
Adherence to hip precautions remains necessary to prevent dislocation, especially for those who underwent a posterior surgical approach. Precautions typically involve avoiding excessive hip flexion past 90 degrees, internal rotation (turning the toes inward), and crossing the legs. Walking is an excellent activity, but it should be done regularly in short bursts rather than long, fatiguing efforts, as walking does not replace targeted strengthening exercises.
Identifying Serious Symptoms Requiring Immediate Medical Attention
While discomfort and mild swelling are normal parts of recovery, certain symptoms indicate a serious complication and require immediate contact with your surgical team or emergency services.
Signs of Infection
Signs of an infection at the surgical site include:
- A persistent fever above 100.4°F or shaking chills.
- A sudden increase in redness, warmth, or tenderness around the incision.
- New or excessive drainage, particularly foul-smelling discharge or pus.
Deep Vein Thrombosis (DVT)
Symptoms of a DVT, a blood clot in the leg, can be subtle but are potentially life-threatening. These include new or sudden severe pain, tenderness, cramping, or swelling in the calf or thigh that does not improve with rest and elevation. If these leg symptoms are accompanied by shortness of breath or chest pain, seek emergency medical attention immediately.
Hip Dislocation
A potential hip dislocation is an urgent complication, typically presenting with a sudden onset of severe, unmanageable pain and the inability to bear weight on the operated leg. The leg may appear visibly shortened or rotated compared to the other leg. If any acute, worsening, or systemic symptoms occur, seek immediate professional medical guidance.