Starting a targeted exercise program before hip replacement surgery can strengthen the muscles around your hip, improve your endurance, and make your recovery smoother. Most prehab programs begin six to eight weeks before surgery, giving you enough time to build meaningful strength without overdoing it. The exercises focus on three areas: strengthening the muscles that support your hip, maintaining cardiovascular fitness, and preparing your upper body for using a walker or crutches afterward.
Why Prehab Matters for Recovery
The logic is straightforward: the stronger you go into surgery, the easier it is to bounce back. A 2023 meta-analysis in Bone & Joint Open found that people who did home-based prehab before joint replacement had high compliance rates (averaging above 90%), and the exercise programs consistently improved preoperative function. For hip replacement specifically, prehab trended toward shorter hospital stays, though the effect was modest compared to knee replacement patients.
The American Academy of Orthopaedic Surgeons rates physical therapy as a moderate-strength recommendation for managing hip osteoarthritis. The American Physical Therapy Association suggests exercising three to five times per week, 15 to 20 minutes per session, with 10 to 15 repetitions per set. That’s a manageable commitment, even when hip pain limits what you can do.
Strengthening Exercises for Your Hip and Thigh
These are the core exercises most orthopedic programs recommend. Aim to do them once or twice a day, working up to 10 to 20 repetitions of each. All of them can be done lying in bed or on a firm surface, which makes them accessible even on high-pain days.
Quad Sets (Thigh Squeezes)
Lie on your back with your leg straight. Tighten the muscle on top of your thigh by pressing the back of your knee firmly into the bed. Hold for five seconds, then relax. This builds the quadriceps, the large muscle group on the front of your thigh that plays a major role in standing up from a chair and walking steadily after surgery.
Glute Sets (Buttock Squeezes)
While lying on your back, squeeze your buttock muscles together as tightly as you can. Hold for five seconds, then release. Your glutes stabilize your pelvis when you walk. Weakness here is one of the main reasons people limp after hip replacement, so building these muscles ahead of time pays off quickly during recovery.
Ankle Pumps
Pull your feet up toward your shins, then push them down and away from you, alternating back and forth in a pumping motion. This might seem too simple to matter, but ankle pumps serve a dual purpose. They maintain circulation in your lower legs (reducing the risk of blood clots after surgery) and keep your calf muscles active. You’ll be asked to do these constantly in the hospital, so practicing beforehand makes them second nature.
Heel Slides
Lying on your back, slowly bend your knee by sliding your heel along the bed toward your buttock. Go as far as comfortable, then slide it back out straight. This maintains your hip’s range of motion and strengthens the muscles that control bending and straightening your leg. If the friction of your heel on the sheet makes it difficult, try wearing a sock or placing a plastic bag under your foot to reduce resistance.
Standing Hip Abduction
Hold onto a counter or sturdy chair for balance. Slowly lift your surgical-side leg out to the side, keeping your toes pointed forward. Lower it back down with control. This targets the muscles on the outer hip that prevent you from tilting or swaying when you walk. Start with whatever range feels manageable and build from there.
Low-Impact Cardio to Build Endurance
Surgery and anesthesia are physically taxing. Having a baseline of cardiovascular fitness helps your body recover faster and gives you more energy for the intensive physical therapy that starts within hours of your procedure. The American Heart Association recommends at least 150 minutes of moderate-intensity cardio per week, but any amount you can manage before surgery is better than none.
The best options keep weight off your hip while still letting you work hard enough to raise your heart rate:
- Swimming or water exercise: Water supports your body weight and reduces joint stress dramatically. Pool walking, water aerobics, or gentle laps all work. This is often the most comfortable option for people with significant hip pain.
- Stationary cycling: Sitting on a bike seat takes your body weight off the hip joint. You can adjust resistance to match your comfort level while still getting a solid workout.
- Rowing machine: The seated position minimizes lower-body joint stress, and you can push the intensity as high as you want. Rowing also engages your arms and core, which helps with overall conditioning.
Don’t let the word “low-impact” fool you into thinking these workouts can’t be challenging. You can send your heart rate as high as you need on a bike or rower. The difference is that these activities protect your joints while doing it.
Upper Body Exercises for Walker and Crutch Use
This is the piece most people overlook. After surgery, you’ll rely on a walker or crutches for several weeks. If your arms and shoulders aren’t prepared, using these devices becomes exhausting fast, and fatigue leads to poor form, which increases your fall risk.
A randomized controlled trial found that patients who added arm and upper body exercises to their rehabilitation program had significantly better outcomes 12 weeks after hip replacement. Their functional ability scores improved by nearly 6 points more than the control group, and their grip strength increased meaningfully in both hands.
Practical exercises to prepare your upper body include:
- Chair push-ups: Sit in a sturdy chair with armrests. Place your hands on the armrests and push yourself up, lifting your weight off the seat. Lower slowly. This mimics the motion of pushing up from a chair or toilet, which you’ll do dozens of times a day after surgery.
- Wall push-ups: Stand about arm’s length from a wall, place your palms flat against it at shoulder height, and do slow push-ups against the wall. This builds chest and tricep strength without putting any strain on your hip.
- Bicep curls: Use a light weight or a can of soup. Curl it slowly up and down, 10 to 15 repetitions per arm. Strong biceps help you control a walker and lower yourself into chairs safely.
How to Structure Your Prehab Schedule
Start six to eight weeks before your surgery date. This gives your muscles enough time to respond to training without rushing the process. A realistic daily schedule looks like this: do your bed-based strengthening exercises (quad sets, glute sets, ankle pumps, heel slides) once or twice a day, spending about 15 to 20 minutes each session. Add your standing hip exercises and upper body work three to five times per week. Fit in two or three cardio sessions per week, even if they’re just 20 minutes of pool walking or easy cycling.
Pain is your guide for intensity. Some discomfort during exercise is normal with hip arthritis, but sharp or worsening pain means you should back off. The goal is progressive loading, not pushing through damage. On days when your hip is particularly inflamed, focus on ankle pumps, upper body work, and gentle range-of-motion movements that don’t aggravate the joint.
Track your repetitions so you can see progress. Starting at 10 reps and working up to 20 over several weeks gives you a clear trajectory and builds confidence heading into surgery. People who feel stronger going in tend to engage more actively with their post-surgical therapy, which is where the real gains happen.