The six-week mark following a total hip replacement is a significant milestone, often marking the transition from initial healing to intermediate rehabilitation. This benchmark is typically accompanied by a scheduled follow-up appointment with the surgeon to formally assess physical progress. For most patients, the focus shifts from managing acute post-operative symptoms to regaining strength, mobility, and independence in daily activities. This six-week point serves as a common moment for adjusting activity levels and setting new therapeutic goals.
Incisional Healing and Pain Status
By six weeks, the surgical incision should be fully closed and dry, with any external sutures or staples likely removed. The wound site may still appear slightly raised, pink, or reddish-purple, which is a normal sign of tissue remodeling beneath the skin. Although the incision is externally healed, internal inflammation continues, which can cause warmth and swelling in the hip and leg.
The nature of the pain changes considerably, moving away from the deep, sharp surgical pain experienced immediately after the procedure. This acute pain is replaced by a more manageable muscular soreness, stiffness, or discomfort linked to physical exertion and therapy exercises. Most patients discontinue narcotic pain medication and rely instead on over-the-counter options like acetaminophen or NSAIDs, provided they are cleared by a physician. Residual swelling in the leg is common and may persist for several months, necessitating the continued use of ice and elevation as needed.
Functional Milestones and Assisted Mobility
The six-week milestone involves a substantial increase in functional independence as strength and endurance improve. Many patients transition completely off a walker or crutches to using a cane, or they may be walking unassisted, particularly indoors. Walking household distances without an assistive device is a common goal for this phase, demonstrating sufficient recovery of gait and balance.
Managing stairs also becomes easier, though patients may still employ a step-by-step technique: leading with the unoperated leg when going up and the operated leg when coming down. Individuals should be able to stand for longer periods and perform basic household tasks, such as light meal preparation or personal care, with greater ease. Progression to walking without an aid is contingent on achieving a proper, non-limping gait pattern, which the physical therapist monitors closely.
Lifting of Activity Restrictions
The six-week post-operative appointment is where the surgeon reviews progress and clears the patient for a broader range of activities. A high-priority restriction frequently lifted at this time is driving. Clearance for driving is typically given if the patient is off all narcotic pain medications, has sufficient strength and range of motion to operate the pedals, and can perform an emergency stop without hesitation.
The side of the surgery matters; patients with a left hip replacement in an automatic car may be cleared sooner than those with a right hip replacement, which affects the brake and accelerator. Weight-bearing limits are often adjusted, with patients typically cleared for full weight-bearing as tolerated unless poor bone quality or a complication was noted during surgery. Lifting restrictions are usually increased from the initial low limit to around 10 pounds, though this should still be done mindfully to protect the hip and back.
Hip precautions, which involve avoiding extreme movements like bending the hip past 90 degrees or crossing the legs, are often modified or discontinued at this stage, depending on the surgical approach used. The surgeon provides specific guidance on whether these dislocation precautions need to be maintained for a longer period. Return-to-work guidelines depend heavily on job type; those with sedentary desk jobs may be cleared to return, while those with physically demanding jobs should expect to remain off work longer.
The Next Phase of Physical Therapy
Following the six-week milestone, physical therapy typically shifts from protective healing and basic range of motion to more aggressive functional strengthening. This phase emphasizes exercises that build muscle strength, improve endurance, and enhance balance. Exercises introduced include mini-squats, side step-ups, and targeted strengthening of the hip abductors and extensors, such as clam shells and leg raises.
The goal is to normalize the gait pattern, improve walking endurance, and integrate the new joint into daily movements. While formal physical therapy sessions may decrease in frequency, commitment to the prescribed home exercise program remains important for continued progress. Full recovery typically takes between three to six months, with some patients continuing to see improvements for up to a year.