Getting More From Your Hip Replacement: Troubleshooting Common Problems after 12 Months
Taking the plunge into hip replacement surgery is a big step, and usually only undertaken after years of hip pain episodes, gradually getting more severe and persistent. The disappearance of that ever-present joint pain after surgery is a welcome relief, but surgery is not the end of the journey. The surgical incisions and bones need to heal, and it’s time to learn to walk and move properly and get those muscles and tendons stronger and healthier again. By 12 months, most people are feeling pretty great but some will come and see us with lingering issues. In this blog, I’ll be sharing my top 3 tips for getting more from your hip replacement if you are experiencing issues after 12 months.
In clinic, I often see patients coming in more than 12 months after their hip replacement, looking for answers.
The common themes are:
- “It’s pretty good… but I feel like I should be getting more out of it.”
- “It was going well until I tried to push things again.”
The longer I’ve been doing this, the more I’ve realized — it usually comes back to a few simple things. Here are the top 3 areas I look at when a hip starts to feel “not quite right” down the track.
This blog will cover the following topics on getting more from your hip replacement:
- Think Shorter Hip Muscles - Not Longer Thigh Muscles after Hip Replacement
- New Hip, Same Movement Habits after Hip Replacement
- The Rest of the Body Still Matters After Hip Replacement
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Because of our expertise in hip conditions, hypermobility, sports injuries, and dance injuries and performance, we also have people visiting us from all over Queensland, Australia and even international visitors. We also have a telehealth service for remote patients.
1. Think Shorter Hip Muscles - Not Longer Thigh Muscles after Hip Replacement
This is something I often explain to my patients when they come to our physiotherapy clinic looking to get more from their hip replacement.
There are 2 main types of muscles around the hip:
- Shorter, deeper muscles that act only across the hip
- And more superficial thigh muscles that can work at the hip but also at another joint nearby, usually the knee.
The shorter hip muscles stabilize the hip joint and control local movement of the hip and pelvis. The more superficial multi-joint muscles come in to help with transferring forces down the limb, especially during long lever movements, where the hip and knee are straighter. The type of exercise you do can bias either of these muscle groups. Certain exercises tend to bias the superficial multi-joint muscles.
Exercises like clams and side leg raises aren’t ‘wrong’ — but in reality, most people:
- Don’t hit the right angles
- Don’t control the movement well enough
- End up overusing superficial muscles.
There is also not as much natural stimulus for the deeper hip muscles when you exercise with your foot off the ground.
The result?
The deeper stabilizers don’t get enough stimulus, resulting in ongoing weakness and/or poor coordination of the deep hip muscles.
This often shows up later when:
- You increase activity
- You load the hip more
- Or something minor triggers a flare-up.
Shift your thinking:
Instead of “global strengthening”, think local hip and pelvic control.
That’s where the deeper muscles do their best work.
Great ways to target these muscles:
- Hip hinge patterns
- Offset or asymmetrical squats
- Single leg stance and control work
These weightbearing (foot on the ground) exercises reflect how your hip actually works in real life.
Many people expect everything to feel completely normal by 12 months after a hip replacement. But if your hip feels good but not quite as strong, smooth, or reliable as you hoped, you’re not alone.
Often the issue isn’t the replacement joint itself. It usually comes back to muscle coordination, lingering movement habits from before surgery, or the rest of the body still catching up after years of compensating for a painful hip.
If you’re unsure what might be limiting your progress, a physiotherapy assessment can help identify the key factors holding you back.
Book in with one of our PhysioTec physiotherapists for comprehensive post–hip replacement assessment. We’ll help you understand what your hip and the rest of your body need to move well again, and create a plan to support your strength, control, and long-term function.
2. New Hip, Same Movement Habits after Hip Replacement
Just because the joint has been replaced… doesn’t mean your movement habits have been.
Due to the pain leading up to surgery, your body naturally adapts by:
- Limping or altering gait
- Offloading the painful side during sit-to-stand
- Shifting posture without realizing.
Those patterns don’t automatically reset after surgery.
So what happens?
Think ‘new hardware but old software.’
You’ve got a new joint, but you’re still running the old movement patterns.
As activity increases, those patterns may:
- Increase load on certain structures
- Reduce your efficiency and endurance
- Trigger irritation in surrounding tissues.
I always take patients back to basics if they are experiencing issues more than 12 months after their hip replacement. We revisit:
- How you walk
- How you sit to stand
- How you load each leg
Small changes here often make a big difference.
3. The Rest of the Body Still Matters After Hip Replacement
Before surgery, your other joints such as the other hip, knees and lower back, would have been heavily relied on as the function of the original hip was deteriorating. Those areas have been doing extra work for a long time.
Increasing pain and stiffness in the hip also results in generally reduced activity levels and deconditioning of your whole system, not just your painful hip.
After surgery:
- Your new hip might be ready
- But the rest of the system might not be.
So when you try to step things up, the new joint might be fine but something else can become the limiting factor:
- Tendon pain
- Knee pain
- Back pain
This is where pacing becomes important.
Think beyond just the hip joint:
- Rebuild overall strength
- Gradually increase load
- Respect the fact that the soft tissues (muscles and tendons) and other joints are still catching up.
A Simple Timeline to Keep in Mind for Recovery after Hip Replacement
- 0–3 months: Build basic strength
- 3–12 months: Develop endurance and capacity
- Beyond 12 months: Refine movement and control
Even after a year:
- You still need to revisit the fundamentals
- You still need to challenge the system
- You’re still building better movement habits, because changing how you move takes time.
Final Thoughts
A lot of the time, what feels like “weakness” isn’t true strength loss.
It’s:
- Lack of optimal coordination and control around the hip
- Inefficient movement patterns, retained from pre-surgery
- Lack of capacity and endurance more broadly down the whole limb.
If in doubt — go back to basics. That’s usually where the answer is.
And remember:
It’s a marathon, not a sprint.
Book Your Assessment
If you feel like you should be getting more out of your hip replacement but something still isn’t quite right, a thorough assessment can help identify what’s holding you back. At PhysioTec, we assess hip muscle function, movement patterns and whole-body strength to pinpoint the factors limiting your progress. Book an assessment with our physiotherapy team to help you build better strength, control and confidence in your new hip
Feeling like you should be getting more out of your hip replacement, even after 12 months?
Book an assessment at PhysioTec and we’ll assess your movement, strength, and control around the hip, identify what may be limiting your progress, and create a personalised plan to help you move with more confidence and get the most from your new hip.
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Author
This blog was written by Eric Huang, one of our sports, strength & conditioning, and cycling physiotherapists. Eric is also highly experienced in the management of hip conditions. He has been providing high-quality services at PhysioTec for over a decade. You can read more about Eric here.
Other Blogs by Eric
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References
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