Exercises Before Hip Replacement: What to Do Before Surgery

By Emma Glynn - The Hip & Knee Physio

If you are looking for exercises before hip replacement, there is a good chance your surgery is either booked or being seriously discussed. That can bring up a very normal question: what should you actually be doing between now and the operation?

Some people stop exercising because the hip hurts and they do not want to make things worse. Others try to push through as much as possible because they want to go into surgery “strong”. Neither extreme is ideal.

Before hip replacement, the goal is usually to maintain as much comfortable strength, movement and general fitness as possible without repeatedly flaring the hip.

I am Emma Glynn, an APA Titled Musculoskeletal Physiotherapist in Camberwell. I work exclusively with hip and knee conditions, including people preparing for hip replacement and people rebuilding afterwards.

For a broader overview of hip arthritis, you can visit my hip osteoarthritis page. If you are still deciding whether surgery is the right step, this article on whether you may need a hip replacement may also be useful.

Does exercise before hip replacement actually help?

Exercise before hip replacement is often called prehabilitation, or prehab. The idea is simple: improve or maintain what you can before surgery so you are not starting from the lowest possible baseline afterwards.

The evidence is not perfect, and it does not show that prehab guarantees a faster or easier recovery for everyone. However, research suggests that exercise-based prehabilitation before total hip replacement may improve some physical function outcomes, such as walking tests, chair-rise ability and stair climbing, compared with no intervention (Widmer et al., 2022). More recent reviews suggest that some forms of pre-operative exercise may offer benefits, although confidence in the evidence varies (Luo et al., 2026).

The safest message is this: exercise before hip replacement may be worthwhile, especially when it is tolerable, structured and matched to your current hip.

That matters because hip arthritis can gradually reduce strength, walking tolerance, balance and confidence. Surgery changes the joint surface, but it does not automatically restore all the strength and conditioning that may have been lost beforehand.

What are the goals before hip replacement?

The aim is not to “fix” severe hip arthritis with exercise once surgery is already planned. The aim is to keep you as prepared as possible for the operation and early recovery.

Pre-op exercises should help you maintain useful capacity, not prove how tough you are.

Before hip replacement, useful goals may include:

• Maintaining hip and leg strength

• Keeping comfortable hip movement where possible

• Maintaining walking or cycling tolerance

• Practising sit-to-stand and basic functional tasks

• Building confidence with walking aids if advised

• Maintaining general fitness

• Reducing avoidable deconditioning

• Preparing for early post-operative exercises

• Understanding what movements aggravate the hip

This is especially important if you have been moving less for months because of pain. A painful hip often leads to a shorter stride, less walking, less stair use and reduced confidence. Over time, the muscles around the hip and thigh can become weaker.

How hard should you exercise before hip replacement?

This is where people often need more guidance than “keep active”. Exercise before hip replacement should be challenging enough to maintain strength and fitness, but not so aggressive that you keep flaring the hip and losing sleep.

A good pre-op exercise dose should feel manageable and should not leave your hip clearly worse the next day.

As a general guide, you may need to reduce the dose if:

• Pain increases sharply during exercise

• You limp more afterwards

• Your walking is worse the next day

• Night pain increases after training

• The hip feels more restricted after exercise

• Symptoms take more than 24 hours to settle

• You need several days to recover from one session

That does not always mean the exercise is wrong. It may mean the range, load, repetitions, speed or frequency needs adjusting.

If you are already in a lot of pain, the starting point may be gentle movement, supported strengthening or cycling rather than long walks, deep squats or heavy gym work.

6 sensible exercises before hip replacement

These exercises are not a personalised program. They are common options that may be used before hip replacement, depending on pain, range, strength, surgical instructions and your current capacity.

The right exercises before hip replacement should target strength and movement without forcing the hip into painful end ranges.

1. Sit-to-stand from a chair

Sit-to-stand is one of the most useful functional exercises because it trains the movement you will use constantly after surgery.

Start from a higher chair if low chairs are painful. Use your hands if needed. Aim for controlled movement rather than speed.

You can make it easier by:

• Using a higher chair

• Using armrests

• Reducing repetitions

• Keeping the stance comfortable

You can make it harder by:

• Reducing hand support

• Slowing the lowering phase

• Adding repetitions

• Holding a light weight if appropriate

2. Glute bridges

Glute bridges can help maintain hip extensor strength without needing to stand. They may be useful if walking and stairs are limited.

Lie on your back with knees bent and feet flat. Gently lift your hips, then lower with control. Keep the range comfortable.

Modify if needed by:

• Reducing the lift height

• Doing fewer repetitions

• Pausing briefly at the top

• Stopping if it causes groin pain or cramping that does not settle

3. Standing hip abduction

This exercise targets the muscles on the outside of the hip, which help control the pelvis during walking.

Stand holding a bench or chair. Move one leg gently out to the side, keeping the pelvis steady. Return slowly.

This should feel like muscle work around the outer hip, not sharp groin pain.

You can adjust it by:

• Keeping the movement smaller

• Holding on for balance

• Adding a light resistance band if tolerated

• Reducing repetitions during a flare

4. Standing hip extension

Standing hip extension can help maintain glute strength and walking-related control.

Hold a bench or chair. Move the leg gently backwards without arching your lower back. Return slowly.

Keep the movement controlled and comfortable. If it causes pinching in the front of the hip, reduce the range.

5. Heel raises

Heel raises help maintain calf strength, balance and walking capacity. They are simple but useful, which is deeply unfair to every overcomplicated exercise trend on the internet.

Stand holding a bench or chair. Rise up onto your toes, then lower slowly.

Start with both legs. Progress only if comfortable and safe.

6. Gentle stationary bike

A stationary bike can help maintain hip movement and general fitness with controlled load. It is often easier to dose than outdoor walking because you can adjust the resistance and time precisely.

Start with:

• Low resistance

• A comfortable seat height

• Short duration

• Smooth pedalling

• No forced hip range

If the hip feels pinchy at the front, the seat may need adjusting or cycling may not be the right option at that stage.

Should you walk before hip replacement?

Walking can be useful before hip replacement if your hip tolerates it. The aim is not necessarily to walk as far as possible. It is to maintain regular activity without repeatedly provoking a flare.

Walking before hip replacement should be based on what your hip can recover from, not what you used to be able to do.

You may need to adjust:

• Distance

• Pace

• Hills

• Surface

• Rest breaks

• Walking aid use

• Recovery days

If 40 minutes causes pain into the evening and worse symptoms the next day, try a shorter walk. If hills flare the hip, use flatter routes for now. If you are limping badly, a walking stick may be helpful, especially if your surgeon or physio recommends it.

Using a stick before surgery is not a failure. It can reduce load and help you move better. The hip does not care about pride. Rude, but true.

What if exercise makes your hip more painful?

If exercise repeatedly makes your hip more painful, do not assume you need to stop everything. First, look at the dose.

Pain after pre-op exercise usually means the program needs adjusting, not that all movement is unsafe.

Options include:

• Reducing range of motion

• Reducing load

• Reducing repetitions

• Doing fewer sessions per week

• Separating walking and strengthening days

• Avoiding deep hip flexion positions

• Using more support

• Swapping to cycling or pool-based exercise if walking is too painful

• Checking whether medication timing needs GP or pharmacist advice

Exercises that may need caution before hip replacement include:

• Deep squats

• Deep lunges

• Heavy leg press into deep hip flexion

• Aggressive hip stretching

• Long hill walks

• Running or jumping if already painful

• High-intensity classes that cannot be modified

This does not mean every one of these is banned. It means they may not be the right choice if your hip is already irritable and surgery is approaching.

Should you stop exercising as surgery gets closer?

In many cases, people can continue appropriate exercise until close to surgery, but this should be guided by your surgeon’s instructions and your health status.

Do not start a completely new, aggressive program right before surgery. Maintain what is useful and keep symptoms settled.

As surgery approaches, the focus may shift toward:

• Comfortable movement

• Gentle strengthening

• Maintaining walking tolerance

• Practising early post-op exercises if advised

• Preparing your home

• Prioritising sleep and recovery

• Avoiding flare-ups from sudden overloading

If your surgeon gives specific instructions about medication, skin care, infection risk, fasting, equipment, walking aids or activity restrictions, follow those instructions.

What else should you prepare besides exercise?

Preparing for hip replacement is not only about exercises. The first few weeks after surgery are easier when your home and support systems are organised.

The American Academy of Orthopaedic Surgeons recommends planning for homecoming after joint replacement, including reducing trip hazards, arranging commonly used items within reach, and considering helpful equipment such as a shower chair, grab bars, raised toilet seat, reacher or long-handled shoehorn where appropriate (AAOS, 2026).

Good preparation means thinking about strength, mobility, safety, support and your early recovery environment.

Before surgery, consider:

• Removing loose rugs and trip hazards

• Placing frequently used items at waist height

• Planning meals for the first week or two

• Organising transport home from hospital

• Checking whether stairs need a plan

• Asking your hospital team about walking aids

• Preparing comfortable seating that is not too low

• Asking about showering and bathroom equipment

• Clarifying medication instructions

• Knowing who to contact if symptoms change after surgery

This is also a good time to read about what happens afterwards. My guide to the hip replacement recovery timelineexplains the early and later phases of rehab.

When a pre-operative physiotherapy assessment may help

A pre-op physio assessment can help you work out what is realistic and useful before surgery. This is particularly valuable if your hip is painful, your walking has reduced, or you are unsure which exercises are safe.

The best pre-op plan is specific to your hip, your surgery timing and the activities you want to return to.

An assessment may include:

• Hip range of motion

• Walking pattern

• Sit-to-stand ability

• Strength testing

• Balance and confidence

• Current exercise tolerance

• Flare-up triggers

• Home setup discussion

• Early post-op expectations

• A plan for exercises before and after surgery

The aim is not to overload you before the operation. It is to prepare sensibly, reduce guesswork and give you a clearer pathway into recovery.

What to do next

If your hip replacement is booked or likely, the time before surgery can still be useful. You do not need to train like an athlete, but you also do not need to sit still and wait for the operation.

Exercises before hip replacement should help you maintain strength, movement and confidence while keeping your hip as settled as possible.

You may benefit from a pre-operative assessment if:

• Your surgery is booked

• You are unsure which exercises are safe

• Walking is becoming harder

• Pain is limiting daily activity

• You are worried about recovery

• You want to go into surgery with a clearer plan

• You want help preparing for the early rehab phase

If you are based in Melbourne’s inner east, including Camberwell, Hawthorn, Kew, Canterbury, Surrey Hills, Glen Iris or nearby, you can book an in-person hip assessment.

I will assess your hip, help you work out what to do before surgery, and guide you toward a plan that matches your current capacity and surgical timeline.

Emma

References

American Academy of Orthopaedic Surgeons. (2026). Preparing for joint replacement surgery. OrthoInfo. https://orthoinfo.aaos.org/treatment/preparing-for-joint-replacement-surgery

American Academy of Orthopaedic Surgeons. (2026). Total hip replacement exercise guide. OrthoInfo. https://orthoinfo.aaos.org/recovery/total-hip-replacement-exercise-guide

Luo, X., Chen, M., Cui, Z., Hu, Y., Zheng, L., Li, H., & Yu, D. (2026). Effectiveness of prehabilitation modalities before total hip arthroplasty: A systematic review and network meta-analysis. Annals of Physical and Rehabilitation Medicine. https://doi.org/10.1016/j.rehab.2026.102001

Widmer, P., Oesch, P., & Bachmann, S. (2022). Effect of prehabilitation in form of exercise and/or education in patients undergoing total hip arthroplasty on postoperative outcomes: A systematic review. Medicina, 58(6), 742. https://doi.org/10.3390/medicina58060742

Medical disclaimer

This blog is general educational information only and is not a substitute for individual medical advice, diagnosis or treatment. Always follow the instructions of your surgeon, GP and hospital team before and after hip replacement surgery. Seek urgent medical review if you develop severe or worsening pain, inability to weight-bear, fever, chest pain, shortness of breath, calf swelling, sudden neurological symptoms, signs of infection, or symptoms that concern you.