A growing number of people having a total hip replacement — particularly those under 65 — want to return to the activities that matter to them: golf, hiking, cycling, tennis, or running. Yet most return-to-sport guidance after THR remains vague, inconsistent, or tied to arbitrary time frames rather than meaningful milestones.
This protocol provides a clear, criteria-based pathway from pre-operative preparation through to full sport reintroduction, grounded in the current evidence base and adaptable to both anterior and posterolateral surgical approaches.
What's Inside:
Developed by Emma Glynn, APA Titled Musculoskeletal Physiotherapist and Clinical Exercise Physiologist, this protocol combines Level 1 and 2 evidence to guide safe, structured return to activity and sport following total hip replacement.
Pre-Operative Phase — Education and Preparation Prehabilitation goals, go-for-surgery criteria including hip abductor strength, quadriceps and hip flexor strength, 6-minute walk test performance — and the evidence for why entering surgery stronger produces better post-operative outcomes.
Phase 1 — Foundation and Protection Post-operative recovery, surgical precaution management for both anterior and posterolateral approaches, early range of motion, gluteal and quadriceps activation, and safe mobilisation. Objective criteria required to progress to Phase 2.
Phase 2 — Gait, Strength and Function Normalising gait pattern, restoring functional hip ROM (flexion ≥100°, extension to neutral, abduction ≥30°), dynamic balance via the mSEBT, step-up control, and 5x Sit-to-Stand. Notes for both surgical approach variations. Objective criteria required to progress to Phase 3.
Phase 3 — Conditioning and Controlled Sport Building strength symmetry across all hip muscle groups, reintroducing low-impact sport, dynamic single-leg control, and 6-minute walk test. Notes on anterior versus posterolateral approach considerations. Objective criteria required to progress to Phase 4.
Phase 4 — Return to High Impact Sport and Performance Hop testing (single-leg hop, triple hop, 30-second double-leg hops), T-test agility, HOOS Sport subscale confidence assessment, and surgeon or physiotherapy clearance. Guidance on which patients require hop testing and which do not, with specific notes on approach-specific considerations for Phase 4 loading.
Phase 5 — Discharge and Re-Injury Prevention Transition to self-managed conditioning, long-term maintenance strategies, injury prevention principles, and load management education.
Final Notes: Suggested return-to-sport timelines for cycling, golf, swimming, hiking, running, and court sports. When to regress or seek review.
Who this is for:
This protocol is designed for adults who have had a total hip replacement and are working toward return to recreational sport or higher-level activity. It is applicable to both anterior and posterolateral surgical approaches, and is designed to be used in conjunction with physiotherapy-guided rehabilitation and in collaboration with the treating surgeon.
Not every patient will be a candidate for high-impact sport after THR. Individual goals, implant considerations, and surgical advice should always inform how this protocol is applied.
A note on what this resource is — and isn't:
This is a general educational and clinical reference resource. It does not replace individual physiotherapy assessment, diagnosis, or treatment, and does not create a physiotherapist-patient relationship. All progression decisions should be made collaboratively between the patient, their physiotherapist, and treating surgeon.
Developed by: Emma Glynn | APA Titled Musculoskeletal Physiotherapist | Clinical Exercise Physiologist The Hip and Knee Physio — Camberwell, Melbourne
