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What Should the First Two Weeks After Hip Replacement Feel Like?
The first two weeks after hip replacement should feel gradual and stepwise: a little better every day, with a predictable bump in soreness around days 3 to 5. That is the shape of a normal recovery, and it is the expectation I want every patient to walk in with.
Most of the worried phone calls I get after hip replacement come from my best recoveries. Not the slow ones. The fast ones. And they almost always come on a Monday.
You probably think the danger in week one is something scary, like an infection or a dislocation. Those are real, but rare. What I see derail the first week is simpler: feeling good.
After more than 20 years and over 700 hip and knee replacements a year in Franklin, this pattern is so predictable I can almost recite it. Three mistakes sit behind nearly every Monday call, and I can tell you the exact days that catch people off guard.
Mistake 1: Why Does Expecting to Feel Normal Right Away Backfire?
Expecting to feel normal the day after hip replacement backfires because the surgery is still a major procedure, and missing your own expectations is one of the biggest drivers of an unhappy recovery. Your body knows what it went through.
You have heard the stories. A neighbor who walked into church a week later. A golf buddy who never used a cane. Some people really do respond that fast. Planning for it is a trap.
We have good data on this from knee replacement. In one study of more than 1,700 patients, the gap between what people expected and what they got was the single biggest predictor of dissatisfaction. Bigger than anything measured on an X-ray.
Here is the expectation I want you to carry instead: gradual and stepwise. Every day a little better than the last is a win. Expect a staircase, not an elevator, and you will be satisfied when you climb it.
Mistake 2: What Is the Honeymoon Window After Hip Replacement?
The honeymoon window is the first two or three days after hip replacement, when the arthritis pain is gone and the numbing medicine from surgery is still working, so you feel better than the healing tissue is ready for. It is the most common setup for a setback in the first two weeks after hip replacement.
The moment your new hip goes in, the bone-on-bone grind is over. We also place numbing medicine around the incision and in the muscles at the end of surgery.
So the first couple of days feel like a honeymoon. You start on a walker because I ask you to, but you feel steady. By day two the walker is in the corner.
Why Do Days 3 to 5 After Hip Replacement Hurt More Than Days 1 and 2?
Days 3 to 5 hurt more because that is when swelling around the hip peaks and the numbing medicine has worn off. Soreness climbs right when you have decided you no longer need help.
Nothing is wrong. The implant is solid, and your new hip can take your full weight from day one. The walker was never about the hip; it is about balance while everything around the hip heals.
When day three brings more soreness than day two, that is not a setback. That is the schedule. Ice it, keep walking, and let it pass.
Why Do the Worried Phone Calls Come on a Monday?
The calls come on Monday because the honeymoon window lines up with the first weekend. Here is the version I hear over and over, not from one patient but as a pattern.
Off the walker on day two. No cane by day three. Feeling great. Then a family event that weekend: a graduation, a reunion, a long day on your feet.
Monday morning, my phone rings. “It was fine, and now it hurts. Something must be wrong.”
Almost always, nothing is wrong. The swelling peaked, the weekend asked too much of healing tissue, and the hip is telling you about it. The fix is not a week of rest; it is short walks and ice, then building again.
Do You Need Physical Therapy in the First Two Weeks After Hip Replacement?
For my hip replacement patients, formal physical therapy is completely optional, and most never go. Walking is the program. Walk, walk, walk, and do your home exercises.
So here is what I ask of you in the first two weeks after hip replacement: start slow, almost insultingly slow, then build every day. Short walks several times a day beat one long march.
Knees are different. After a knee replacement, therapy is not optional; everybody goes. Knee patients should read my post on the top mistakes after knee replacement.
What Does Winning the First Week After Hip Replacement Look Like?
Winning the first week after hip replacement looks boring: walking the day of surgery, a walker for a few days, a cane when you are steady, a soreness bump around days 3 to 5, and free movement around the house by week two. Boring is what we want.
- Day of surgery: You are up and walking. Every one of my patients walks the same day, and you practice stairs with us before you leave.
- Days 1 and 2 at home: Walker, with short walks several times a day. Not one long march. Short and often.
- Walker to cane: When you are steady, the walker becomes a cane. For hips, that is usually days, not weeks. Let steadiness make the call, not the calendar.
- Days 3 through 5: Expect the soreness to bump. Walk anyway, gentler and shorter if you need to, but walk.
- Week two: Most people are moving around the house freely and starting to really trust the hip. That is the staircase.
Because I use the anterior approach for nearly all of my patients, the classic list of hip precautions generally does not apply. Sleep in whatever position is comfortable and avoid only the extremes of motion. Posterior approach patients may need more protection early on. More in my posts on anterior hip precautions and sleep after hip replacement.
Mistake 3: Can You Shower or Take a Bath in the First Two Weeks After Hip Replacement?
You can shower the day you get home from hip replacement, but you cannot soak: no bathtub, no pool, no hot tub until the incision is completely healed, usually around the 3 to 4 week mark. This is the shortest mistake on the list and the one that surprises people most in the first two weeks after hip replacement.
The dressing we put on in surgery is waterproof. Water can run over it, and a clean, sealed incision handles a shower under that dressing just fine.
Soaking is a different story. Sitting in water softens the skin edges and gives bacteria a path in before the incision has closed. That is not a risk worth taking for a bath you can put off a few weeks.
When Should You Call Your Surgeon in the First Two Weeks?
Call your surgeon right away in the first two weeks after hip replacement if your pain is suddenly out of control, if you have a fever, or if anything is draining from the incision. The scary stuff is rare, but it is not zero. Do not wait and wonder.
Calf pain, calf swelling, or a warm tender spot behind the knee also need a same-day call, since those can signal a blood clot. Sudden chest pain or shortness of breath is a 911 call. The full list is in my post on the top 5 mistakes after hip replacement. How to tell healing pain from pain that is not normal is the next article.
You will never bother us by calling. I would much rather hear from you once too often than once too late.
Planning Hip Replacement in Franklin, Nashville, or Columbia?
The first two weeks after hip replacement go the way they should when three things are in place before surgery day: honest expectations, a plan to walk short and often, and a home set up for the honeymoon window.
I am a board-certified orthopedic surgeon, and I perform hip replacement using the anterior approach and Mako® robotic-assisted technology at the Bone and Joint Institute of Tennessee in Franklin; I also serve as a consultant to Stryker for the Mako platform. Patients come from Nashville, Brentwood, Columbia, and across Middle Tennessee, and most go home the same day.
Ready to plan a hip replacement you will recover from well? Schedule a consultation at the Bone and Joint Institute of Tennessee, 3000 Edward Curd Lane, Franklin, TN 37067, or call (615) 791-2630. No referral required. The free hip replacement guide covers how to set up your home before surgery.
Watch: Why Your Hip Replacement Recovery Is Stalled
Dr. Calendine walks through the three mistakes behind almost every worried Monday phone call in the first two weeks after hip replacement: expecting to feel normal the next day, overdoing it in the honeymoon window, and soaking the incision too soon. Watch on YouTube and subscribe to @BoneDoctor_YouTube for the next video on telling healing pain from pain that is not normal.
Medical Disclaimer
This article is for educational purposes only and does not replace personalized medical advice. Recovery instructions vary by surgical approach and individual health factors; always follow your surgical team’s guidance. In an emergency, call 911.
References
- Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res. 2010;468(1):57-63. PubMed
- Scott CE, Howie CR, MacDonald D, Biant LC. Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br. 2010;92(9):1253-1258. PubMed
- American Academy of Orthopaedic Surgeons. Activities After Total Hip Replacement. OrthoInfo. orthoinfo.aaos.org
- American Academy of Orthopaedic Surgeons. Total Hip Replacement. OrthoInfo. orthoinfo.aaos.org
