Most Common Mistakes After Hip Replacement Surgery
The most common mistakes after hip replacement are skipping physical therapy, doing too much too soon, ignoring hip precautions, neglecting medications, and falling at home. None of them happen on purpose. All of them are avoidable. The patients who recover fastest treat the first 12 weeks as a job: they show up to therapy, follow restrictions, take their meds, and remove fall risks from their home before surgery day.
A hip replacement is one of the most successful operations in modern medicine. Most of my patients are back to walking comfortably within a few weeks and back to the activities they love within a few months. But the surgery itself is only half the equation. The other half is recovery — and that part is yours to run.
Over the past two decades I’ve performed thousands of hip replacements at the Bone and Joint Institute of Tennessee in Franklin. The patients who do best are not the ones with the youngest joints or the strongest legs. They’re the ones who avoid a short list of predictable mistakes during the first three months. Here are the five I see most often, and what to do instead.
Mistake 1: Skipping Physical Therapy or Doing It Half-Heartedly
Physical therapy is not optional. It is the single biggest predictor of how well your new hip will function a year from now.
I tell my patients that the hip replacement gives you the hardware. Physical therapy gives you the software. The muscles around your hip joint went through surgery too. They need to be retrained to support the new implant, restore your gait, and rebuild the strength you lost in the months before surgery when you were limping and avoiding stairs.
Patients who skip sessions, stop early because they “feel fine,” or coast through home exercises without effort end up with three predictable problems: stiffness that becomes permanent, a limp that becomes a habit, and weakness that puts them at higher risk of falls. None of those are easy to reverse six months out.
What to do instead:
- Start prehab before surgery. Two to four weeks of focused strengthening on your hip flexors, glutes, and core makes recovery faster on the other side.
- Attend every physical therapy session your team prescribes.
- Do your home exercises on the days you don’t see your therapist. The home program is not a suggestion.
- Tell your therapist if something hurts in a new way. They will adjust the plan.
Mistake 2: Doing Too Much Too Soon
This is the flip side of mistake one, and it’s just as damaging. Patients who feel good at week three sometimes decide they’re ready to mow the lawn, lift their grandchildren, or return to pickleball. The hip feels fine in the moment. The swelling, irritation, and setback show up two days later.
The new implant is solid almost immediately. The soft tissue around it — muscle, capsule, incision — takes longer. Pushing into high-impact activity, heavy lifting, or long days on your feet before that tissue is healed creates inflammation, slows recovery, and occasionally causes real injury.
Driving is another common overreach. Most patients are not safe to drive for at least two to four weeks after a right hip replacement, longer if they’re still taking narcotic pain medication. Reaction time matters. So does the ability to stomp the brake without thinking.
What to do instead:
- Follow your surgeon’s specific timeline for returning to work, driving, and exercise.
- Use the pain and swelling test. If an activity leaves you in noticeably more pain or swelling the next day, you did too much. Scale back.
- Walk every day. Walking is the one activity you almost cannot overdo in early recovery.
- Wait for clearance before resuming high-impact sports, sexual activity, or anything that requires deep hip flexion or rotation.
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Mistake 3: Ignoring Hip Precautions at Home
For the first 6 -12 weeks, your surgeon may give you a short list of movement restrictions (often depending on your specific surgery and surgical approach used). The exact list depends on which surgical approach was used. The direct anterior approach I use for most of my patients carries fewer restrictions than the older posterior approach, but every patient still has some.
Some common restrictions may include avoiding extreme hip flexion past 90 degrees, avoiding crossing the operated leg over the midline, and avoiding twisting your hip when standing or turning. Violating these positions in the early weeks is how dislocations happen — and a dislocation in the first three months almost always means a trip to the emergency room and, occasionally, a second surgery. The most common offenders are not exercise positions. They’re everyday furniture. Deep couches, low recliners, and bucket-seat cars all force the hip into a flexed position that puts the joint at the edge of safe range. Toilet seats below standard height do the same thing.
Increasingly, with the use of Direct Anterior Approach, many patients return home the same day of surgery with limited or no hip movement restrictions or precautions. It is important to follow YOUR surgeon’s specific postoperative recovery plan.
What to do instead:
- Set up your home before surgery, not after. Borrow or rent a raised toilet seat. Remove the deep cushioned chair from your living room and replace it with a firm dining chair with armrests.
- Sleep on your back with a pillow between your knees for the first 4 to 6 weeks.
- Don’t reach down to pick things up off the floor. Use a reacher tool or ask someone else.
- Get in and out of the car carefully — operated leg first going in, last coming out, with the seat slid all the way back and reclined slightly.
Mistake 4: Stopping Medications Early or Taking Them Wrong
You will leave the hospital with a short list of medications. Most patients receive a blood thinner to prevent dangerous clots, a short-term pain medication, and often an anti-inflammatory. Each one does a specific job. Stopping any of them early — because you feel better, because you’re worried about side effects, or because you forgot — creates real risk.
The blood thinner is the one I worry about most. Hip replacement patients are at meaningful risk of developing a deep vein thrombosis, or DVT, in the first few weeks after surgery. A DVT that breaks loose and travels to the lungs becomes a pulmonary embolism, which is life-threatening. Blood thinners are how we prevent that. The full course matters.
Pain medications are different. Patients are right to be cautious with narcotics, and we want to wean off them as quickly as safely possible. But the first few days are not the time to be a hero. Pain that gets ahead of you is harder to control, slows your physical therapy, and disrupts sleep — and sleep is when your body does most of its healing.
What to do instead:
- Take blood thinners exactly as prescribed for the full duration. Do not stop early without talking to your surgical team.
- Take pain medication on schedule for the first 48 to 72 hours, then begin tapering as comfort allows.
- Pair pain medication with anti-inflammatories if both are prescribed — they work better together than either does alone.
- If you have concerns about any medication, call the office before you stop. We can almost always find a workable alternative.
Mistake 5: Falling at Home
This is the mistake that ends recoveries early. A fall in the first 12 weeks after hip replacement can dislocate the new joint, fracture the bone around the implant, or tear the soft tissue that’s still healing. Some of these injuries require a second surgery. All of them set recovery back by months.
The people who fall after hip replacement are rarely doing anything dramatic. They trip over a throw rug, get tangled in a dog leash, miss a step on a porch they’ve walked a thousand times, or stand up too fast and lose their balance. The hip itself is not the problem. The environment is.
What to do instead — set this up before surgery:
- Remove every throw rug from every walking path. Tape down rug edges that have to stay.
- Clear cords, magazines, and clutter from hallways and stairs.
- Install grab bars in the shower and beside the toilet. They take an hour and prevent the most common bathroom falls.
- Add a nightlight to the path between the bedroom and bathroom.
- Use your walker or cane every time, even for short trips, until your surgical team clears you to stop.
- Talk to family about the dog. Pets are loving. Pets are also unpredictable. Arrange a dog walker or a friend to handle the leash for the first few weeks.
- Wear shoes with backs and grippy soles. Slip-on slippers are responsible for more falls than anyone admits.
When to Call Your Surgical Team
Most of recovery is uneventful. But there are warning signs that always justify a phone call. Contact your surgical team promptly if you notice any of the following:
- A fever above 101.5°F, drainage from the incision, or redness that’s expanding rather than fading.
- Calf pain, calf swelling, or a warm tender spot in the back of the leg — possible signs of a blood clot.
- Sudden shortness of breath or chest pain — call 911 immediately and tell them you had recent hip surgery.
- A sharp pop or sudden severe pain in the new hip, especially with a change in leg length or rotation — possible dislocation.
- Pain that’s getting worse instead of better after the second week.
You will never bother me by calling. I would much rather hear from you once too often than once too late.
Common Mistakes After Hip Replacement | A Final Thought
A successful hip replacement is a partnership. I do my part in the operating room. You do your part in the kitchen, the bathroom, the physical therapy gym, and the bedroom over the three months that follow. Patients who treat recovery with the same seriousness they brought to choosing a surgeon almost always do well. The hip is durable. The implant is reliable. The variable is you.
If you’re preparing for or recovering from hip replacement and have questions about your specific situation, our team is here. Every hip is different, every patient is different, and the right answer is the one that fits your circumstances.
Ready to Plan a Hip Replacement You’ll Recover From Well?
Dr. Cory Calendine, MD has performed thousands of hip replacements using the muscle-sparing anterior approach and Stryker Mako® robotic-assisted technology at the Bone and Joint Institute of Tennessee in Franklin, TN. From the first consultation through your final recovery milestone, you’ll have a clear plan and a team that answers the phone. Schedule a consult or call our office today: (615) 791-2630
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 the specific guidance provided by your surgical team. If you experience any concerning symptoms after hip replacement, contact your surgeon’s office directly.
