Younger Hip Replacements in Former Athletes: Is Rehabilitation Keeping Up?
- Jacinta Horan
- Mar 6
- 4 min read
Introduction
Working in the space of chronic athletic hip and groin pain, I am seeing a growing number of former athletes requiring total hip replacements in their 40s. Advances in surgical techniques and prosthetic materials mean that younger patients no longer need to “wait it out” for another decade while living with pain and declining function. However, while surgery has evolved rapidly, post‑operative rehabilitation expectations have not progressed at the same pace.
A Changing Patient Population
For many years, hip replacements were primarily performed in older adults whose main goal was to reduce pain and improve basic daily function. Today, many patients undergoing surgery are still in the workforce and want to return to higher levels of exercise and recreational sport. This shift in patient goals raises an important question: should rehabilitation programmes look different for younger, more active individuals?
Standard Rehabilitation – Is It Enough?
Early physiotherapy after hip replacement remains essential. The first stage of rehabilitation focuses on restoring mobility, managing pain and swelling, learning to walk safely, and gradually returning to normal movement patterns. While these early goals remain important, the rehabilitation pathway often stops progressing much beyond this point. Many patients are discharged with only basic exercise guidance after their hospital stay.
The New Zealand Context
In New Zealand, hospital stays after joint replacement are becoming shorter due to increasing pressure on the healthcare system. Patients often receive physiotherapy only in the first 48 hours following surgery before returning home with a standard exercise booklet. For younger patients hoping to return to sport or higher levels of activity, this limited support may not fully prepare them for the demands they want to return to.
What Does the Research Say?
Some studies suggest that individualised pre‑ and post‑operative rehabilitation programmes do not provide significantly better outcomes. However, many of these studies are low quality, highly variable in design, and in some cases more than 30 years old. Importantly, the population undergoing hip replacement today is very different from the populations studied historically.
The Role of Strength and Exercise
Hip osteoarthritis often leads to weakness and muscle loss, particularly in the gluteal muscles. Once the early healing phase has passed, rehabilitation should focus on restoring strength through functional, weight‑bearing exercises. Exercises such as single‑leg standing, hip hitching, squats, bridges, and sidestepping are often more effective than non‑weight‑bearing exercises such as clams or side‑lying leg lifts.
Considering Surgical Healing
Rehabilitation programmes must also consider surgical healing timelines. Capsular repairs typically take around three to four months to form a strong scar, meaning excessive loads or aggressive movements should be avoided during this period.
Pool‑Based Exercise
Pool rehabilitation is commonly recommended after surgery. While it can be useful for early movement and confidence, the reduced gravitational load means the gluteal muscles may be less stimulated. When using the pool, exercises that maintain contact with the pool floor—such as walking, step‑ups, or side‑stepping—can provide more functional stimulus.
Looking Ahead
Total hip replacements are highly successful in reducing pain and improving quality of life. However, the demographics of patients undergoing this surgery are changing. As younger and more active people receive hip replacements, rehabilitation programmes should evolve to support their goals.
Individualised physiotherapy led programmes involving progressive strengthening, targeted exercise, and longer‑term rehabilitation support could help many patients return not just to daily function, but to the sports and activities they value. The cost of structured pre- and post-operative rehabilitation is small when compared with the potential outcomes – a return to an active, healthy life, whether that is in the water, on the road, or on the ski slopes.
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