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Total Hip Arthroplasty/Hemiarthroplasty Rehab Protocol

Total Hip Arthroplasty/Hemiarthroplasty Rehab Protocol-Brigham and Woman's Hospital


Phase I: Immediately Post-Operatively (Days 0-3)

  • Goals: Perform bed mobility and transfers with minimal assistance while maintaining WB precautions, ambulate 25-100 feet w/ assistive device, stair training as appropriate for home ambulation, independently perform SLR, regain 80° PROM and AROM flexion, verbalize precautions
  • Exercises: Quad, hamstring, and glute sets, gait training on level surfaces, A/AA/PROM exercises, SLRs, soft tissue massage, transfer training
  • Modalities: Cryotherapy application 5 times daily and 20 min before/after exercise program
  • Precautions: WBAT w/ assistive device, monitor wound healing and signs for DVT and PE, no exercises with weights or resistance, avoid torque and twisting forces across knee
  • Criteria to move to Phase II: AROM: Hip flexion 0-90°, hip abduction 0-30°, independent in transfers and ambulation for 100 feet w/ assistive device

Phase II: Motion Phase (Day 3-Week 6)

  • Goals: Muscle strengthening of entire hip girdle, begin proprioceptive training, continue with gait, endurance, and functional training and mobility
  • Exercises:
    • Weeks 1-4: AROM hip abduction, quad, hamstring, and glute isometrics, heelslides, gait training, stationary biking, closed chain proprioception exercises
    • Weeks 4-6: Continue/progress above exercises with resistance as tolerated, front/lateral step up/downs, ¼ front lunge, sit to stand exercises, ambulation on uneven surfaces
  • Criteria to move to Phase III: AROM of hip motion 0-110°, good quad control, independently ambulates 800 feet w/o assistive device or gait deviations

Phase III: Intermediate Phase (Weeks 7-12)

  • Goals: Adequate strength of all LE musculature, return to most functional activities
  • Exercises: Progress with above strengthening, endurance, and proprioception exercises
  • Criteria to move to Phase IV: 4+/5 of all LE musculature, minimal to no pain or swelling

Phase IV: Advanced Strengthening and Higher Level Functioning

  • Goals: Return to appropriate sports/recreational activities, enhance strength, endurance, and proprioception
  • Exercises: Progress above exercises, increase duration of endurance activities, return-to-work tasks, squatting
  • Criteria for discharge: Non antalgic and independent gait, independent in step over step stair climbing, pain-free AROM, 4+/5 LE strength, normal age-appropriate balance and proprioception, and independent in home exercise program


1. Total Hip Arthroplasty/Hemiarthroplasty Protocol. Brigham and Women's Hospital Web site.