Hip replacement recovery: preparing your home and your help

Most of a hip replacement recovery happens at home, not in a hospital. So the two most useful things you can do before surgery have nothing to do with the operating room. Set up the house. Settle who is helping you.

This article covers both, plus the first weeks and what the evidence shows about “hip precautions.” The practice’s home preparation checklist has the room-by-room list. This is the why behind it.

What should I set up before surgery?

A clear, well-lit walking path, and a firm place to sit and sleep.

For the first week or two you will walk with a walker or crutches. Walk the route you will actually use, from the car to the bed, the bathroom, and the kitchen, and fix what could trip you. Move loose rugs and cords. Light the route for night trips. Put the things you use every day where you can reach them without deep bending or a step stool. Decide where the pets will be. Set up one firm chair with arms, a bed you can get in and out of, and the bathroom equipment your team recommends. The full checklist walks through each room.

Why so much fuss about tripping? Falls are the enemy of a new hip. In a large review of hip replacement studies, falls caused about one in four dislocations. And fixing hazards helps. A Cochrane review found that in older adults already at higher risk of falling, removing home hazards cut falls by about a third (nine trials, about 1,500 people). That evidence comes from the general older population, not from joint replacement patients. But in the weeks after hip surgery, you are exactly the person it describes: someone whose fall risk is higher than usual.

Do I need someone at home?

For the first day or two, yes. After that, it depends.

You need a ride home, because you cannot drive yourself. You need a capable adult staying with you, or checking in closely, for the first day or two. And three more things should be settled out loud before surgery day. Who picks up the prescriptions. Who that adult is. Which number you will call with a concern, day or night.

What if you live alone? That question has been studied properly. Surgeons in Philadelphia followed 910 consecutive hip and knee replacement patients. Of those who went home, 138 lived alone for the first two weeks and 631 lived with others. The patients living alone had no more complications and no more unplanned returns to the hospital. They did stay an extra night in the hospital more often, and they used more home nursing and therapy visits. Living alone changes the plan. It does not have to change the destination.

Do most people go home, or to a rehab facility?

Home, and that is by design.

Approximately 90% of primary hip and knee replacements go home the same day. What that number includes is its own article. The short version: the decision is made before surgery, and a prepared home with a capable adult in it is part of what makes you a candidate.

A rehab facility is still the right choice for some people, and using one when it is needed is good judgment, not failure. But it is not a gentler default. A 2025 study of 400,321 Medicare knee replacements found that going somewhere other than home after surgery cost 3.9 times as much over the first year. Read that number carefully. It is knee data, not hip data. And it is not mostly about the facility’s bill. About a third of the high-cost patients had a complication. Harder recoveries are part of what sends people to facilities in the first place. The lesson is that the whole plan points home, and the preparation above is what makes that plan work.

What are the first weeks like?

Walking, from the first day, with support.

In the first days the work is simple. Walk short distances often, manage swelling and discomfort, protect the incision, and follow the instruction sheet for your operation. The walker retires when you show you are safe without it, not on a set date. Over the next few weeks the walks get longer, the house gets easier, and therapy shifts from safety to strength. How soon will I walk and the recovery timeline cover this stretch in more detail, including why two people with the same operation can have very different months.

What are hip precautions?

Movement rules some patients get after a hip replacement. The classic list: do not bend the hip past a right angle, do not cross your legs, do not twist the foot inward. For decades they were standard, meant to guard the new hip against dislocation while the tissue around it heals.

Here is what happened when researchers tested them.

A 2005 randomized trial followed 303 hips. Every patient kept basic movement limits, but only half got the extras: an abduction pillow, raised toilet seats and chairs, and bans on side sleeping and riding in cars. One hip dislocated in the entire study, and it was in the group with the extra restrictions. The patients without them got back to side sleeping, driving, and work sooner, and were happier with the pace of recovery. The extras also cost about $655 more per patient, in 2005 dollars.

A 2020 randomized trial did the same test with almost 600 hips, dropping the movement rules entirely for half. About 1 hip in 100 dislocated, with no difference between groups, and the unrestricted patients found daily life easier at six weeks. One trial that size cannot catch a rare event on its own, which is why the pooled reviews matter. A 2023 review combined nine studies covering 8,835 patients and found no difference, or close to none, in early dislocations. Its authors were careful about it. The studies were not strong, and better ones could change the answer. Their conclusion was that the evidence does not support routine precautions, not that precautions are proven useless.

One more finding is worth sitting with. Across 9,599 hip replacements, dislocation happened in about 2 percent of hips with precautions and about 2 percent without, and falls caused about one in four of the dislocations that did happen. A rule list cannot prevent a fall. A cleared, well-lit hallway can.

So why might your surgeon still give you precautions? These studies span different surgical approaches, and they report averages across thousands of patients. You are one specific hip. Protocols vary with the approach used, the implants chosen, your anatomy, and what the surgeon saw during your operation. Some patients get few formal rules at all. Others get specific rules for specific reasons. The instruction sheet you go home with was written for your hip, and it outranks this article and everything else you read. Follow it. And if you want to know why a rule is on your list, ask. That is a fair question with a real answer.

When should I call the office?

Most recoveries move steadily forward. For any of these, call promptly instead of waiting for the next appointment:

• Fever or chills
• Redness that spreads, or drainage from the incision
• Calf pain, or new swelling in one calf
• Pain that climbs instead of gradually settling
• A hip that suddenly will not bear weight, or a leg that suddenly looks shorter or turned

Chest pain, sudden shortness of breath, or new confusion are emergencies. Call 911, not the office.

Where this fits in Dr. Patel’s practice

The home plan is part of the surgical plan. Before surgery, the team goes over your home setup and your help while deciding whether same-day discharge fits you. Surgery-center patients typically go home about five hours after surgery. That means the first night of recovery happens in the home you prepared. That is the point of preparing it.

Worth asking at the visit

• What movement rules will I have, if any, and for how long?
• Who needs to be with me at home, and for how long?
• What equipment do you actually want me to have, and what can I skip?
• What would make a rehab facility the safer choice for me?
• When could I expect to drive, sleep on my side, and go back to work?

The total hip replacement page covers how the operation is performed and how candidacy is decided, and the home preparation checklist is the list to walk through this week, not the night before.