Anterior Hip Replacement: How Prehab and Expert Rehab Speed Up Your Recovery

By Geoff Scott, Founder & Senior Physiotherapist, Hauora

By Geoff Scott, Founder of Hauora and former Head of Medicine and Sports Science at Tottenham Hotspur

An anterior hip replacement can get you back on your feet quickly, but the operation is only half the story. How strong and well prepared you are going in, and how well your rehab is run afterwards, have a big influence on how fast and how fully you recover.

I spent 20 years in Premier League football, where we prepared players for surgery as carefully as we planned their return. The principle is simple: the stronger you are before an operation, the easier the road back. We now use exactly the same approach with hip replacement patients at our clinic in Primrose Hill.

This guide explains what an anterior hip replacement is, how it compares with other approaches, why prehab is worth doing, what recovery typically looks like week by week, and how we help you get back to walking, golf, tennis or the gym. If you have surgery coming up, you can book a prehab assessment with us.

Anterior hip replacement: the short answer

What it is: a hip replacement done through the front of the hip, working between muscles rather than cutting through them.

How common it is: in the UK, the posterior (back) approach is still the most widely used. The anterior approach is growing and is far more common in the United States.

The main benefit: many patients feel more comfortable and move more easily in the first few weeks. By around a year, results are generally similar whichever approach is used.

Prehab helps: building strength, mobility and confidence before surgery makes the early weeks easier and gets you ready for rehab.

Rehab matters most: a structured programme after surgery, progressed by an experienced physio, is what gets you from walking again to doing everything you want to do.

Anterior vs posterior hip replacement: which is more common?

In the UK, the posterior approach is still the most common. A large study of more than 720,000 hip replacements in the National Joint Registry found about 55% were done through the posterior approach and 36% through the lateral approach, with the anterior approach a small minority. The anterior approach has grown in popularity since, and is far more widely used in the United States.

Patients often ask us which is best. The honest answer is that each has strengths, and the most important factor is your surgeon’s experience with the approach they recommend.

Anterior. How it’s done: through the front of the hip, working between muscles rather than detaching them. What to know: often a little less pain and quicker early mobility; fewer movement restrictions for many patients; temporary numbness on the outer thigh is more common.
Posterior. How it’s done: through the back of the hip and buttock. What to know: the most common approach in the UK, with excellent long-term results; some surgeons ask you to avoid deep bending or crossing your legs for the first few weeks.
Lateral. How it’s done: through the side of the hip. What to know: used in around a third of UK operations in the registry study; can affect the muscles that stabilise the hip, so a limp may take longer to settle.

By around a year after surgery, most patients do well with any of these approaches. Where the anterior approach tends to stand out is the first six weeks or so, which is exactly when good rehab makes the biggest difference.

We work with patients after all three approaches, and we always follow your surgeon’s protocol and any movement precautions they set.

Prehab before hip replacement: getting in the best shape for surgery

Prehab simply means rehab before your operation. In elite sport we never send a player into surgery unprepared, and I see the same logic work for hip replacement patients. You can’t control the operation, but you can control how ready your body and your home are for it.

Research shows prehab can improve strength, fitness and confidence before surgery. The evidence on whether it changes long-term results after hip replacement is more mixed, and a 2023 review found only small effects. In my experience, the biggest benefit is practical: patients who have already learned their exercises, practised on crutches and built some strength tend to find the first few weeks far less daunting.

What a prehab programme involves

Ideally, we start six to eight weeks before your operation, but even two or three weeks helps.

Strength: exercises for the glutes, thighs and calves, such as sit-to-stands, bridges and step-ups, adjusted to your pain
Fitness: cycling, swimming or walking within comfort, to build stamina for recovery
Mobility: keeping the hip and back moving as freely as your arthritis allows
Rehearsal: practising walking with crutches, stairs, and getting in and out of bed and the car
Your first rehab exercises: learning them now, so you can start straight away after surgery
Home set-up: checking chair and bed heights, and clearing trip hazards
Baseline tests: measuring your strength, walking and sit-to-stand, so we can track your recovery against them

Nutrition and recovery

Good nutrition helps wound healing and muscle recovery. Our nutrition and recovery service can help you get your protein intake and general nutrition right before and after surgery. Anything medical, such as weight targets, blood sugar or medication, should always be discussed with your surgeon or GP.

Anterior hip replacement recovery timeline

Every patient and every surgeon is different, so treat this as a typical guide rather than a rulebook. Your surgeon’s instructions always come first.

Hospital (day 0 to 2). What’s typical: standing and walking with a frame or crutches, often on the day of surgery or the next day. Most people go home within one to two days. Rehab focus: getting moving safely, managing pain, practising stairs.
Weeks 1 to 2. What’s typical: walking with crutches, short frequent walks, swelling and stiffness easing. Rehab focus: gentle hip and thigh exercises, walking pattern, swelling control.
Weeks 2 to 6. What’s typical: reducing to one crutch or none as advised. Many people return to desk work in this period. Rehab focus: building strength, balance and walking distance; exercise bike once your surgeon is happy.
Weeks 6 to 12. What’s typical: walking without aids, driving for many people, swimming once the wound has healed. Rehab focus: progressive strength training, stairs, getting up from low chairs, longer walks.
Months 3 to 6. What’s typical: most people feel close to normal. Golf, cycling, hiking and doubles tennis often return. Rehab focus: sport-specific work, power and endurance.
Up to 12 months. What’s typical: strength and confidence keep improving. Rehab focus: keeping strong for the long term.

The gap between a good and a great outcome usually opens up after the first six weeks. That’s when many patients are discharged from routine physio, even though they still have plenty of strength to rebuild. This is where we make the biggest difference.

Rehab after hip replacement at Hauora

Our approach after surgery is the same one we used with Premier League players: follow the surgeon’s plan, measure everything, and progress only when you’re ready.

How it works

We start soon after you’re home. Usually within the first couple of weeks, once your surgeon is happy, with a full physiotherapy assessment.
We work to your surgeon’s protocol. Including any movement precautions, and we keep them updated on your progress.
We measure your progress. Hip range, strength on each side, sit-to-stand, single-leg balance and walking, compared with your prehab baseline.
We fix the limp. A lasting limp is usually down to weak hip muscles, especially the gluteals at the side of the hip. Targeted strength work is how it goes.
We build you back up. From walking and stairs to the gym, golf course or tennis court, with our strength and movement coaching taking over once you’re ready.

Why the later stages matter

Many people are told they’re doing well at six weeks because they can walk without crutches. But strength in the operated leg often still lags well behind the other side. Left alone, that can mean ongoing stiffness, a limp, back or knee aches, or simply never feeling quite right. We keep going until you’re strong, balanced and confident, not just walking.

You’ll also leave every session with a clear home programme, so the work continues between visits.

Getting back to driving, golf, tennis and the gym

These are the questions we’re asked most. The timings below are typical, and your surgeon has the final say.

Driving: often around 4 to 6 weeks. There’s no fixed legal waiting period in the UK, but you must be able to control the car safely, including an emergency stop. Check with your surgeon and your insurer.
Desk work: often 2 to 6 weeks. Sooner if you can work from home and move around regularly.
Exercise bike: often 2 to 4 weeks. One of the best early exercises for range and fitness.
Swimming: once the wound has fully healed. Some surgeons ask you to avoid breaststroke kick for a while.
Golf: putting and chipping from about 6 weeks, full swing from about 3 months. We build hip rotation and strength for the swing first.
Tennis and padel: doubles from about 3 to 6 months. Singles and padel need more speed and change of direction, so we test for it.
Gym: light strength work early, heavier lifting progressively. We’ll show you which exercises and loads are right at each stage.
Running: discuss with your surgeon. Views vary. Many surgeons prefer low-impact sport for the long-term health of the new joint.

We treat each of these like a return to sport in football: we set the target, rebuild the qualities it needs, then test them before you go back.

Why choose Hauora for your hip replacement prehab and rehab

Before founding Hauora, I spent 20 years at Tottenham Hotspur, first as Head of Physiotherapy and then as Head of Medicine and Sports Science, and later served as Director of Medicine and Performance at Nottingham Forest. Preparing players for surgery and rebuilding them afterwards was a core part of the job, always working closely with leading orthopaedic surgeons.

Senior clinicians only. You’ll be seen by me or by Jason Oliveira, who spent more than seven years at Saracens and specialises in pre- and post-operative rehab.
Before and after, in one place. The same team takes you from prehab through to full recovery, so nothing gets lost.
We work with your surgeon. We follow their protocol and keep them updated on your progress.
Time to do it properly. Physiotherapy sessions are 45 minutes.
More than physio. Strength coaching and nutrition support under one roof.

We also help patients after knee replacement and ACL surgery, and you can read our guide to what makes an elite sports physiotherapist.

Find us in Primrose Hill

Hauora, At The Core, The Courtyard, 44 Gloucester Avenue, Primrose Hill, London NW1 8JD, five minutes’ walk from Chalk Farm station. We’re easy to reach from St John’s Wood, Marylebone, Camden, Belsize Park, Hampstead and Kentish Town, and convenient for patients having surgery at the private hospitals in St John’s Wood and Marylebone.

We’re open Monday to Saturday, 8am to 6pm. A 45-minute physiotherapy session is £155; see our fees for other options.

Book your hip replacement prehab assessment

The best time to start is as soon as you have a date for surgery. Book online, call 020 4541 8924 or email contact@hauora.com.

Hip replacement FAQs

Is anterior hip replacement better than posterior?

Neither is better for everyone. The anterior approach often means a little less pain and quicker mobility in the first few weeks, while the posterior approach is the most common in the UK and has excellent long-term results. By about a year, outcomes are generally similar. Your surgeon’s experience with their chosen approach matters most.

How long does it take to recover from an anterior hip replacement?

Most people walk on the day of surgery or the next day, and many are off crutches within about six weeks. Most feel close to normal by three to six months, and strength and confidence keep improving for up to a year.

What is prehab, and when should I start?

Prehab is exercise and preparation before your operation to build strength, fitness and confidence. Ideally start six to eight weeks before surgery, but even two or three weeks is worthwhile.

Will I need physio after a hip replacement?

Yes. Physiotherapy helps you walk well, rebuild strength and get back to the activities you enjoy. Many people stop too early, once they can walk without crutches, when there is still strength to regain.

Are there restrictions after an anterior hip replacement?

Many surgeons set fewer movement restrictions after the anterior approach than after the posterior approach, but this varies. Always follow the precautions your surgeon gives you.

When can I drive after a hip replacement?

Often around four to six weeks. There’s no fixed legal waiting period in the UK, but you must be able to control the car safely, including an emergency stop. Check with your surgeon and your insurer first.

Do I need a referral to see a physio at Hauora?

No. You can book directly. If you’re claiming through health insurance, check with your insurer first, as some ask for a referral.