The first week is about pain management, learning to move safely, and preventing blood clots

Your first week after hip replacement is a recovery period, not a return to normal. You will spend most of it managing pain, using a walker or crutches, and doing physical therapy exercises in bed or sitting down. The surgical site will be swollen and tender. You will take prescription pain medication on a schedule, not just when pain breaks through. A physical therapist will visit your hospital room or home to show you how to move without damaging the new joint — these movements feel awkward at first because your hip has a new range of limits.

Expect to feel tired. Surgery depletes your body's resources, and pain interrupts sleep even with medication. You may also feel emotional — this is normal after a major procedure. Most people go home within one to three days after surgery, depending on how well they can manage stairs and bathroom transfers with help.

Key Takeaways

  • Pain medication is given on a schedule during the first week, and you should take it before pain becomes severe rather than waiting until it does.
  • You will use a walker or crutches and cannot put full weight on the surgical leg until your surgeon says otherwise, usually after several weeks.
  • Physical therapy starts in the hospital or at home within 24 hours and focuses on gentle range-of-motion exercises and safe transfers.
  • Blood clot prevention is critical — you may wear compression stockings, take blood thinners, or use a sequential compression device on your legs.
  • Swelling, bruising, and mild drainage from the incision are normal; fever, severe swelling, or foul-smelling drainage warrant a call to your surgeon.

Pain management and medication during the first week

You will receive pain medication before you leave the operating room, and the hospital will continue it on a regular schedule — usually every 4 to 6 hours for stronger opioids, or every 6 to 8 hours for extended-release versions. Do not wait until pain is severe to take the next dose. Pain that builds up is harder to control than pain you prevent. Your surgeon or nurse will give you a written schedule and instructions on what to do if breakthrough pain occurs between doses.

Most people go home with a prescription for opioid pain medication (such as oxycodone or hydrocodone) and are told to take it as directed for the first week or two. You will also receive instructions on over-the-counter options like acetaminophen or ibuprofen to use alongside or instead of prescription medication as pain decreases. Ice applied to the hip for 15 to 20 minutes several times a day also reduces pain and swelling — your surgeon will tell you when it is safe to ice the incision directly versus icing through a towel.

Constipation is a common side effect of opioid pain medication. Ask your surgeon or pharmacist about a stool softener or laxative before you leave the hospital. Staying hydrated and eating fiber-rich foods also helps, though you may have little appetite in the first few days.

Movement restrictions and using assistive devices

You will not bear full weight on the surgical leg for at least 4 to 6 weeks after surgery — your surgeon will tell you the exact timeline. For the first week, you will use a walker or crutches to move around, and a physical therapist will teach you the correct way to use them. The goal is to protect the new joint while it begins to heal.

Your hip also has movement restrictions to prevent dislocation. You must avoid bending your hip more than 90 degrees (roughly a right angle), crossing your legs, or turning your knee inward. These restrictions usually last 6 to 12 weeks. Your physical therapist will show you how to sit, stand, and lie down without violating these limits. A raised toilet seat and a reacher tool (a long stick with a grabbing hand at the end) help you manage bathroom and dressing tasks without bending too far.

Stairs are difficult in the first week. If you must use them, go up leading with your good leg and down leading with the surgical leg — your physical therapist will practice this with you. Many people sleep downstairs for the first week or two to avoid stairs entirely.

Physical therapy exercises and what they accomplish

Physical therapy begins within 24 hours of surgery, often while you are still in the hospital. The first-week exercises are gentle and focus on preventing stiffness and blood clots. You will do ankle pumps (pointing and flexing your foot), quad sets (tightening the thigh muscle without moving the leg), and glute sets (squeezing the buttock muscle). These isometric exercises — where you contract muscles without moving the joint — build strength without stressing the new hip.

You will also do passive range-of-motion exercises, where a therapist or machine gently moves your hip through its safe range while you relax. This prevents scar tissue from forming and keeps the joint mobile. Lying on your back and sliding your heel toward your buttock (keeping your knee bent) is a common exercise. Walking with your walker, even just a few steps, also counts as therapy and helps your body adjust to the new joint.

Do the exercises your therapist assigns, even if they feel pointless or cause mild discomfort. Skipping them in the first week leads to stiffness and slower recovery later. Your therapist will give you a written sheet with pictures showing each exercise and how many repetitions to do daily.

Swelling, bruising, and incision care

Swelling peaks around day 3 to 5 after surgery and gradually decreases over weeks. Bruising around the incision and down the thigh is normal and fades over time. Elevation and ice reduce swelling — keep your leg raised on pillows when sitting or lying down, and ice for 15 to 20 minutes several times daily as your surgeon directs.

Your incision will have stitches or staples that are usually removed 10 to 14 days after surgery at a follow-up appointment. Until then, keep it clean and dry. You may shower after the first 24 to 48 hours if your surgeon approves, but do not soak the incision in a bath. Pat it dry gently afterward. Some clear or slightly bloody drainage is normal; a small amount of oozing onto the bandage does not mean something is wrong.

Call your surgeon if you notice fever above 101°F, increasing redness or warmth around the incision, foul-smelling drainage, opening of the incision, or swelling that worsens instead of improving. These signs can indicate infection.

Blood clot prevention measures

Hip replacement surgery carries a risk of blood clots forming in the legs. Your surgeon will use one or more prevention methods during your first week. You may wear compression stockings (tight socks that squeeze your calf) continuously or during the day. You may take a blood thinner medication by mouth or injection — common options include aspirin, enoxaparin (Lovenox), or apixaban (Eliquat). Some hospitals use a sequential compression device, an inflatable sleeve around your calf that rhythmically squeezes to keep blood moving.

These measures are important even though they feel uncomfortable. Continue them for as long as your surgeon recommends, usually 10 to 35 days depending on your risk factors. Signs of a blood clot include sudden calf swelling, warmth, redness, or pain in one leg that is worse than the other. Call your surgeon when ready if you notice these symptoms.

Sleep, rest, and managing fatigue

Sleep is difficult in the first week because pain, medication side effects, and the need to keep your hip in a safe position all interfere. You may sleep better propped up on several pillows rather than flat. A pillow between your knees helps keep your hip aligned and prevents crossing your legs during sleep. Take your pain medication before bed so it has time to work.

You will feel exhausted even when you are resting. This is your body's response to surgery and healing. Rest as much as you need. Naps are fine. Pushing yourself to "do more" in the first week does not speed recovery — it increases pain and swelling. Your job is to follow your physical therapy routine and manage pain, not to return to normal activity.

If you cannot sleep despite medication and positioning, talk to your surgeon. Sometimes a different pain medication or a mild sleep aid helps in the short term.

When to call your surgeon

Contact your surgeon right away if you experience fever above 101°F, signs of infection at the incision, sudden increase in swelling or pain, calf swelling or warmth in one leg, chest pain or shortness of breath, or inability to move your toes or foot. These symptoms can indicate infection, blood clots, or other complications that need prompt attention.

Also call if you have questions about your pain medication, physical therapy exercises, or movement restrictions. Your surgeon's office expects these calls in the first week and would rather answer a question than have you guess wrong and delay your recovery.

Frequently Asked Questions

Can I go home the same day as surgery?

Most people stay in the hospital for one to three days after hip replacement. Same-day discharge is rare and requires that you can safely transfer, use the bathroom, manage stairs, and have a caregiver at home. Your surgeon will decide based on how well you are moving and managing pain on the day after surgery.

How much pain should I expect?

Pain is usually moderate to severe in the first 24 to 48 hours, then gradually decreases. By the end of the first week, many people describe it as a dull ache rather than sharp pain, though this varies. Pain medication should keep it manageable — if it does not, tell your surgeon.

What if I cannot do the physical therapy exercises because they hurt?

Mild discomfort during therapy is normal, but sharp pain is not. Tell your therapist if an exercise causes sharp pain — they can modify it or try a different approach. Skipping exercises entirely leads to stiffness, so work with your therapist to find versions you can tolerate.

Is it normal to feel depressed or anxious after surgery?

Yes. Pain, disrupted sleep, loss of independence, and the stress of recovery can trigger low mood or anxiety. These feelings usually improve as pain decreases and you regain mobility. If they persist or worsen, mention it to your surgeon — they can refer you to support or adjust your medication.

When can I drive again?

You cannot drive while taking opioid pain medication or while your leg is immobilized. Most people are cleared to drive 4 to 6 weeks after surgery, once they can bear weight and have stopped opioids. Ask your surgeon for specific clearance before you drive.