There’s a stretch of time in hip arthritis that nobody prepares you for.
It runs from the appointment where someone first says the word, through however long it takes to be seen, through however long the list is, and up to the day of surgery — if surgery is where you end up at all.
For many people that’s a long period. And the prevailing assumption is that it’s dead time. Nothing to do but manage, wait, and hope things don’t get much worse.
That assumption costs people a great deal, because what happens during that period meaningfully affects where you finish up.
Here’s the whole pathway, stage by stage, and what’s worth doing at each point.
Stage One: Before Anyone Has Mentioned Surgery
Where you are: Groin pain, stiffness in the morning, difficulty with socks and shoes, a limp late in the day. Possibly an X-ray and the word arthritis.
What’s worth knowing: Exercise is recommended as a core treatment for osteoarthritis regardless of how severe the changes are, and it’s recommended alongside education and, where relevant, weight management. It isn’t a holding measure while you wait for something more definitive — it’s the first-line treatment.
It’s also the treatment most people never actually receive. A substantial proportion of those referred for an orthopaedic opinion have never been through a structured strengthening programme for the affected joint.
A word about the X-ray. The correlation between what appears on imaging and what someone experiences is weaker than people assume. Considerable changes can accompany modest symptoms, and vice versa. The picture isn’t the prognosis, and it certainly isn’t a countdown.
What to do now: Get a proper programme. Strength work through the hip and the whole leg, aerobic activity you tolerate, and range of movement work. Expect it to take months and to require progression.
Honest note: The evidence for exercise in hip osteoarthritis is less strong than for knee, with smaller reported effects. It remains the best-supported non-surgical option, it helps a great many people meaningfully, and it isn’t a cure.
Stage Two: On the List
Where you are: A decision has been made that surgery is appropriate, and now there’s a wait.
The temptation: To do less. It hurts, surgery is coming, and there’s an intuitive logic to conserving the joint until someone replaces it.
Why that’s the wrong call: You will be operated on with the body you arrive with. Muscle lost during the wait doesn’t come back on its own afterwards — it has to be rebuilt, from a lower starting point, whilst also recovering from major surgery.
Better preoperative function is generally associated with better postoperative function. The stronger and more mobile you are going in, the less ground there is to make up.
What about “prehab” specifically? Worth being straight about this. The evidence for structured pre-operative exercise programmes is mixed. Some studies report improved function in the early postoperative period and shorter hospital stays; the longer-term differences are less consistent, partly because most people do well after hip replacement regardless.
So the honest framing isn’t that prehabilitation transforms your outcome. It’s that arriving deconditioned makes the early recovery harder, and that the waiting period is otherwise wasted.
What to do now:
Keep strength work going, adapted to what your hip tolerates. Loading doesn’t have to mean deep squats — there are ways to load a hip that isn’t happy at end range.
Work the other leg. It carries you through the early recovery, and it’s often neglected.
Work your upper body. You’ll be using sticks or crutches, and pushing up out of chairs.
Practise the movements you’ll need — getting in and out of a chair, on and off a bed, stairs.
Address anything else that’s deteriorated whilst you’ve been favouring one side. Backs and knees frequently pick up the slack.
Sort your home in advance rather than in the week before. Chair heights, bed height, bathroom, stairs, and where things are stored.
What to raise with your GP or the surgical team: pain management whilst waiting, whether your position on the list should be reviewed if things deteriorate significantly, and anything that might affect surgery — weight, smoking, blood sugar control, anaemia, dental health.
Stage Three: The Weeks Before
Where you are: A date, and a mixture of relief and apprehension.
What to do: Continue exercising up to the point you’re advised to stop. Prepare the house properly. Arrange help for the first fortnight. Understand what the first weeks will actually involve, including any movement precautions your surgical team specifies — these vary by surgical approach and are their call, not something to take from an article.
Worth doing: Write down what you want to get back to. Specific things — the garden, a particular walk, sleeping on your side, driving. Recovery is easier to navigate with concrete targets than a vague hope of feeling better.
Stage Four: After
Where you are: Through it, sore, and being told to get moving faster than feels reasonable.
What to know: Modern recovery is considerably more active than it was a generation ago. Getting up and moving early is a deliberate part of the process.
The pattern we see most often: People do the prescribed rehabilitation until they can walk comfortably and manage daily life, then stop — typically somewhere around six to twelve weeks. At that point the joint is fine and the muscles around it are still substantially weaker than the other side.
That residual weakness is where limping, reduced confidence, and a smaller life quietly come from. The joint was replaced; the strength wasn’t.
What to do: Keep going after the formal follow-ups end. Progress from walking to genuine strengthening. Expect meaningful gains for a year or more, not twelve weeks.
Stage Five: The Hip You Didn’t Have Replaced
Worth a mention because it’s routinely ignored. Many people go on to develop symptoms in the other hip, and the years spent limping and compensating place load on the other side, the knees, and the back.
The strength work that helped you before surgery is the same work that protects everything else afterwards.
What This Adds Up To
The waiting period is not dead time. It’s the one part of this pathway you have direct control over, and what you do with it shapes how the rest goes.
Nobody is suggesting exercise removes the need for surgery when a hip genuinely needs replacing. Some hips do. But arriving strong, mobile and prepared changes the recovery considerably — and for a proportion of people, a properly delivered programme changes the timeline of whether surgery is needed at all.
When to Seek Prompt Advice
Get medical advice for a sudden marked deterioration; hip pain following a fall, particularly with an inability to weight-bear; hip pain with fever or feeling generally unwell; night pain that’s severe and unrelenting; unexplained weight loss alongside joint pain; or, after surgery, increasing pain, wound problems, fever, or new calf pain and swelling.
Let’s Make the Wait Count
Whether you’re newly diagnosed, on a list, or months past an operation and not where you hoped to be, there’s usually more available than you’ve been offered.
Chadwick’s Physiotherapy offers a free discovery visit at no cost and no obligation. You’ll get an assessment of your strength, movement and current function, an honest conversation about where you are, and a programme built for the stage you’re actually at.
We work alongside your GP and surgical team, not instead of them.