If you’ve had a hip or knee replacement, the surgery is the easy part for a lot of people. Getting back to training afterwards is where it gets real. Here’s how I handle it, and what the research says about the timeline.
First: get the green light
Before I train anyone after a joint replacement, I need the green light from their surgeon, physio or doctor. I also need the client to feel confident themselves. Both matter. Clearance tells us it’s safe. Confidence tells us they’re ready. If either is missing, I wait.
What the research says about recovery
Recovery takes a while, and most of the big gains come early. In an Australian study that followed 122 hip and knee replacement patients for a year, most of the improvement happened in the first six months, and hip patients improved faster than knee patients. The US society of hip and knee surgeons says most people return to their pre-surgery activities within four to six months, starting within the first three. Their advice is to stick with low-impact activity, be careful with medium-impact, and avoid high-impact sports.
That last part isn’t settled, though. A 2026 review found no clear consensus on how much activity is safe after a hip replacement, and said the evidence is limited and low quality. So if you’re hoping to get back to something more demanding, ask your surgeon. It’s a conversation worth having before you start.
There’s also evidence that progressive strength training helps. A review of seven trials found it improved muscle strength and function in hip patients, with more limited effects in knee patients.
What the first sessions look like
The first session is mostly about holding my client’s hand and building confidence back in the studio. The biggest hurdle can be as simple as turning up on the first day. We might just do the exercises their physio has given them, plus a little isolated upper body work.
From there, it’s led by the client. They tell me how they feel each session, and we take it from there, building every session in confidence, strength and stability.
Hip and knee returns are mostly the same approach. The main thing I change is the exercise selection.
The biggest mistake
The biggest mistake I see is doing nothing. People leave it too long to come back, or stop doing their physio exercises, or get lazy. Then the injured area never gets back to its full potential. In my experience, getting back to even 80 per cent can take months, and sometimes years, and keeping the joint strong is a lifelong job. It’s not something you put on the back burner and forget about.
If you’re about to have surgery, my post on training before joint surgery covers how to prepare. And if arthritis is part of the picture, you might also find exercising with arthritis useful.
One of my clients was back training about ten weeks after a hip replacement, after months of preparing beforehand. Everyone’s different, and I can’t promise that timeline for anyone else, but it shows what’s possible when the work is done early and the physio is on board.
Ready to get back to it?
If you’ve been cleared and you’re not sure where to start, come and talk to me. I train people in small groups of up to six here in Maroubra, and I’ll work with whatever your surgeon and physio advise.
Sources
- Naylor JM, Harmer AR, Heard RC, Harris IA. Patterns of recovery following knee and hip replacement in an Australian cohort. Aust Health Rev, 2009;33(1):124-135.
- American Association of Hip and Knee Surgeons. Resuming sports after hip replacement (patient guidance).
- Clark SC, Rohdenburg JE, Taunton MJ, Hevesi M. Returning to sports and high-impact exercise after total hip arthroplasty: what should we be recommending in 2026. Orthop Rev, 2026;18.
- Skoffer B, Dalgas U, Mechlenburg I. Progressive resistance training before and after total hip and knee arthroplasty: a systematic review. Clin Rehabil, 2015;29(1):14-29.