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Upcoming Hip Replacement Surgery

I’m 61 yo with upcoming left total hip replacement surgery.
My training in the past has been more powerlifting focused, for many years. Squat day, BP day, DL day, accessory day. I don’t plan to return to powerlifting type training for multiple reasons. No bad feelings. I want my training to be fun, challenging and healthy. I’ve maintained a fairly good cardiac base through the years.
I’m looking for help and guidance on two questions.

  1. How do you measure progress with BB? It’s an aesthetic based endeavor. I enjoy lifting and training, I have no plans to compete. I’m look for a different challenge than a max weight, and I’m wondering if that can be found with BB?
  2. Advice on a simple leg day routine. No squats, no lunges , no DL. No leg press. I train at home, I have seated knee extensions, seated hamstring curls, 45 degree back extension bench and a low cable for pull through. I’ve always trained glute and hamstrings fairly rigorously with my supplemental and accessory movements.
    A little extra quad work, but I am naturally more quad dominant,as are many.
    Last points, I’m also an Orthopaedic Surgeon, so the initial rehab I feel good about. As many are probably aware many physicians are not “ experts or experienced lifters”. I’ve got plenty of years in lifting, but looking forward to training in a different manner.
    Thanks for all thoughts. I trust if this topic is in the wrong location, the moderator Chris Colucci will move its location.

Are you having the anterior approach, rather than old school lateral incision? If so, you should expect a much quicker recovery, and not have to worry about the 3 no-no’s s/p THA. Dan John has had the anterior approach, and has had great results. Still trains, maybe not barbell squats, but does plenty of kettlebell work, including swings. Lots of mobility work, being able to squat, but not with heavy weights. I will try to pull up some of his post-replacement stuff that he is doing now…

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Do you access to physiotherapists or exercise physiologists?

Total curiosity (I’m studying physiotherapy), do you specialise in any joints/procedures within your practice?

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Are variations of the powerlifts off the table because they would be the most efficient way of building up your lower body without necessarily loading it up as much like Romanian Deadlifts and High Bar Squats.

Without the big lifts and variations or lunges, leg Press and hack squat (I’m assuming) you’re really limiting yourself. Dems all the main movement patterns that can be loaded and progressed. Outside of that working towards weighted pistol squats is about it and those are limited by balance a lot.

Coming from powerlifting one way of tracking progress of hypertrophy could be to measure estimated 1RM for your bodybuilding movements and corresponding body part using moderate to high reps like if your DB Press e-1RM it 8RM goes up you’ve made gains

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Anterior approach.
I’m sure plenty of folks squat after. 1/4 squats would probably be safe from a dislocation, I want to avoid axial loading the implant.
Time will tell on hip hinge, so RDL or SLDL might be ok.
I’ve enjoyed his writing. Thank you for the help and reference.

I do.
PTs are great in general for lots of rehab. I’m looking more for someone who has some specific experience knowledge in returning to weights safety after an anterior THR.
I do mostly fracture work (trauma) and spine surgery. Some metastatic bone stabilization as well.
My interest after the initial recovery is activity I enjoy. Lifting weights, and balancing wear on the implant. Wearing of the polyethylene cup liner of the acetabular component is a big determination of life of the implant.

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Thank you.
Some probably are.

Considering you called them PT’s, I’m assuming that you’re in North America. One of the great things over there is that there are a lot of physios with a background in exercise and fitness, who’ll tend to carry the CSCS (Certified Strength and Conditioning Specialist). If you are in fact in North America, I’d recommend you seek out a PT with the CSCS. If you’re in Europe or Australasia, equivalent certifications you might see are UKSCA and ASCA, respectively.

Definitely, we’re actually doing our orthopaedic surgery unit now, so it’s pretty cool I came across you :joy:. In practice, how much guidance do orthopaedic surgeons tend to give the post-op physiotherapists? We’ve been give a lot of information over the past four week (in which time they crammed all orthopaedics for the whole degree :roll_eyes:) and it’s just a bit overwhelming :grimacing:.

Anyways, back to your main question that popped out at me

You can definitely do isolation movements so all your leg extension / leg curl variations are totally chill (as I’m sure you know). If you’re not planning on avoiding all loading of the hip (which would be understandable), I don’t see why partial squats aren’t an option. I would also think you could do exercises like rack pulls, block pulls or high-handed trap bar pulls.

We’ve been taught anterior approach replacements dislocate at end-ranges of flexion or extension, or combined adduction with external rotation. Again, if your concern with lower body exercises is dislocation, you could pretty easily stay out of the zone with an exercise like a box squat, for example.

Now, if you want to minimise overall loading of the hip, you could always find way to make compound exercises “harder.” Pre-exhaust methods and slow tempos could both be ways to get this done. Say you started your workout with high-volume leg extensions and leg curls, you could then move to something like a (partial range) squat variation with 5s eccentrics. By that time the load you’d be able to handle would be pretty low so I’d imagine total loading on the hip would reduced. Just something to consider, and I trust your education on orthopaedic prostheses far more than mine.

EDIT: Also, consider looking in to blood flow restriction training, not so much for the hip muscles, but it’s a very effective way to get a searing quad/hamstring pump without any load, and I believe (not certain) that hypertrophy benefits are comparable to normal resistance training, as it simply allows you to achieve failure at a lighter load. At the very least, it would help attenuate detraining. You could consider a leg day that looks something like:

1: Sled warm-up (forward/backward/lateral drags): 5-10mim continuous
2A: Leg Extension: idk whatever floats your boat
2B: Leg Curl: as above
3: Light Goblet (or even bodyweight) Squats w BFR: I’ve seen sets of up to 4 minutes used (I’ll link some resources for BFR strength training below)
4: Something heavy-ish if you wanted to do it like a high box squat or rack pull

BFR resources:


From Squat University with Dr Horschieg DPT

From Strength Chat with Kabuki Strength

And Dr Mario Novo’s website: http://liftersclinic.com/

I’m lead to believe Dr Novo (DPT) is one of the best clinicians when it comes to the application of blood flow restriction training


Two clinicians who I (and many others) think are among the best in the world when it comes to returning lifters to former function (and you can work with them online):

  • Dr Jordan Shallow
  • Bill Hartman works at IFAST gym in Indianapolis. I’ve got no idea if that’s close to you :joy:, but at least unlike Shallow, it’s a real address
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Great information. Much appreciated.
Yes , I’m in the USA.
As far as direction with PT ( physical therapy), I only write the prescription for goals, definitely not the specific exercises. Like WBAT( weight bearing as tolerated) , or quad strengthening after a quad tendon repair. Or AAROM ( active assisted range of motion)after distal humerus fixation. I’m guessing the abbreviation are the same where you are.

Dislocation after ante surgery is usually in extension with external rotation.Early post op can be when the affected limb is in stance phase of gait and the other limb during swing starts to make a turn away, so left leg is fixed and a turn to the right is made , and the down limb can’t support the move.
Posterolateral approach can lead to abduction weakness and even if the glute medius is not cut, a portion of the max is divided in line with its fibers,and repaired during closure. Those dislocate in flexion,adduction and internal rotation. Low chairs are a danger zone
As far as exercises go, I want to avoid the axial load of a bar on my back. Rack pulls and RDLs will probably be ok.
I’ve never done or tried blood flow restriction. I’m intrigued with pre exhaustion, and that’s a great idea. I’ll probably start with a variety of isolation movements, and see. I’m not sure how or when full rom compound barbell movements will fit in.
Thank you for the help. Any further thoughts or information most welcomed.

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Glad I could help, and thank you for clarifying my own understanding :slightly_smiling_face:

So as far as programming, starting proximal to distal.
A hinge movement, first BW then either DB or a bar, cable or band pull through, or 45 degree back extensions with the pads lower. Relatively close stance.
Progressive abduction strengthening exercises
Step ups
Knee extensions
Hamstring curls, standing,seated, prone
Calve raises.
A variety of isolation type movements adding to a relatively comprehensive lower extremity strength plan.
Sets and reps and frequency will work itself out with time as will resistance. Much better to start light get a little endurance and build from there.
Your posts have been a real help to my developing some thoughts

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Just read this.
Sounds super simple and fun.
Thank you.

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To close the loop.
I had my hip replacement 3 weeks ago.
I’m doing great.
Specifics are in my training log on the 35+.
Thank you to all for the comments.


A little late to the thread but I had both hips resurfaced in 2012, approx. 6 months apart. I had the lateral incision done on both. I was 41 years old when I had the surgeries.

My doctor didn’t mention PT until I asked and I went for the first one. I did not go to the second and there was and is no difference in my hips. The best piece of advice I received was when you walk, try and walk with perfect walking form.

I did have to alter my squat and deadlift stances and make them more narrow as in shoulder width is most comfortable now.

Otherwise I have no limitations and my Doc told me to let pain be my guide. My deadlift and squat are as good as ever and more importantly, pain free.

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