Follow your surgeon's orders and this eight-phase plan to safely and successfully return to cycling after a total hip replacement.
An orthopedic team at the Mayo Clinic performed the first successful hip replacement surgery in the United States on March 10, 1969. Americans transitioned to more active lifestyles and extended their healthy lives at the century’s onset. Individuals began taking up recreational and leisure activities like cycling in more significant numbers in the early 1900s.
More patients developed overuse disorders and degenerative joint disease as a result. The need for innovative ways to reduce pain and improve quality of life prompted surgeons to explore the first modern means of replacing hip joints. Unfortunately, cycling after a hip replacement was not encouraged.
The prevailing wisdom of surgeons and therapists was to advise the athlete suffering from hip pain, usually of arthritic origin, to “put it off as long as you can.” The artificial hip prosthesis had a finite lifespan of approximately 15 to 20 years back then.
Impact and excessive weight-bearing activity sped up the timeline, and surgeons advised against it for the most part. The options were limited and did not include resuming pre-surgical athletic activity. A lot has changed since then, and cycling after a total hip replacement is now a realistically attainable goal.
Total Hip Replacements Are Common For Cyclists
The lifetime incidence of hip pain in the general population is high. Symptomatic hip osteoarthritis, a common cause of hip pain, is about 25 percent in individuals over 85. That figure increases to 60 percent in former athletes. The percentages will rise as the trend toward an active aging population continues.
Cycling may not be the underlying cause of your hip pain or the reason you’re a hip replacement surgical candidate. However, the likelihood is good that you may become a candidate if you enjoy a healthy lifestyle that includes cycling as you age.
With the American Academy of Orthopedic Surgeons [Feb. 2022] reporting almost 2.4 million hip and knee surgeries in 2021, an 18.3 percent increase from 2020, the chances are good. The chances you’ll have to stop cycling after a total hip replacement—not good!
What is a Total Hip Replacement?
Total hip replacement, also known as hip arthroplasty, is a surgical procedure addressing severe hip pain that interferes with daily life. The hip is a ball (at the top of the femur or thigh bone) and socket (in the pelvis or hip bone) joint. Hip replacement surgery involves replacing one or both parts of the joint.
Total hip replacement includes switching out both the damaged ball and socket with an artificial prosthesis. A partial hip replacement is when only one or the other is surgically corrected.
Traditional hip replacement involves a large (approximately 10 cm) incision, usually through the side (lateral approach) or the back (posterior approach) of the thigh. Recovery takes time because muscles and tendons are detached and repaired during the procedure. In addition, there is a risk of dislocation in the acute post-operative phase.
Innovations in surgical techniques trend towards the more minimally invasive anterior approach. The surgeon will make a few smaller incisions and move the muscles and tendons aside rather than cutting and suturing them back. The recovery time is shorter, and there is less risk of dislocation.
Your surgeon and physical therapist will help you make the right choice and warn you against dislocation.
Cyclists Are Excellent Total Hip Replacement Candidates
Cyclists suffering from hip osteoarthritis are often surgical candidates. Osteoarthritis is a chronic degenerative joint disease affecting many middle-aged adults, especially active individuals like cyclists.
Osteoarthritis is the breakdown of joint cartilage over time due to repetitive stress or wear and tear. The protecting joint cartilage deteriorates, and bone thickening and spurs emerge. The result is severe and debilitating pain that interferes with mobility and recreation.
Individuals who have rheumatoid arthritis, avascular necrosis, traumatic hip injury (fracture), tumors, and congenital skeletal disorders are also hip replacement candidates.
When is it Time To Think About Hip Replacement?
Some surgeons and physical therapists say, “You’ll know when you know” when asked by their cycling patients. They mean that when an individual’s quality of life suffers from hip pain, it’s time for a replacement.
For the general population, it’s when sleep is interrupted, and simple tasks like climbing stairs or doing light housework are too painful to endure comfortably. Cyclists place a premium on pain-free pedaling to judge their life quality.
At first, hip pain will restrict the cyclist’s ability to come out of the saddle on climbs. Then a rider will feel pain during strenuous seated efforts and when in a time trial position. It’s when short rides become too much to bear that a cyclist knows it’s time.
Cycling After a Total Hip Replacement Recovery—The Acute Phase
The road to cycling after a total hip replacement recovery begins the moment the surgery is complete. Cyclists are highly motivated, making them strong surgical candidates with excellent post-surgical prognoses.
Shortly after surgery, a physical therapist will encourage you to get up and move around as soon as you can tolerate it. The hospital’s surgical team will discharge most cycling patients when they demonstrate they can walk (with a cane or walker), climb stairs, and get in and out of the car.
In the acute recovery phase (five to ten days after surgery), it’s vital to be sensible and compliant. Here are a few critical things to consider.
- Keep the surgical area clean and dry, monitor for signs of infection—fever, pus, heat, redness, and swelling—and notify your surgeon immediately if you suspect anything.
- Take all prescribed medications and resume a regular diet as instructed.
- Follow the strict instructions of your surgeon and physical therapist, including dislocation precautions.
- Elevate your leg and use ice to control swelling while resting.
- Perform the exercises your Physical Therapist recommends, and don’t overdo it because you think it will help you get back on the bike sooner.
Your acute post-surgical recovery will be smooth, and that’s when it’s time to ask, “When can I start riding my bike again?” Once your surgeon and physical therapist give you the okay, it’s the time!
Cycling After a Total Hip Replacement—Return to Cycling Protocol
The following post-surgical Cycling After a Total Hip Replacement protocol is the evolution of evidence-based information and years of personal and clinical experience with roots in a plan devised by Brigham and Women’s Hospital.
Before we get started, there are a few things that we need to get out of the way first.
- You can walk, climb stairs, stand for long periods, rise from chairs, and get in and out of your car with little to no pain.
- You have little to no swelling and a P.T.-approved range of motion in your hips, knees, and ankles.
- There is no swelling, redness, or excessive tenderness at the surgical site.
- A 15-minute easy spin produces no sharp pain during the ride or excessive soreness afterward.
- Your bike is fit correctly, preferably by a certified professional, and your orthopedic physician and physical therapist cleared you to begin.
Once you’ve fulfilled the prerequisites, it’s time to begin your post-surgical return to cycling after a total hip replacement journey. The initial two months are crucial and will focus on a steady but conservative progression with actions when faced with tightness and pain symptoms.
Perform each phase of the eight-phase plan every other day for a week before moving on if you don’t experience pain or other symptoms.
You can find the Training Zones based on the standard set by Joe Friel and adopted by TrainingPeaks here. Since it is a primary framework, you may use power and heart rate interchangeably. First, use an indoor trainer or stationary bike to prevent traumatic injury from falls or crashes. The important thing is to follow the progression and avoid advancing to the next phase unless you are pain-free.
Every athlete and injury experience is individual. Don’t be discouraged if you have to repeat a phase or extend “The Plan” period. Trust the process.
Stiffness Assessment and Action
Stiffness or tightness are expected and normal when returning to cycling following a total hip replacement. Don’t be discouraged. Here’s how you should handle it!
- If you experience stiffness during a phase, stop and gently stretch the target area for 30 to 60 seconds (per your Physical Therapist’s recommendations) and resume where you left off. Be sure to follow the dislocation precautions strictly.
- If the tightness returns, repeat the above process until the phase is complete, as long as the stiffness doesn’t progress to pain.
- If the stiffness isn’t resolved by steps 1 and 2 and affects your pedaling form, finish the time with an easy zone one spin. Begin with the same phase after taking a day to recover and only advance to the next when you can complete it successfully without pain or stiffness limitations.
Pain Assessment and Action
Pain is a more serious sign than stiffness, and you must treat it with concern. Have a healthy respect for the symptom but don’t be alarmed. Here’s what to do!
- If you experience mild pain at the beginning of the phase that subsides within ten minutes, continue to complete the phase but don’t advance to the next until you are pain-free. Don’t push through acute sharp pain. Notify your surgeon immediately.
- If you experience pain at the onset that doesn’t go away or worsens, stop and begin your gentle stretching and ice recovery routine. Return to the same phase after a day of rest.
- If pain is noted only after finishing the phase, comes on at night, or is noticed in the morning, be sure to perform your recovery routine and repeat the same one next time after a rest day.
It’s vital to be mindful of the pain you are experiencing. If the symptoms are more stiffness than pain, they don’t affect your ability to pedal, and it moves around or goes away as you warm up, then you are okay.
However, if the pain is sharp and causes you to stop pedaling, wakes you up at night, worsens the more you ride, affects your pedaling ability, and causes swelling, it is not okay.
Contact your healthcare professional right away! Be careful and trust the process!
The Final Phase—Cycling After a Total Hip Replacement Like Before
You’ve done the hard work, and your preparation, diligence, and discipline have made you successful. The first two to three months after surgery are critical in setting the groundwork and building a solid base. Continue to increase your volume and intensity by 10 percent a week until you are at pre-injury levels.
Monitor your symptoms and be willing to step back and add some rest days if pain develops. When in doubt and the symptoms persist, seek re-assessment by your health professional. The objective perspective of a certified cycling coach is always a good idea to help you to the next level.
Of course, the suggestions are a basic framework that will vary based on an athlete’s individual experience and is not a replacement for the authoritative personal advice from your healthcare or fitness professional.
Conclusion—Cycling After a Total Hip Replacement Better Than Before!
Cycling After a Total Hip Replacement is a new lease on your riding life. If you are sensible about your recovery and rehab successfully, you’ll be stronger and happier than before.
Follow the strict orders of your surgeon and physical therapist. Monitor the warning signs of infection and pain. Avoid the tendency to do too much!
You’ll be riding better than before and without hip pain!
What is your post-surgery return to cycling after a total hip replacement experience?
Any tips that made your riding rehab and recovery a success? Comment below! Your fellow cyclists want to know.
Semi-retired as owner and director of his private Orthopedic Physical Therapy practice after over 20 years, Chris is blessed with the freedom to pursue his passion for virtual cycling and writing. On a continual quest to give back to his bike for all the rewarding experiences and relationships it has provided him, he created a non-profit. Chris is committed to helping others with his bike through its work and the pages of his site.
In the summer of 2022, he rode 3,900 miles from San Francisco to New York to support the charity he founded, TheDIRTDadFund. His “Gain Cave” resides on the North Fork of Long Island, where he lives with his beautiful wife and is proud of his two independent children.
You will read him promoting his passion on the pages of Cycling Weekly, Cycling News, road.cc, Zwift Insider, Endurance.biz, and Bicycling. Chris is co-host of The Virtual Velo Podcast, too!