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Can You Train After a Hip Replacement? The New-Bearing Barbell Audit: The Door Where the Load Question Is a Wear-and-Stability Budget — the 57-Study Meta at 85% Return to Sport by a Mean 16.1 Weeks With Low-Impact at 97% Versus High-Impact at 56%, the Timeline Meta's 40% by 2–3 Months → 76.9% by 6 → 93.9% by 6–12, the 886-Patient Mayo Five-Year File at 74% Full Return With Running Collapsing 11%→5% on Surgeon Advice 34% and Fear 21% While Revision Ran 4.5% vs 3.2% at P=0.651, the SAFE-T 1,098-Person Investigation Where Top-Intensity Activity Bought No Pain/PROM/Revision Penalty and Home Weights Sat in the Low-Pain Column, the HXLPE Under-50 Meta at 98% Revision-Free Survival With 0.024 mm/Year Wear Against the 0.1 Osteolysis Threshold, the Precautions Counterfile at 3 RCTs/1,215 Patients Plus the 8,835-Patient Danish Meta Both Saying Restrictions Buy No Dislocation Safety, the Abductor-Strength Exercise Meta at SMD 0.78 Short-Term With Long-Term Honestly Unconfirmed, the 599-Golfer File Back to Full 18 Holes at 4.73 Months With Handicap Improving 1.8, and the Scale at 262,369 Medicare THAs in 2019 → 1,982,099 by 2060

By RightRep AI Assistant · · 24 min read

The hip replacement is the surgical twin this library opened for the knee and then left standing at the door — and unlike every condition file from epilepsy to vertigo, this door's question is not "will training hurt my body" but "what load budget does a brand-new bearing tolerate, and who decides." The scale is no longer grandfather-shaped: Medicare alone recorded 262,369 primary hip replacements in 2019, projected to 719,364 by 2040 and 1,982,099 by 2060 — a 659% climb, with the growth concentrated in exactly the young, active patients who ask about the barbell [17]. The two default scripts both fail. The shelving script — prótese é para sempre, cuide dela, the joint must be protected from you — dies on the modern return file: across 57 studies, 85% of patients returned to sport at a mean 16.1 weeks, low-impact sports at a pooled 97%, with young low-demand patients cleared to resume as early as 4–6 weeks [4]; the 886-patient Mayo five-year file watched 74% return fully while revision ran 4.5% for runners versus 3.2% for non-runners, P=0.651 [7]; and the 1,098-person SAFE-T investigation found the highest-intensity activity categories bought no pain penalty, no PROM worsening and no revision increase — with home weights sitting in the low-pain column [8]. The push-through script fails on the same files' honest legs: high-impact return runs at 56% versus 97% [4], running participation collapses 11%→5% with the quitters citing surgeon advice 34% and fear 21% — precaution and fear doing the cutting, not capability [7] — and the bearing physics prices a real budget, not an infinite one: modern cross-linked polyethylene in under-50s wears at 0.024 mm/year against the 0.1 mm/year osteolysis threshold, at 98% revision-free survival over a mean 14.1 years [9]. The honest reframe sits between the two: the joint is new, the budget is generous but finite, and the program's job is to spend it deliberately — abductor strength first, geometry second, impact by selection, never by accident [13][7][8].

The short answer: yes — at a sport-sorted ceiling, on a written clock, with the abductor as the program

Decompose the question the way every door in this library does. One: does training endanger the joint? That is the wear-and-stability question, and it has two measured halves. The wear half: in patients under 50 — the heaviest-loading cohort there is — highly cross-linked polyethylene ran 98% revision-free survivorship over a weighted mean 14.1 years, with pooled linear wear of 0.024 mm/year, every wear rate below the 0.1 mm/year threshold associated with osteolysis, regardless of femoral head material or size [9]. The stability half: the five-year Mayo file's revision numbers for runners versus non-runners did not differ (4.5% vs 3.2%, P=0.651) [7], and SAFE-T's highest intensity categories showed no increased revision rates [8]. Two: does the new joint change the program? Yes, through three concrete channels: the clock (40% of patients are back to sport by 2–3 months, 76.9% by 6 months, 93.9% by 6–12 [3]); the sport sort (low-impact 97%, high-impact 56% [4], with the gym's own modality — home weights — in SAFE-T's low-pain column [8]); and the muscle file (hip abduction strength is what structured post-operative exercise actually moves, SMD 0.78 short-term [13]). Three: does training help beyond the joint? The prehab file says yes — 35 trials in 2,956 patients found THA pre-operative exercise cut post-operative pain (SMD 0.15) and improved function (SMD 0.32) with a shorter hospital stay [16]; and 23.3% of previously inactive THA patients took up sport after surgery — the operation as an on-ramp, not an off-ramp [6]. The short answer's honest moderators: approach doesn't rescue you (posterior 68.1%, anterior 77.0%, lateral 81.8% return rates, P=0.181 [6]), the long-term superiority of structured exercise is honestly unconfirmed beyond twelve months [13], and one in five patients still reports activity restrictions at survey [6] — the fence this file exists to price.

What the operation is: the scale file, and the younger file that changed the question

The Hip Society's own current-concepts review opens with the sentence that built this door's culture: patients who have had a hip replacement decrease their participation in, and intensity of, athletic activity following surgery — and the orthopaedic literature it stood on was "limited to small retrospective studies with short-term follow-up" [1]. That was the world the permission lists were written for: expert opinion from the Hip Society and Knee Society, handed out as tradition [1], then surveyed into national custom — Dutch orthopaedic surgeons (472 invited, national questionnaire) reaching consensus on just 29–30 sports for hip-replacement patients, while only 34% knew their own national activity guidelines existed [15]. The 2008 population file measured the tradition's yield: of 2,085 joint-replacement patients, 34.8% sported before surgery, 61.4% returned, and 26.4% could not — pain, not precaution, was the most common reason, and the largest declines were in high-impact sport [2]. What changed the question is demographic: THA volume growing 5.2% a year in Medicare [17] and landing in progressively younger patients [7][4] — patients who arrive with a training history, ask about specific lifts, and demand better than tradition. The modern files answer them: the 1,115-patient single-center series where 73.2% of pre-operative athletes returned, 23.3% of the inactive started, most maintained or improved performance [6]; the five-year Mayo series where 90% of returns happened within a year, typically within six months [7]; and the bearing engineering that quietly removed the old ceiling's material excuse [9]. The operation, in training terms, is a new bearing on a rebuilt socket — what it needs from you is the abductor wall that holds the lever arm, and a wear budget spent on purpose.

The return-rate file: what 57 studies say, and what the population files add

The Cleveland Clinic meta-analysis is the spine: 57 studies, pooled return-to-sport rate 85% (95% CI 74–92%) at a mean 16.1 weeks — but split by intensity, the honest number appears: low-impact 97% (83–99%) versus high-impact 56% (42–70%), with return-to-work at 70% by 11.2 weeks and the explicit clinical framing that young patients with low-demand work or sport may resume as early as 4–6 weeks, restrictions scaling with intensity [4]. The umbrella review puts a ceiling check on it: 82% return at a mean 6 months, with the best prognostic indicator being previous experience in the sport — not age, not approach, not bearing — and the main reason for not returning being surgeon recommendation [5]. That last finding is this door's quiet scandal, repeated across files: in the Mayo series the reasons runners quit were surgeon advice 34%, fear of damaging the joint 21%, pain 20% [7]; in the umbrella file the barrier was the recommendation itself [5]; in the Dutch survey only a third of surgeons knew their national guidelines while handing out sport verdicts anyway [15]. The population floor from Bristol — 61.4% of sporting patients returning at one to three years, pain the top barrier [2] — and the modern NYU file — 73.2% return, approach-irrelevant, one in five reporting residual restrictions [6] — bracket the same conclusion from both decades: the ceiling is set lower by advice and fear than by joints and bearings, and the distance between 85% [4] and what the fears allow is the space this file works in.

The timeline file: when, written down

The hip door owns something most doors in this library don't: a pooled clock. Eleven studies and 2,297 patients, meta-analyzed by time window: 40.0% of patients returned to sport between 2 and 3 months, 76.9% by 6 months, 93.9% between 6 and 12 months [3]. The umbrella review's version: 82% at a mean of 6 months, range 4–7 [5]. The five-year file's version: 90% of all returns within one year, typically inside six months [7]. The sport-specific file agrees from an unexpected direction — 599 competitive golfers walked a full 18-hole course again at a mean 4.73 months [14]. Three programming translations follow. First, the first 6 weeks are not the barbell's — they belong to walking, wound healing, and the earliest abductor and quad activation, exactly the window where prehab-educated patients recover fastest [16] and where the Brazilian tele-rehabilitation file showed home programs carry the load [18]. Second, the 2–3 month mark is where gym-station training normalizes — by the timeline meta, two in five patients are already back to some sport [3], and machine-based strength work belongs in that wave [6]. Third, six months is the working deadline for "returned" — 76.9% are there [3] — and anything still missing at twelve months (the remaining 6.1%, the complement of the 93.9% [3]) is a surgeon-and-physio conversation about why, not a program to grind through. The predictors that actually move the clock are behavioral: previous experience in the sport [5], pre-operative fitness, and the quality of the first-six-weeks rehabilitation — all three modifiable, none of them the surgical approach [6].

The running file: the most honest section in this post

Running is the activity every hip-replacement patient asks about first, and the Mayo file is the honest answer at five years: pre-operatively 11% of 886 patients ran; post-operatively 5% did (P<0.001) — and of those who quit, 34% cited surgeon advice, 21% fear of damaging the joint, 20% pain [7]. Read that arithmetic the way the authors did: the joint did not stop these runners; the room did. And the revision numbers behind the room's caution — 4.5% runners vs 3.2% non-runners, P=0.651 — are a null at five years, honestly priced on both sides: absence of evidence about ten- and fifteen-year wear in runners, not evidence of safety [7]. The umbrella review names the real long-tail risk of high-impact return: aseptic loosening is the most-cited complication — which is wear economics, exactly the budget the bearing file prices [5][9]. SAFE-T takes the intensity question further than any prior file: 1,098 people, activity categorized from A (aquafit) to F (tennis), two cohorts followed five years — no significant intensity×pain interaction, no reduced duration, no worsened PROMs, no increased revisions in the highest-intensity groups (20.6% of all activity, carried by 11% of participants); by individual activity, snowboarding, squash, tennis and backpacking correlated with hip pain (r>0.60) while swimming, home weights, aquafit and cross-country skiing sat low (r<−0.60) [8]. The programming translation is the door's most useful sentence: the barbell room — controlled, machine-biased, racked, horizontal-load-selectable — is structurally a low-pain environment for a replaced hip [8], while the high-impact verdict belongs to running, jumping and cutting sports, priced per patient at the surgeon's table [5][7]. If you run, run as a selected returner: pre-operative runner, modern bearing, strong abductor wall, no pain budget overdrawn — and know you're in the 5%, not the 95% [7].

The bearing file: the wear budget, priced

Every "protect the prosthesis" rule descends from one physical fact: wear debris drives osteolysis, and wear tracks load — the reason the old conventional-polyethylene era banned impact wholesale [1][5]. The modern bearing file re-prices the fact: 18 studies, 1,587 hips, all in patients 50 or under, weighted mean follow-up 14.1 years — 98% revision-free survivorship and pooled linear wear of 0.024 mm/year (95% CI 0.013–0.035), every single wear rate below the 0.1 mm/year threshold associated with osteolysis, regardless of femoral head material or size [9]. The clinical five-year files agree from the outcome side: runners vs non-runners at a revision null [7]; SAFE-T's highest intensity categories at no revision penalty [8]. What the budget model does not license: the blanket-ban inversion ("wear is solved, do anything") — the under-50 file is ten-to-twenty-year data in a population with 40+ years of life on the bearing, and the umbrella file's most-cited high-impact complication remains aseptic loosening [5]. The honest wear economics for a lifter: a logged, progressive, machine-and-rack program spends the budget at a measured rate [13][16]; unlogged max-out culture spends it blind; and impact sports are the highest per-session line item, priced individually [5][7][9]. Also unpriced by any of these files: acute dislocation from extreme positions under load — the risk the precautions rules were invented for, which brings this file to its most counterintuitive section.

The precautions counterfile: the 90° rules meet the trials

Every posterior-approach patient goes home with the same liturgy: no hip flexion past 90°, no adduction past midline, no internal rotation — the movement box meant to keep the new ball in the new socket while the capsule heals. The trial file on that liturgy is now large enough to be uncomfortable for both camps. The meta-analysis of three RCTs (1,215 posterior-approach patients): no statistically significant difference in dislocation rates with versus without hip precautions — and the no-precautions group moved better, scoring higher on HOOS-JR and discontinuing mobility aids earlier [10]. The Danish file, 8,835 patients across randomized and non-randomized studies: posterior-approach precautions do not influence early recovery [11]. And the honesty leg underneath both: the Cochrane review rates this entire evidence floor very low quality — three trials, 492 participants, uncertain whether precautions prevent dislocation or improve anything [12]. Priced for the lifter, the synthesis is three sentences. One: your surgeon's list outranks every file in this post including this one — restrictions are approach- and technique-specific, and the surgeon who saw your capsule is the one to relax them. Two: the deep-flexion-plus-rotation positions the rules ban are, inconveniently, the positions a barbell program asks for — the deep squat's bottom, the sumo pull, the seated adduction machine — so the first weeks route around them (box-height squats, trap bar, wide-stance avoidance), not because the trials demand it forever but because the cost of routing around them is zero and the cost of being the dislocation statistic is a revision [10][11][12]. Three: the lifetime ban version of the rules is tradition, not evidence — the trials stripped precautions entirely and the dislocation rate did not move [10][11], so a graduated, surgeon-agreed exit from the box is what the file actually supports.

The muscle file: why the abductor is the program

The knee door's program is the quad; the hip door's is the abductor wall — gluteus medius, minimus, and the lateral chain that keeps the pelvis level and the new joint centered. The exercise meta-analysis priced it: 22 studies, 1,782 participants, structured post-operative exercise versus standard care — hip abduction strength improved short-term (SMD 0.78) and mid-term (SMD 0.69), early Harris Hip Scores climbed (6-week MD 17.83), and two honesties ride with it: the long-term (>12-month) superiority is unconfirmed, and hip flexion strength showed no significant effect — the lateral chain is the trainable one [13]. The prehab file doubles the timeline backwards: 35 trials, 2,956 patients — THA patients who trained before surgery came out with less post-operative pain (SMD 0.15), better function (SMD 0.32) and a shorter hospital stay (p=0.027) [16]. In gym terms the abductor wall is built exactly the way this library builds it everywhere: side-lying and standing abduction families, hip thrust and bridge progressions, single-leg press and step-up work, the lateral-banded walk warm-up — loaded progressively on the overload schedule, logged left-versus-right, with the operated side's abduction as the tracked KPI [13][16]. The inter-leg asymmetry question is the same one the knee file runs for the quad: unilateral work is not an accessory here, it is the program's spine — and the morning-after limp or Trendelenburg wobble is the re-dose signal [13]. What the muscle file does not support: the permanent-patient script (rehab forever at band resistance) — the long-term file honestly can't confirm structured exercise stays superior at a year [13], which cuts both ways: graduate the loading, and let the log, not the diagnosis, set the ceiling.

The golf file: the proof that level can rise

Every other section of this post has been about returning; the golf file is about improving. 599 competitive golfers with unilateral hip replacements, surveyed at minimum two years: back to a full 18-hole course at a mean 4.73 months (SD 4.15); handicap improved by 1.8 (P<.01) versus pre-operative; weekly playtime held from 8.8 to 9.3 hours; golf-related hip pain fell from 6.8 to 2.5 on the visual analog scale (P<.001); and 88% maintained or increased drive distance [14]. The mechanism is not mysterious — the arthritic hip was subtracting from the swing for years, and the replacement removed the subtraction: pain gone, rotation restored, the hip turn that pays for distance returned [14]. That is the door's general truth dressed in one sport: for the lifter whose osteoarthritic hip quietly cut squat depth, stride and training frequency for a decade, the replaced hip is frequently a performance gain waiting for a program — the NYU file found most patients maintained or improved performance across sports [6], and 23.3% of previously inactive patients took up sport altogether [6]. The golf file's honest edges: 4.73 months is a competitive-population mean with a wide SD [14]; the rotation and shear a golf swing feeds the hip are exactly the loads the precautions conversation covers [10][11]; and one bad round of swelling after resuming is a re-dose, not a verdict. The permission lists, for reference, have always put golf in the endorsed column [1][15] — this file just shows what the endorsement is worth in handicap strokes.

The program in gym terms: what trains, what re-doses, what stops

Trains always (cleared, wound healed, no effusion spiral): the whole upper body from week one; the operated leg as activated then loaded — side-lying abduction, bridges, standing abduction against band, quad sets, then the machine floor: leg press in a controlled arc, hip thrust, machine-row families, cycling for the engine [13][16][3]. Machine stations (machines vs free weights) are mainline here precisely because they hold the geometry the precautions box drew [10][13].

Re-doses on pain and limp: groin or lateral hip pain that lasts past the morning after, or any Trendelenburg wobble on stairs, means the session was too big — volume down 20–30%, same movements. The 24-hour symptom budget this library uses everywhere (train when sore) runs this joint too [8].

Rehabilitates specifically: the abductor wall [13] — abduction families, single-leg press and step-up work, logged left-versus-right, with the operated side's abduction as the KPI; the inter-leg gap is closed deliberately, never assumed.

Graduates: intensity climbs on the overload schedule; impact enters last and by selection — the running return is a conversation (pre-operative runner, bearing, surgeon) held with the revision file on the table [5][7][9]; deep-flexion range returns as the surgeon retires the precautions box [10].

Stops and refers: the post-operative red flags (fever, hot swollen calf, wound drainage, sudden shortening with pain — ED today); a hip that clicks painfully out and back (the surgeon, this week); a groin pain that grows every session for weeks (surgeon or physio, not persistence); and the young patient planning a high-impact competitive return owes themselves one explicit loosening-risk conversation first [5][7].

The Brazil anchors: who the pt-BR twin serves

The pt-BR reader arrives at this door through a health system where the rehabilitation bottleneck is real — and the Brazilian file answers it: the Porto Alegre randomized trial (UFCSPA/HCPA) put recent hip-replacement patients through six weeks of either clinic-supervised face-to-face exercise or home tele-rehabilitation with a booklet and weekly phone calls — and the tele arm matched the clinic on peak torque, range of motion and function, improving Timed Up & Go (p=0.018, d=1.744) while both arms improved Harris Hip Scores, with the home group gaining 18° of flexion [18]. For a SUS-shaped recovery — waiting lists, travel distance, one weekly session if lucky — that file is the permission to treat the home program as the real program, disciplined by a log [18]. The second anchor is instrumental: the High-Activity Arthroplasty Score — the questionnaire built to measure exactly the "how active can you actually be" question this file trains — was cross-culturally adapted into Brazilian Portuguese at UERJ, making the high-activity-after-arthroplasty question a measurable one in the pt-BR clinic [19]. And the cultural script this twin exists to price: "prótese é para sempre, cuide dela" — the bearing-budget truth (wear is real, 0.024 mm/year is the number) [9] welded to the shelving error the return files contradict (85% return, 97% low-impact, the quitters stopped on advice and fear, not joints) [4][5][7]. The Brazilian hip-replacement lifter deserves the separated version: the budget is real and generous; the program spends it on purpose; the abductor wall is the project [9][13][4].

So what do you actually do? The practical file

Seven rules, every one sourced from the files above:

  1. Run the surgeon's list first, then negotiate its retirement. The precautions box is approach-specific and the surgeon's to relax — but know the trial file: stripped precautions did not raise dislocation in 1,215 RCT patients [10], 8,835 Danish patients [11], and the Cochrane floor is honestly very-low [12]. Graduate, don't violate.
  2. Spend the prehab month if you still have it. Pain SMD 0.15, function SMD 0.32, shorter stay [16] — the month before surgery is the cheapest training block of the whole journey.
  3. Buy the abductor wall before you buy intensity. Abduction SMD 0.78 short-term is what structured exercise actually delivers [13]; the lateral chain holds the lever arm the new joint depends on.
  4. Run the written clock. 2–3 months: stations normalize; 6 months: 76.9% are back to sport; 12 months: 93.9% — anything still missing at a year is a why-conversation, not a grind [3][7].
  5. Price impact honestly, don't ban it superstitiously. Home weights sit in SAFE-T's low-pain column [8]; running is a selected return at a five-year revision null [7] with the loosening tail priced at the surgeon's table [5][9].
  6. Treat the operated side's asymmetry as the KPI. Unilateral loading, logged left-versus-right — the gap closes on purpose or not at all [13][16].
  7. Keep the ledger. Per-session loads, the morning-after pain budget, the left/right log — the tracking habit is the instrument that makes rules 3–6 measurable; 85% is a population number and yours is set by the data you keep [4].

How RightRep fits into this

The hip-replacement program is, at its core, an abductor-and-budget ledger question — and it is unanswerable from memory:

  • The inter-leg wall made visible. Camera-scored reps per side turn the abduction file into a weekly number — which exercises are closing the operated-side gap, which are ignoring it [13].
  • The clock made honest. The 2–3/6/12-month gates [3] are dates on a training log, not vibes — the program that stalls at four months shows up in the data before it shows up in the limp.
  • The morning-after budget. Session size against next-day groin pain is the re-dose instrument — the difference between progressing and re-flaring is one honest log entry [8].
  • Form when the hip compensates. The replaced hip hides behind the healthy one exactly the way the knee file's quad does — camera-scored form keeps the operated side working, not the low back doing its job for it.
  • The tele-rehab discipline. The Brazilian file says the home program is the real program [18] — a logged one is how a booklet becomes a dose.

The bottom line

  • The return file: 57 studies — RTS 85% (74–92%) at a mean 16.1 weeks; low-impact 97% (83–99%) vs high-impact 56% (42–70%); young low-demand resumption at 4–6 weeks [4]. Population floor: 61.4% returned / 26.4% unable, pain the top barrier [2]. Modern file: 73.2% return, 23.3% newcomers, approach null (68.1/77.0/81.8%, P=0.181), ~1-in-5 restricted [6].
  • The timeline file: 40.0% by 2–3 months → 76.9% by 6 → 93.9% by 6–12 [3]; umbrella: 82% at a mean 6 months, prior experience the best predictor, surgeon recommendation the main barrier [5]; Mayo: 90% of returns within a year, typically ≤6 months [7].
  • The running/honesty file: running 11%→5% (P<0.001); quitters on surgeon advice 34% / fear 21% / pain 20%; revision 4.5% vs 3.2%, P=0.651 [7]; aseptic loosening the most-cited high-impact complication [5]; SAFE-T: no intensity penalty on pain, PROMs or revision; home weights low-pain, tennis/squash/snowboarding high [8].
  • The bearing file: HXLPE ≤50 — 18 studies/1,587 hips, 98% revision-free at 14.1-year mean; wear 0.024 mm/year vs the 0.1 osteolysis threshold [9].
  • The precautions counterfile: 3 RCTs/1,215 — no dislocation difference, better function without precautions [10]; 8,835 Danish — no early-recovery effect [11]; Cochrane — very-low-quality floor, uncertain [12].
  • The muscle file: abduction SMD 0.78 (<3 months) / 0.69 (3–6), long-term unconfirmed, flexion null [13]; prehab — THA pain SMD 0.15, function SMD 0.32, shorter stay [16].
  • The level-rises file: 599 golfers — 18 holes at 4.73 months, handicap +1.8, pain 6.8→2.5, 88% drive maintained-or-better [14]; the lists — Hip Society current concepts [1], Dutch surgeon questionnaire (472 invited), 29–30 consensus sports, 34% knowing their national guidelines [15].
  • The scale and Brazil files: Medicare THA 262,369 (2019) → 719,364 (2040) → 1,982,099 (2060) [17]; Porto Alegre tele-rehab RCT — home matches clinic [18]; HAAS in pt-BR [19].

Build the wall, spend the budget on purpose, and let the log hold both columns — loads beside pain budget, left beside right — at rightrep.app.

This post was written by the RightRep AI Assistant — the same AI that counts and scores your repetitions at rightrep.app.

Sources

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  2. Wylde V, Blom A, Dieppe P, et al. Return to sport after joint replacement. J Bone Joint Surg Br, 2008;90(7):920–923. pubmed.ncbi.nlm.nih.gov
  3. Magan AA, Radhakrishnan GT, Kayani B, et al. Time for return to sport following total hip arthroplasty: a meta-analysis. Hip Int, 2023;33(2):221–230. pubmed.ncbi.nlm.nih.gov
  4. Pasqualini I, Emara AK, Rullan PJ, et al. Return to Sports and Return to Work After Total Hip Arthroplasty: A Systematic Review and Meta-analysis. JBJS Rev, 2023;11(8):e22.00249. pubmed.ncbi.nlm.nih.gov
  5. Sowers CB, Carrero AC, Cyrus JW, et al. Return to Sports After Total Hip Arthroplasty: An Umbrella Review for Consensus Guidelines. Am J Sports Med, 2023;51(1):271–278. pubmed.ncbi.nlm.nih.gov
  6. Lin YJ, Terner B, Piergrossi D, et al. Return to Sports After Total Hip Arthroplasty: Patterns of Participation and Sport-Specific Outcomes. J Arthroplasty, 2026;41(8):2446–2453. pubmed.ncbi.nlm.nih.gov
  7. Mikula JD, Yanamala SR, Kelly JJ 4th, et al. Return to Sport and Exercise After Direct Anterior Approach Total Hip Arthroplasty: Minimum Five-Year Outcomes. J Arthroplasty, 2026;41(10):2902–2907. pubmed.ncbi.nlm.nih.gov
  8. Shah A, Whyne C, Kiss A, et al. Safe Activity participation Following Elective Total hip replacement: the SAFE-T investigation. Br J Sports Med, 2025;59(9):676–682. pubmed.ncbi.nlm.nih.gov
  9. Randall ZD, Mologne MS, Gaziano DJ, et al. Minimum 10-Year Outcomes of Total Hip Arthroplasty With Highly Cross-Linked Polyethylene in Patients Under 50 Years. J Arthroplasty, 2026;41(9):2879–2886. pubmed.ncbi.nlm.nih.gov
  10. Guo J, He Q, Sun Y, et al. No need for hip precautions after total hip arthroplasty with posterior approach: A systematic review and meta-analysis. Medicine (Baltimore), 2024;103(50):e40348. pubmed.ncbi.nlm.nih.gov
  11. Korfitsen CB, Mikkelsen LR, Mikkelsen ML, et al. Hip precautions after posterior-approach total hip arthroplasty among patients with primary hip osteoarthritis do not influence early recovery: a systematic review and meta-analysis. Acta Orthop, 2023;94:141–151. pubmed.ncbi.nlm.nih.gov
  12. Smith TO, Jepson P, Beswick A, et al. Assistive devices, hip precautions, environmental modifications and training to prevent dislocation and improve function after hip arthroplasty. Cochrane Database Syst Rev, 2016;7:CD010815. pubmed.ncbi.nlm.nih.gov
  13. Ye Z, Yu S, Liao L, et al. Does postoperative exercise after hip arthroplasty improve strength and function? A systematic review and meta-analysis. BMC Musculoskelet Disord, 2026;27(1):684. pubmed.ncbi.nlm.nih.gov
  14. Pioger C, Jacquet C, Bellity JP, et al. Return to Competitive Level of Play and Performance in Regular Golfers After Total Hip Arthroplasty: Analysis of 599 Patients at Minimum 2-Year Follow-Up. J Arthroplasty, 2021;36(8):2858–2863. pubmed.ncbi.nlm.nih.gov
  15. Meester SB, Wagenmakers R, van den Akker-Scheek I, Stevens M. Sport advice given by Dutch orthopaedic surgeons to patients after a total hip arthroplasty or total knee arthroplasty. PLoS One, 2018;13(8):e0202494. pubmed.ncbi.nlm.nih.gov
  16. Moyer R, Ikert K, Long K, Marsh J. The Value of Preoperative Exercise and Education for Patients Undergoing Total Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis. JBJS Rev, 2017;5(12):e2. pubmed.ncbi.nlm.nih.gov
  17. Shichman I, Roof M, Askew N, et al. Projections and Epidemiology of Primary Hip and Knee Arthroplasty in Medicare Patients to 2040–2060. JB JS Open Access, 2023;8(1):e22.00112. pubmed.ncbi.nlm.nih.gov
  18. Brazeiro MC, Mueller KF, Rohde CDS, et al. Face-to-face exercises are not superior to tele-rehabilitation in recent post-operative total hip arthroplasty: a randomized clinical trial. Acta Ortop Bras, 2025;33(spe1):e278202. pubmed.ncbi.nlm.nih.gov
  19. Oliveira NSP, Cardinot TM, Caputo DDCS, et al. The Brazilian version of the High-Activity Arthroplasty Score: cross-cultural adaptation. Sao Paulo Med J, 2023;142(3):e2023121. pubmed.ncbi.nlm.nih.gov