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Expert care for your hip & knee

Clear, evidence-based information to help you understand your diagnosis, prepare for treatment, and feel confident every step of the way.

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Specialist orthopaedic surgeon

Specialist orthopaedic care

Our education content is written and reviewed by specialist orthopaedic surgeons specialising in hip & knee conditions - so you can trust what you read.

Evidence-based content
All information is reviewed against current clinical guidelines and kept up to date.
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Whether you are seen on the NHS or privately, this resource is free and open to everyone.
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Access information at any time - before your appointment, late at night, or on the day of surgery.
Surgery pathway

From your first appointment to full recovery

Step-by-step guides for before, during, and after your procedure - including what to bring, how to prepare your home, and what recovery looks like week by week.

1
Pre-operative assessment
2
The day of surgery
3
Immediate recovery (ward)
4
Home recovery & physiotherapy
5
Follow-up & outcome review
✓
Back to full activity
Patient recovering from hip or knee surgery
Back to full strength
Surgical team operating in theatre
Surgery preparation

Surgery prep guides

Select your procedure below for a step-by-step guide covering your pre-assessment, the day of surgery, and your recovery - tailored to your specific operation.

Hip procedures
Hip surgery guides
Knee procedures
Knee surgery guides
General preparation
Applies to all procedures

Whatever your operation, there are steps that apply to everyone - fasting, medication review, arranging transport, and preparing your home. These are covered in every guide.

🚫No food or drink from midnight before surgery
💊Review blood thinners with your team
🚗Arrange a driver and overnight support
🚭Stop smoking before surgery
Patient reported outcomes

My outcome scores

These validated questionnaires help your surgical team track how your hip or knee is affecting your daily life. Each takes about 2 minutes. Your answers are saved privately in your browser.

OHS

Oxford Hip Score

12 questions assessing pain and function for hip surgery and hip replacement. Validated since 1996.

OKS

Oxford Knee Score

12 questions assessing pain and function for knee surgery and knee replacement. Validated since 1998.

Patient education

Hip & knee physiotherapy

A guide to rehabilitation covering key terms, common exercises, stages of recovery, and when to seek advice from your clinical team.

Important: This page provides general educational information only. Always follow the specific exercise programme given to you by your physiotherapist or surgeon. Do not start new exercises after surgery without clinical guidance.
Physiotherapy terms explained

Understanding the language your physiotherapist uses helps you get more from your appointments and rehabilitation programme.

Range of motion (ROM)
How far you can move a joint in a given direction, measured in degrees. Your physiotherapist records ROM at each appointment to track progress. After hip or knee surgery, regaining full ROM is a primary goal of early rehabilitation.
Active ROM
Movement you produce yourself using your own muscles - for example, actively lifting your leg or straightening your knee. Active ROM tests the strength of the muscles around the joint as well as the joint's movement.
Passive ROM
Movement produced by your physiotherapist or a mechanical device, without muscle effort from you. Useful in the early stages after surgery when active muscle contraction is painful or restricted.
Quadriceps (quads)
The large group of four muscles at the front of the thigh that straighten (extend) the knee. Quad weakness is the most common functional problem after knee surgery. Regaining quad strength is central to all knee rehabilitation programmes.
Hamstrings
The muscles at the back of the thigh that bend (flex) the knee and extend the hip. Hamstring strength is important for knee stability and for returning to sport after ACL reconstruction. The hamstring tendons are often used as the graft for ACL reconstruction.
Hip abductors
The muscles on the outer hip (gluteus medius and minimus) that move the leg out to the side. Hip abductor weakness is extremely common in hip and knee pain and is a key target of rehabilitation for both conditions - it reduces inward collapse of the knee (dynamic valgus) during walking and sport.
Gluteal muscles
The three muscles of the buttock (gluteus maximus, medius, and minimus). Glute strength is fundamental to hip function after replacement or fracture, and to knee health during loading activities. Glute max extends the hip; glute med stabilises the pelvis during single-leg activities.
Isometric exercise
Contracting a muscle without moving the joint - for example, tightening the quadriceps while the leg is flat on the bed (quad set). Isometric exercises are safe in the very early post-operative period as they strengthen without stressing the healing tissue.
Eccentric exercise
Muscle contraction while the muscle is lengthening - for example, slowly lowering yourself from a step. Eccentric loading is particularly important in tendon rehabilitation (patellar tendinopathy) and in building functional strength around the hip and knee.
Weight-bearing (WB)
The amount of body weight put through the operated leg. Your surgeon will prescribe a specific weight-bearing status after surgery: full weight-bearing (FWB), partial weight-bearing (PWB), or non-weight-bearing (NWB). Always follow the prescribed status to protect healing bone and tissue.
Gait re-education
Relearning a normal walking pattern after surgery or injury. A limp or altered gait after hip or knee surgery can cause secondary problems in the opposite leg, the back, and the hip if not corrected early. Physiotherapists assess and correct gait as mobility improves.
Proprioception
The body's sense of joint position in space. Proprioception is impaired after joint injury and surgery. Balance exercises on unstable surfaces are used to retrain proprioception, which is essential before returning to sport after ACL reconstruction or other knee surgery.
Limb symmetry index (LSI)
A measure comparing strength or function between the operated and non-operated leg, expressed as a percentage. An LSI of over 90% for quadriceps and hamstring strength and hop tests is required before safe return to pivoting sport after ACL reconstruction.
Hip precautions
Movement restrictions advised after hip replacement to reduce dislocation risk. Specific precautions depend on the surgical approach - your surgical team will advise you. Common restrictions include avoiding crossing the legs and bending the hip beyond 90 degrees in the early post-operative weeks.
Common exercises

Always follow the specific programme given by your physiotherapist or surgical team. The exercises below are commonly used in hip and knee rehabilitation but may not all be appropriate for your stage of recovery.

Quad set (isometric quadriceps)
Lying flat, tighten the quadriceps by pushing the back of the knee into the bed and holding for 5-10 seconds. The first exercise after most knee and hip operations. Safe to begin on day 1 after surgery.
Straight leg raise (SLR)
Lying flat, tighten the quad and lift the straight leg to the height of the opposite bent knee. Builds quad and hip flexor strength without bending the knee. Important after knee replacement and ACL reconstruction.
Ankle pumps
Repeatedly flexing and extending the ankle while lying or sitting. Activates the calf muscle pump to reduce leg swelling and DVT risk. Should be performed frequently throughout the day after hip or knee surgery.
Heel slides
Lying flat, slowly slide the heel towards the buttocks to bend the knee, then slowly back. Restores knee flexion after replacement or surgery. The target is 90 degrees of flexion by 6 weeks after total knee replacement.
Hip abductor slide
Lying flat, slide the operated leg out to the side and back without rotating. Activates the gluteus medius. Commonly prescribed after hip replacement to begin rebuilding abductor strength while observing hip precautions.
Clam exercise
Lying on your side with knees bent, lift the top knee upward like a clamshell opening, keeping the feet together. A key hip abductor and external rotator exercise. Used in hip rehabilitation and knee rehabilitation to reduce dynamic valgus.
Bridging
Lying on your back with knees bent, push through the feet to lift the hips off the bed. Strengthens the gluteal muscles and hamstrings. Progressed from two-leg to single-leg bridging. Safe and effective early after hip and knee replacement.
Mini squats / wall squats
Standing with back against a wall, sliding down to approximately 30-45 degrees of knee bend and holding. Builds quad and glute strength through a functional range. Weight must be directed through heels. Introduced when full weight-bearing is established.
Step-ups
Stepping up onto a low step with the operated leg leading. Strengthens the quadriceps and glutes in a functional pattern. Height of the step is progressed gradually. A marker of good functional strength is completing a single leg step-down under control.
Stationary cycling
Low-impact cardiovascular exercise that maintains knee flexion and hip mobility. Seat height is initially raised to reduce the range of movement required. Introduced at 6-8 weeks after most hip and knee procedures. One of the best exercises for maintaining fitness during recovery.
Swimming
Excellent low-impact exercise for cardiovascular fitness and joint mobility after hip and knee surgery. Can usually be started once the wound is fully healed (approximately 2-4 weeks after arthroscopy, 4-6 weeks after replacement). Breaststroke is generally avoided early after hip replacement due to the rotational forces.
Nordic hamstring curl
An eccentric hamstring exercise performed by slowly lowering the body forward from a kneeling position. Used in the later stages of ACL rehabilitation to build hamstring strength and reduce re-injury risk. Also used in ACL injury prevention programmes.
Stages of rehabilitation

Timelines vary significantly between conditions, procedures, and individuals. Always follow the programme set by your clinical team. The stages below reflect typical recovery after hip or knee surgery.

1
Phase 1 — Acute phase
Days 1–14 after surgery or injury
The priority is protecting healing tissue, controlling pain and swelling, and preventing unnecessary stiffness. Physiotherapy begins on the day after most hip and knee operations. For hip replacement: standing and walking with a frame begins on day 1. For knee replacement: knee bend exercises and quad sets begin immediately. For ACL reconstruction: maintaining full knee extension from day 1 is critical to prevent arthrofibrosis.
Pain and swelling controlled with ice and elevation
Full weight-bearing as prescribed (immediately for most hip and knee replacements)
Quad set and ankle pump exercises started
Walking with appropriate aid (frame or crutches)
2
Phase 2 — Mobility and early strength
Weeks 2–6
Progressive increase in walking distance and independence. Hip replacement: transition from frame to crutches to single stick. Observe hip precautions as directed by your surgical team. Knee replacement: target 90 degrees of knee flexion by 6 weeks. ACL reconstruction: achieve full extension, progressive quad strengthening, begin cycling.
Walking distance increasing steadily
90 degrees knee flexion (knee replacement goal at 6 weeks)
Wound healed, stitches or clips removed (10-14 days)
Stairs managed step-over-step
Hip abductor and glute strengthening begun
3
Phase 3 — Strengthening
Weeks 6–12
The focus shifts to building functional strength in the quadriceps, gluteals, and hip abductors. Most patients return to driving during this phase. Swimming and stationary cycling are introduced. For joint replacement patients: walking without aids by 6-8 weeks. For ACL reconstruction: progressive quad and hamstring strengthening, proprioception exercises.
Walking unaided on level ground
Returned to driving (6-10 weeks, cleared by surgeon)
Swimming started (wound healed)
Stationary cycling commenced
Functional exercises: mini squats, step-ups, bridging
4
Phase 4 — Functional recovery
Months 3–6
For hip and knee replacement: low-impact activities such as cycling, swimming, walking on varied terrain, and light gardening. Continued strength building. For ACL and meniscal repair patients: progressive running programme begins at 3-4 months. Sport-specific drills for cutting and change of direction from months 4-5.
Confident walking on all surfaces including hills and uneven ground
Low-impact sport (golf, cycling, swimming)
ACL: jogging programme started, sport-specific training
Returning to social activities and hobbies
5
Phase 5 — Full recovery
Months 6–12+
Hip and knee replacement patients continue to improve for 12-18 months. ACL reconstruction patients return to full competitive sport at 9-12 months, guided by limb symmetry index (LSI) testing rather than time alone. Hip arthroscopy patients return to sport at 4-6 months. Maintaining a long-term exercise programme is important for implant longevity and joint health.
ACL: return to competitive pivoting sport after LSI >90%
Joint replacement: maximum improvement reached
Long-term exercise habit established
Annual review with surgical team as appropriate
Getting the most from rehabilitation

Patients who engage consistently with physiotherapy and maintain realistic expectations tend to achieve the best outcomes after hip and knee surgery.

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Consistency over intensity
Doing your exercises every day matters more than occasional intensive effort. Tissue healing and strength development follow biological timelines that cannot be significantly shortened.
🧢
Ice is your friend
Ice applied for 15-20 minutes after exercise significantly reduces post-activity swelling and pain in the early weeks after hip and knee surgery. Use a cloth between ice and skin to prevent ice burns.
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Track your progress
Recovery after joint replacement and ACL reconstruction is gradual. Record your walking distance, knee bend, and pain level weekly. Seeing measurable progress over weeks is motivating and helps identify any plateaus early.
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Respect hip precautions
After hip replacement, the precautions given by your surgical team are designed to prevent dislocation while the soft tissues heal. Follow them strictly for the duration specified — typically 6-12 weeks. Ask your team if you are unsure what is and is not permitted.
🏃
Walking is rehabilitation
Regular walking on level ground is one of the most beneficial activities after hip and knee replacement. It builds strength, improves movement, reduces swelling through the muscle pump, and supports cardiovascular fitness. Gradually extend your distance each day.
😴
Rest and sleep support recovery
Tissue repair happens during sleep. Aim for 7-9 hours. Elevating the operated leg (above heart height) during rest periods significantly reduces swelling in the early post-operative weeks.
🤼
Do not rush return to sport
After ACL reconstruction, premature return to pivoting sport is the most common cause of graft re-rupture. Return to sport must be guided by limb symmetry index (LSI) testing — achieving over 90% symmetry — not by how many months have passed.
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Nutrition supports healing
Adequate protein intake supports muscle rebuilding after surgery. Vitamin D and calcium are important for bone healing. If you smoke, stopping before and after surgery significantly improves wound healing and recovery from hip and knee procedures.
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Communicate with your team
Tell your physiotherapist if an exercise is causing sharp pain rather than the expected muscle discomfort. Your programme should be adjusted to your current ability and progress. There are no benefits to exercising through severe pain.
When to seek help

Most discomfort during rehabilitation is expected and manageable. The symptoms below are not normal — they may indicate a complication requiring prompt assessment.

🚨 Contact your clinical team promptly if you experience:
Sudden severe increase in hip or knee pain not explained by a new activity
Increasing redness, warmth, or swelling around the wound or joint
Wound discharge, wound opening, or signs of infection (fever over 38°C)
A clunk, pop, or sudden loss of stability in the hip suggesting dislocation
Complete loss of ability to actively straighten the knee (may indicate extensor mechanism failure)
Calf pain, calf swelling, or redness in the lower leg (possible DVT)
Breathlessness, chest pain, or coughing blood (possible pulmonary embolism — call 999)
Foot drop or new numbness or weakness in the foot or lower leg (possible nerve injury)
A fall onto the operated hip or knee — attend A&E for assessment even if pain seems minor
Normal discomfort during recovery includes aching after exercise (settles within 24 hours), mild swelling that reduces with rest and elevation, and general fatigue in the early weeks. If you are unsure whether a symptom is normal, contact your physiotherapist or surgical team — it is always better to check.
Patient education

Patient club

A safe space to get plain-English answers about your hip or knee condition. Watch recorded Q&A videos from our clinical team and use the AI assistant for general questions.

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Ask anything

Get plain-English answers about your condition, treatment, or recovery - available any time.

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Video Q&A library

Watch recorded sessions where our clinical team answer the most common patient questions. Free to watch.

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Community

Hear from other patients about their experiences with hip & knee conditions and recovery.

Choose a topic

Focus the Q&A conversation

This Q&A assistant provides general patient education only. It cannot give personal medical advice or replace a consultation with your surgeon.
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Hip & Knee Club - Patient Video Q&A
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James M. 10:04
Can a partial rotator cuff tear heal without surgery?
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Clinical team Host 10:06
Great question - yes, many partial tears improve significantly with physiotherapy and time. We generally try non-operative treatment for at least 3-6 months first before considering surgery.
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Submit a question

Patient education
Video Q&A library
New videos added regularly

Patient Q&A videos

Recorded sessions answering the most common patient questions

🎥

Hip replacement - from decision to recovery

Total hip replacement: the operation, hospital stay, hip precautions, and what recovery really looks like.

Available now - 42 min
🎥

Knee replacement - partial vs total

The difference between unicompartmental and total knee replacement - which is right for you?

Coming soon
🎥

Hip fracture - surgery and rehabilitation

What happens when you break your hip, what the operation involves, and how rehabilitation works.

Coming soon
🎥

ACL injury and sports knee - surgery and return to sport

ACL reconstruction, meniscal tears, and patellar instability - when surgery is needed and what recovery involves.

Coming soon
Legal information

Privacy policy

Hip & Knee Club patient education

Last updated: May 2026 - Version 1.0

Who we are

This website is operated by the Hip & Knee Club, a patient education service providing information about hip & knee conditions.

For the purposes of UK data protection law (the UK General Data Protection Regulation and the Data Protection Act 2018), the data controller is the Hip & Knee Club.

This website is a patient information resource only. It is not a clinical system and does not form part of your NHS patient record.

What information we collect

Information you provide

This website does not require you to create an account or provide personal information to use it. The following optional features may involve you entering information:

  • Patient outcome scores (PROMs): If you complete the Oxford Hip Score or Oxford Knee Score, your name (if entered) and score results are stored only in your own browser using localStorage. This information never leaves your device and is not transmitted to us or any third party.
  • Patient Club Q&A: Questions you submit to the AI Q&A assistant are sent to Anthropic's API for processing. Please do not include personal details, NHS numbers, or medical information in your questions. Anthropic's privacy policy applies to this processing.
  • Email results: Using the "Email results" button on the scores page opens your email client with a pre-filled message. We do not receive, store, or process this email.

Information collected automatically

This website does not use cookies, tracking pixels, or analytics tools. We do not collect your IP address, location, device information, or browsing behaviour. No data is transmitted to us when you browse this site.

How we use information

Because we collect no personal data from this website, there is no data processing to describe for standard browsing. The PROMS data you enter remains entirely on your own device.

If you contact us directly by email (for example via the research contact address), your email will be handled in accordance with standard NHS data protection policies and the NHS Records Management Code of Practice.

Third-party services

Anthropic API (Patient Club Q&A)

The Patient Club Q&A assistant uses the Anthropic Claude API. When you submit a question, the text of your question is sent to Anthropic's servers for processing. Anthropic's privacy policy is available at anthropic.com/privacy. We recommend you do not include personal, medical, or identifying information in your questions.

Unsplash (photography)

Some condition page images are loaded from Unsplash (images.unsplash.com). Unsplash's privacy policy applies when these images are loaded by your browser. You can view Unsplash's privacy policy at unsplash.com/privacy.

Google Fonts

This website loads fonts (Fraunces and Plus Jakarta Sans) from Google Fonts. When fonts are loaded, your browser may send a request to Google's servers. Google's privacy policy applies. You can view it at policies.google.com/privacy.

Cookies

This website does not use cookies. The scores page uses localStorage - a browser feature that stores data locally on your device only. localStorage data is not transmitted over the internet and cannot be accessed by us. You can clear localStorage data at any time through your browser settings.

Your rights

Under UK data protection law you have the right to:

  • Access personal data held about you
  • Correct inaccurate personal data
  • Request deletion of personal data
  • Object to processing of your personal data
  • Data portability
  • Lodge a complaint with the Information Commissioner's Office (ICO)

As this website does not collect personal data, most of these rights are not applicable to your use of this site. If you have contacted us by email or have questions about your NHS records, please contact the Trust's Data Protection Officer.

Children

This website is intended for adults aged 18 and over. We do not knowingly collect information from children. If you believe a child has provided information through this website, please contact us.

Links to other websites

This website contains links to external websites including NHS.uk, BESS, ASES, and journal publishers. We are not responsible for the privacy practices of those websites and recommend you review their privacy policies before using them.

Changes to this policy

We may update this privacy policy from time to time. The date at the top of this page will be updated when changes are made. We encourage you to review this policy periodically.

Contact us

Data Protection Officer

Hip & Knee Club
For general enquiries about this website: contact your clinical team
For data protection matters: dpo@imperial.nhs.uk
To complain to the ICO: ico.org.uk - 0303 123 1113

Legal information

Accessibility statement

Hip & Knee Club patient education

Last updated: May 2026 - Version 1.0

Our commitment

The Hip & Knee Club is committed to making this website as accessible as possible for all users, including those with disabilities. We aim to comply with the Web Content Accessibility Guidelines (WCAG) 2.1 at Level AA, as required by the Public Sector Bodies (Websites and Mobile Applications) Accessibility Regulations 2018.

We recognise that accessibility is an ongoing commitment and we continue to improve the experience for all users.

How accessible this website is

We know some parts of this website work well for accessibility and some areas need further improvement.

🔍
Keyboard navigation Partially met
Most interactive elements can be reached by keyboard. Some custom components (the Teams mock meeting interface) have limited keyboard support.
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Screen reader compatibility Partial
Core content pages are readable by screen readers. SVG diagrams include title and desc elements. The AI Q&A interface has basic ARIA labelling.
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Colour contrast Met
Text and background colours have been selected to meet WCAG AA contrast ratios (minimum 4.5:1 for normal text, 3:1 for large text).
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Resizable text Met
The website can be zoomed to 200% without loss of content or functionality. Text scales correctly using relative units.
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Images and media Partial
Informational images include descriptive alt text. The embedded exercise and range-of-motion images have detailed alt text describing all content.
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Mobile and responsive design Met
The website is fully responsive and designed for use on mobile devices. Touch targets meet the recommended 44x44px minimum size.
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Video and audio content Planned
Video Q&A content is planned. Captions and transcripts will be provided when video content is added to the Patient Club section.

Known accessibility issues

We are aware of the following limitations and are working to address them:

  • Teams mock meeting interface: The Patient Club virtual meeting interface is primarily a visual demonstration and has limited screen reader and keyboard support. The Q&A text input and submit button are fully accessible.
  • Complex tables: The journal club results table includes merged cells that may not be fully announced by all screen readers.
  • PDF download: No PDF documents are provided at this time.
  • Focus management: When navigating between pages using the main navigation, focus is returned to the top of the page but a visible focus indicator is not always shown on the main content area.
  • Language attribute: The main page language is declared as English (lang="en"). Content in other languages is not yet available.

Technical information

This website is built as a single HTML file using standard web technologies (HTML5, CSS3, and JavaScript). It does not require any plugins to use.

The following assistive technologies have been used to test this website:

  • VoiceOver on macOS and iOS (Safari)
  • NVDA on Windows (Chrome)
  • Keyboard-only navigation (Chrome)
  • Chrome DevTools accessibility inspector
  • axe accessibility linter

Disproportionate burden

We have not made any claims of disproportionate burden under the accessibility regulations at this time. We are committed to addressing all known issues progressively.

What to do if you cannot access parts of this website

If you need information on this website in a different format such as accessible PDF, large print, Easy Read, audio recording, or in a different language, please contact your clinical team who will arrange this for you.

We will consider your request and get back to you within 10 working days.

Reporting accessibility problems

We welcome feedback on the accessibility of this website. If you find any problems not listed on this page or think we are not meeting accessibility requirements, please let us know.

Contact us about accessibility

Please contact your clinical team who will be happy to assist with any accessibility requirements.

Enforcement procedure

The Equality and Human Rights Commission (EHRC) is responsible for enforcing the Public Sector Bodies Accessibility Regulations 2018. If you are not happy with how we respond to your complaint, contact the Equality Advisory and Support Service (EASS) at equalityadvisoryservice.com.

Preparation of this accessibility statement

This statement was prepared in May 2026. It was reviewed by the Hip & Knee Club development team based on self-assessment against the WCAG 2.1 AA standard. A formal independent accessibility audit is planned as part of the next development phase.