Your Complete Guide to Cycling After a Hip Replacement

Whether you're a dedicated cyclist looking to get back on the bike or someone looking for a low-impact way to stay active after hip replacement surgery, you may have a lot of questions. Most importantly, can you bike after a hip replacement?

Luckily, with proper rehabilitation and recovery, the answer is yes. In fact, exercise immediately following hip replacement surgery is vital for recovery, according to the American Academy of Orthopaedic Surgeons (AAOS), and cycling can help after a total hip replacement under the right conditions, according to an April 2010 study in the ​Journal of Bone and Joint Surgery​.

Patients typically return to full mobility following a period of physical therapy and rehabilitation that include low-impact exercises, like using a recumbent bike, according to the University of Washington Department of Orthopaedics and Sports Medicine.

Start out slowly, and gradually increase your activity as you become stronger. Experts typically recommend starting with 20 to 30 minutes of exercise two or three times a day in early rehabilitation to prevent atrophy, increase muscle tone and maintain flexibility, according to the AAOS.

Read on to find out how to get back into (or start) cycling after the procedure, the best type of bike to use and safety precautions to pay attention to during your rehab.

During a hip replacement, an orthopedic surgeon removes the damaged parts of your hip joint and replaces them with parts usually made of metal, ceramic and very hard plastic. This artificial (prosthetic) joint helps reduce pain and improve function, according to the Mayo Clinic.

Over 450,000 people undergo hip replacement surgery every year in the United States, per the AAOS. Hip replacements in the past were reserved for older adults and people with mobility issues who usually did not expect to restore full mobility capabilities, according to the University of Washington.

But as more and more procedures are performed on an increasingly younger population, physicians and rehabilitation therapists rely more heavily on rehab equipment that can help patients regain full use of their legs and hips and return to an active lifestyle.

Patients usually prefer to replace a hip once it's been so damaged and worn down with arthritis that it causes constant pain, according to the University of Washington.

The Mayo Clinic suggests talking to your doctor about a hip replacement if your hip pain:

• Persists, despite pain medication
• Worsens with walking, even with a cane or walker
• Interferes with sleep
• Affects the ability to walk up or down stairs
• Makes it difficult to rise from a seated position

As mentioned above, exercise is key when recovering from hip replacement surgery. But it's important to keep in mind your hip is at a greater risk of dislocating after this surgery, according to Alberta Health, so rehabilitation after hip replacement surgery is a gradual process.

You'll begin some strengthening exercises — such as ankle pumps, ankle rotations and glute contractions — as soon as the day after your replacement to prevent muscle atrophy and promote circulation.

Next, you'll move to standing exercises like knee raises, hip abductions and hip extensions. For these standing exercises, you'll want to make sure you don't lift your knee higher than your waist, according to the AAOS.

You'll tackle more strenuous exercises as you heal and gain more strength.

Follow-up care is of utmost importance to your recovery process — and your safety — according to Alberta Health. Make and go to all appointments, and call your doctor or physical therapist if any issues arise.

The best way to ensure that certain exercises are safe for you is to talk with your doctor and physical therapist.

With that being said, you may be wondering: How long after a hip replacement can I ride a bike? It's best to begin cycling when the swelling from the surgery abates and you've accomplished mobility exercises, such as walking and leg lifts.

There are three main types of bikes people most commonly use for exercise: an outdoor bike, an upright stationary bike (think: a Peloton) or a stationary recumbent bike (where you pedal from a seated chair-like position).

According to the total hip replacement post-op clinical practice guidelines from The Ohio State University Wexner Medical Center, here's when you can begin using each type of bike:

Here are a few tips to keep in mind when using the recumbent or upright stationary bikes in your early weeks of rehab.

​Recumbent Bike​

A stationary recumbent bike has a wider seat than an upright cycle, according to the International Sports Sciences Association (ISSA), providing additional comfort to those fresh out of surgery.

A recumbent bike is one built with the seat parallel to the pedals so the rider's legs are extended forward and less pressure is applied to the hip joints and lower back. A recumbent stationary bike is more stable, per the ISSA, and doesn't require the rider to maintain their balance. And, you don't have to worry about your new hip joints bending or twisting — you can pedal with your legs and hips without fear.

A recumbent bike is also a built-in upper-body workout because of the attached handlebars. Plus, you can increase your resistance as you gains strength. You can adjust the length of riding time and level of resistance as your therpay continues.

The seat should be set far enough from the front of the bike so your legs can reach full extension.

Set the bike for backwards pedaling to warm up. Once the pain of the movement subsides, you can switch to forward pedaling and continue for 10 to 15 minutes twice a day. Stop pedaling if pain persists, however, to avoid complications.

​Upright Stationary Bike​

If you don't have access to a recumbent stationary bike, an upright stationary bike is still a great option. Here are a few tips for using an upright stationary bike after a hip replacement.

1. Raise the seat of your stationary bike to a level at which your foot rests on the pedal when your knee is almost completely straight. Cycling helps you regain mobility in your hip, but keeping the seat too low might cause you to dangerously over-flex your hip joint during the recovery period, according to the AAOS.
2. Pedal backward to minimize the pressure you put on your hips when you first start to cycle as part of your rehab, per the AAOS. You may only be able to cycle for a few minutes at a time in the early stages of physical therapy. If you feel any hip pain from your Peloton bike (or other upright stationary bike) regardless of the amount of time you've been pedaling, stop immediately.
3. Progress to forward cycling once you have been cleared by your doctor or physical therapist to do so. At this point, you shouldn't feel pain when you pedal backward. Check with your medical care provider to determine if you are ready to ride a regular bike as opposed to a stationary bike.
4. Increase both your cycling time and the resistance level of your cycling as you recover from your hip replacement. After four to six weeks' time, you can increase your biking time to about 30 minutes at least three times weekly, according to the AAOS.