Pilates Wellness Wednesday: Could Prehab Help Some People Avoid a Hip Replacement?

Woman holding her hip, showing discomfort and reduced mobility in daily life

This week I heard something on a podcast that stopped me in my tracks. A therapist was talking about how popular prehab exercises have become for people preparing for a hip replacement. What caught my attention was her claim that a large number of her patients ended up not needing surgery at all once they began the right exercise programme.

That sounds dramatic, but interestingly it is not as far-fetched as some people might think.

When many people start to feel persistent hip pain, stiffness, or reduced mobility, they often put it down to getting older, wear and tear, or simply “one of those things”. The trouble is that once pain becomes part of daily life, people often start moving less. Then strength drops, mobility becomes poorer, confidence falls, and the whole situation begins to spiral.

What feels like ageing may actually be a combination of pain, deconditioning, weakness, and loss of movement options.

Research does show that exercise can make a real difference. A long-term randomised trial found that people with hip osteoarthritis who took part in exercise therapy alongside patient education had a reduced need for total hip replacement compared with those who received education alone. The authors reported a 44% reduction in the need for surgery in the exercise group. That is not a miracle cure, but it is a serious result that deserves attention.

There are also programme-based outcomes that support this idea. A report from Bournemouth University’s Orthopaedic Research Institute on its CHAIN programme, which combines cycling and education for people with hip arthritis, states that at five years, 60% of participants had avoided a hip replacement. That figure is remarkably close to the one mentioned on the radio. It does not prove that every person can avoid surgery through exercise, but it does support the idea that for some people the right programme can delay, and sometimes prevent, the need for an operation.

This matters because exercise is still one of the main treatments recommended for osteoarthritis. NICE advises that people with osteoarthritis should be offered therapeutic exercise tailored to their needs, including local muscle strengthening and general aerobic fitness. NICE also recommends preoperative rehabilitation advice for people waiting for hip replacement, so the idea of preparing the body before surgery is already part of mainstream guidance.

What does that mean in practical terms? It means that hip pain should not automatically be treated as an unavoidable sign of ageing. Sometimes the body is asking for better movement, stronger support around the joint, improved balance, and more confidence in walking, standing, climbing stairs, and getting up from a chair. It also means that pain in the hip is not always just about the hip itself. Weakness in the glutes, poor pelvic control, reduced spinal mobility, and general inactivity can all contribute to how the joint feels and functions.

This is where good movement teaching becomes so valuable. In a Pilates setting, the goal is not to pretend that every arthritic hip can be fixed with a few leg lifts and a hopeful smile. The goal is to improve support, alignment, control, breathing, stamina, and confidence so that the client moves better and feels more capable in daily life. For some people that may reduce symptoms enough that surgery can be delayed. For others it may help them go into surgery stronger and recover better afterwards.

That is an important distinction. Prehab is not about denying medical care. It is about making sure that surgery is not the first and only answer when movement, strength, and function have not yet been properly addressed. In some cases surgery will still be the right choice. But for others, what looks like inevitable decline may actually be a body that has become underused, under-challenged, and less supported than it needs to be.

Recent reviews of prehabilitation suggest benefits for pain, function, strength, and quality of life, but they also remind us that the evidence is mixed and that results vary between programmes. So the honest message is this: exercise may not save every hip from surgery, but it can absolutely change the pathway for some people, and it should not be overlooked.

For Pilates teachers, this is a useful reminder. When a client tells you their hip hurts, do not assume the problem is purely age or damage. Look at how they move. Look at their confidence. Look at what they have stopped doing. Look at what needs strengthening and what needs mobilising. Most of all, remember that function can often improve long before anyone reaches the point of surgery.

Sometimes the most important message a client can hear is this: pain does not always mean the end of the story.

References

National Institute for Health and Care Excellence (NICE). Osteoarthritis in over 16s: diagnosis and management. 19 October 2022.https://www.nice.org.uk/guidance/ng226/chapter/Recommendations

National Institute for Health and Care Excellence (NICE). Joint replacement (primary): preoperative rehabilitation advice for hip and knee replacement. Quality Standard QS206. 29 March 2022.https://www.nice.org.uk/guidance/QS206/chapter/quality-statement-1-preoperative-rehabilitation-advice-for-hip-and-knee-replacement

Svege I, Nordsletten L, Fernandes L, Risberg MA. Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis. Annals of the Rheumatic Diseases. 2015.https://pubmed.ncbi.nlm.nih.gov/24255546/

Bournemouth University Orthopaedic Research Institute. Prof Middleton: How to avoid hip surgery. 18 April 2024.https://microsites.bournemouth.ac.uk/ori/2024/04/18/prof-middleton-how-to-avoid-surgery-hip-surgery/

Adebero T, et al. Effectiveness of prehabilitation on outcomes following total knee and hip arthroplasty for osteoarthritis. 2024.https://pubmed.ncbi.nlm.nih.gov/38349251/