Hip arthroscopy recovery timeline, week by week.

weeks 0–2

Weeks 0-2 · acute and protected

The first ten to fourteen days are protected, almost always with crutches. The ISHA 2024 physiotherapy agreement describes Phase 1 as flat-foot weight-bearing with assistive devices, which means you can put your foot down for balance but the leg isn't doing the work. Standing pain is usually a 3-5/10 in this window; rest pain settles into the 2-3/10 range by day five or so.

Cunningham's cohort reported an average pain of 2.8/10 by week two — a drop of about 2.4 points from a 5.2 baseline. More than half had met a meaningful pain-reduction threshold by post-operative day two. If your pain is still climbing rather than falling at day four or five, that is worth a call to whoever did the operation; it isn't necessarily a problem, but it isn't the modal trajectory either.

Sleep is genuinely awful for the first ten days. Most people sleep on their back with a pillow under the operative leg and lose the deep sleep stages until the swelling drops. This usually settles by the end of week two without any specific intervention.

• wk 0 ·Protected flat-foot weight bearing with crutches (0-2 weeks; longer if microfracture or chondral repair was performed)

weeks 2–6

Weeks 2-6 · weaning the crutches

This is the phase where the protocols diverge the most. ISHA's Phase 2 expects normalized gait by 2-4 weeks; conservative protocols allow up to 6-8 weeks. The midpoint, around four weeks, is a fair planning assumption if you don't know what your surgeon prefers. Driving comes back at roughly the same point — Hassebrock's brake-reaction-time meta-analysis put the safe return at four weeks, contingent on being off narcotic pain medication and on the operated side not being the brake foot.

Pain in this window is interpolated rather than measured, but the shape is clear: by week six Cunningham's cohort averaged about 2/10, down from 2.8/10 at week two. If your average is still north of 4/10 at six weeks, the residual pain isn't necessarily structural — flexor irritation, post-operative bursitis, and pelvic tilt changes all show up at this stage — but it does warrant a conversation. Hip flexor pain at the front of the joint is the single most common complaint and usually responds to load management plus targeted PT.

ROM goals at the end of this phase, per ISHA, are 90 degrees of pain-free hip flexion and 10 degrees of extension. Most physiotherapists test these around week 4-6 as part of the decision to progress.

• wk 4 ·Off crutches / normalized gait (About 2-6 weeks, protocol-dependent)
• wk 4 ·Return to driving (Around 4 weeks, also depends on opioids and right-vs-left side)

weeks 6–12

Weeks 6-12 · strength and capacity

This is the strength phase. Pain is generally well-controlled — the cohort average drops from about 2/10 at week six to about 2/10 at week twelve (so plateaued, not actively improving), but the work shifts from tolerance to capacity. Closed-chain squat patterns, single-leg work, bridging, and the early stages of hip abductor strengthening all happen in this window.

Cunningham's twelve-week endpoint had the cohort averaging just under 1/10 on the worst day in a typical week, with weekly diary data running about 0.9/10 by the end. A separate three-month FAI cohort measured rest pain at about 1.5/10 and activity pain at about 3.4/10 — a much bigger gap than the single number suggests, and a fair preview of the next nine months: rest gets quiet quickly, but anything that loads the hip dynamically will still talk to you.

Return to running starts at the back of this phase for accelerated protocols (week 8) and at the front of the next one for conservative protocols (week 14-18). The ISHA criteria are strength at >=80% of the contralateral side and a HOS-Sport score >=85% — criteria, not a fixed date.

weeks 12–26

Weeks 12-26 · running, then sport-specific

Running is the first big load that the hip has to absorb cyclically. Most accelerated protocols start it around week 8-12; the ISHA consensus puts it in Phase 5 at weeks 12-18. The honest answer is that almost nobody runs comfortably on the first attempt — it's usually one or two cycles of progress-and-back-off before a sustainable cadence sits in.

Return-to-work has the widest range of any milestone here. Blaeser's meta-analysis put the pooled mean at 115 days (~16 weeks) with a range of 17 to 219 days, and light/sedentary professions came back roughly twice as fast as physical ones. Single-procedure FAI cohorts have reported return-to-work as early as 9 weeks for desk roles. If your job lets you sit, you're probably back well before this window closes; if it doesn't, plan for the back half.

At six months interpolated pain is about 2.5/10 and the milestone work is sport-specific: change of direction, deceleration, plyometric load. This is where people who try to skip phases get a setback, and where people who run a careful return-to-sport protocol stop noticing the hip in daily life.

• wk 14 ·Start running (8-18 weeks, criteria-based)

weeks 26–52

Weeks 26-52 · return to sport and beyond

Memon's return-to-sport meta-analysis reported a pooled mean time to sport of 7.4 months (about 32 weeks), with a 95% confidence interval of 6.1 to 8.8 months and a return-to-sport rate of about 85%. Sport type matters: endurance sports come back closer to five months, cutting and pivoting sports closer to eight or nine. The DHAR registry, which then tracks people out to a year and beyond, reports rest NRS of 1.9/10 and walking NRS of 2.7/10 at twelve months — both essentially flat at two years, so this is the long-term floor for most people, not a way-station.

If pain at twelve months is still in the 4-5/10 range during walking, that is outside the typical band and usually flags either an incomplete labral repair, a chondral lesion that didn't heal as hoped, or unrelated hip flexor or pelvic-floor pathology. Worth raising with your surgeon rather than assuming it'll fade with more time.

• wk 30 ·Return to sport (About 6-9 months, sport-dependent)