Advice guide
Prehab: Preparing Your Body for Hip or Knee Replacement
Waiting for a hip or knee replacement is a strange period. The joint usually hurts, activity has often dropped away, and the natural instinct is to rest until the date arrives. Prehabilitation takes the opposite view: the weeks before surgery are an opportunity to arrive in the best condition you reasonably can. The general principle is well established, because strength, mobility and confidence going into an operation influence the starting point afterwards. What we cannot do is promise a particular result, since recovery depends on the surgery, your health and many things outside anyone's control.
What prehab is trying to achieve
Four things, in rough order of importance. None of them require heroics, and all of them are achievable alongside a painful joint if the work is graded properly.
- Maintain or build strength in the muscles around the joint and in the opposite limb
- Keep as much movement as the joint comfortably allows
- Practise the movements you will need immediately afterwards, such as getting out of a chair and using crutches
- Prepare the home so the first fortnight is straightforward
- Set expectations, so what happens after the operation is familiar rather than alarming
Strength work when the joint hurts
Working around a painful joint is a skill, and it is where an assessment earns its keep. Loading can often be maintained through positions the joint tolerates, even when walking is limited. Non weight bearing work, short range movements and work on the other leg all contribute. Upper body strength matters more than people expect, because crutches and pushing up out of chairs demand it. General fitness matters too, and where walking is painful, cycling, water based exercise or seated cardiovascular work can maintain it.
A rough weekly structure
This is a general template, and your own plan should be built around your joint, your health and your surgeon's advice.
| Focus | Frequency | Examples |
|---|---|---|
| Lower limb strength | 2 to 3 times a week | Sit to stand, step ups within comfort, seated leg extensions |
| Upper body strength | 2 times a week | Chair push ups, band rows, shoulder press with light weight |
| Movement and mobility | Daily | Gentle range of movement work for hip or knee |
| Cardiovascular | Most days | Walking within comfort, static bike, pool based work |
| Practice skills | Weekly | Crutch technique, stairs, getting in and out of bed and the car |
Getting the house ready
The practical preparation is easy to postpone and genuinely useful. Doing it a fortnight before rather than the night before takes the pressure off.
- Clear trip hazards, particularly loose rugs and trailing cables on your usual routes
- Move frequently used items to waist height so you are not reaching low or high
- Set up a comfortable chair with arms at a height you can rise from easily
- Sort out equipment in advance if it has been recommended, such as a raised toilet seat or a perching stool
- Batch cook and freeze a few meals, and arrange help with shopping for the first fortnight
- Plan how you will get to and from hospital, and who will be around in the first few days
Questions worth asking your surgical team
Going in informed makes the recovery feel far less uncertain. Write the answers down, because it is difficult to retain detail on the day.
- What weight bearing status will I have immediately afterwards?
- Are there movements or positions I must avoid, and for how long?
- What does the hospital physiotherapy plan look like before I am discharged?
- When can I expect to drive, return to work and resume specific activities?
- When will wounds be reviewed, and who do I contact if I am worried?
- Is outpatient physiotherapy arranged, or should I organise it myself?
What happens after, in outline
Early rehabilitation focuses on movement, walking safely and managing swelling, and it usually starts in hospital within a day of surgery. Over the following weeks the focus moves to range of movement, then to strength, then to getting back to the activities that mattered to you. Progress varies widely between individuals, and comparing yourself with someone else's timeline is rarely helpful. Contact your surgical team urgently rather than your physiotherapist for signs of infection such as increasing redness, heat or discharge from the wound, fever, calf pain and swelling, breathlessness or chest pain, or a sudden loss of function in the operated limb.
Common questions
How long before surgery should I start prehab?
Any period helps, and six to twelve weeks gives more room to build strength. If your date is closer than that, focus on practising the practical skills and preparing the house.
Will exercise damage the joint before surgery?
Sensible graded exercise is not considered harmful to an arthritic joint. Load is adjusted to what the joint tolerates, and the aim is to work within comfort rather than through significant pain.
Should I lose weight before the operation?
Where relevant, your surgical team may advise it, since it reduces load through the joint and can influence surgical risk. That conversation belongs with them rather than with us.
Can I have physio while waiting on the NHS list?
Yes, and many people do. Tell us the plan and the expected timing so we can build the programme around it rather than cutting across it.
Will I need physio after the operation?
Most people have some rehabilitation afterwards, whether through the hospital, the NHS community service or privately. Arrangements vary by hospital, so ask your team what is included.
How soon will I be back to normal?
That varies widely and depends on the operation, your health and your starting point, so we will not put a figure on it. Your surgical team can give guidance specific to your procedure.