Pre-habilitation — Getting Stronger Before Surgery

Part of The Joint Replacement Guide — Phase 2: Considering Surgery · Article 11 of 42 · Hip & Knee

Key Points

  • Prehabilitation (“prehab”) means preparing your body — and sometimes your mind — before surgery, not just recovering afterwards.
  • Going into surgery stronger is generally associated with an easier, faster recovery coming out.
  • A good prehab programme usually covers exercise, nutrition, and psychological preparation together.
  • Even a few weeks of focused prehab can make a measurable difference, especially if you’ve been limited by pain for some time.

What Is Prehabilitation?

Most people are familiar with rehabilitation — the process of regaining strength and function after surgery. Prehabilitation applies a similar principle in reverse: preparing your body in the weeks or months before your operation, a little like training for an athletic event. The main focus is usually targeted strengthening of the muscles around the joint being replaced — particularly the quadriceps for a knee replacement, and the gluteal muscles for a hip replacement — alongside general cardiovascular fitness where possible.

The Evidence

The evidence base for prehabilitation is genuinely growing but still developing. Several studies show that structured pre-operative exercise programmes are associated with improved strength and function in the early weeks after surgery, and generally improved confidence and reduced anxiety going into the operation. Its effect on longer-term outcomes — a year or more after surgery — is less clear-cut and remains an active area of research, so it’s honest to say prehab is best understood as something that reliably helps the early recovery period, rather than a guaranteed way to improve your final result.

What a Good Prehab Programme Includes

  • Structured exercise — ideally guided by a physiotherapist, or a well-designed home programme if in-person input isn’t available in your area, focusing on the muscles that support your affected joint.
  • Nutrition — eating well supports both muscle-building and wound healing, and ties in with the weight and general health optimisation covered in the previous article.
  • Addressing modifiable risk factors — smoking cessation, blood sugar control, and anaemia correction, run alongside your exercise programme rather than instead of it.
  • Psychological preparation — understanding what to expect, setting realistic goals, and addressing any anxiety about the operation, all of which are linked to smoother recoveries.

Practical Tips

Start as early as you reasonably can — ideally from the point you’re listed for surgery, rather than cramming in the final week or two beforehand. Consistency matters more than intensity: regular, moderate exercise sustained over several weeks produces better results than occasional, intense sessions. Work within your pain limits rather than pushing through significant pain, and ask your GP or physiotherapist whether a formal prehab programme is available in your area, as provision does vary between hospitals and regions.

In More Depth

The rationale for prehab is partly mechanistic: pre-operative muscle strength is one of the more consistent predictors of early functional recovery after joint replacement, and many patients have become significantly deconditioned by the time they reach surgery, simply because pain has limited their activity for months or years beforehand. This means there is often real capacity for improvement even in a relatively short window before surgery — a concept sometimes referred to as the “prehab window” — because the starting point for many patients is lower than their underlying physical capability, rather than because of any irreversible decline.

This article is general information and does not replace individual clinical advice. Please speak to your physiotherapist or surgical team before starting a new exercise programme ahead of surgery.

Sources

  • NICE guideline NG157 — Joint replacement (primary): hip, knee and shoulder (2020)
  • Centre for Perioperative Care (CPOC) — prehabilitation guidance
  • Chartered Society of Physiotherapy — prehabilitation resources
  • ERAS Society — Enhanced Recovery After Surgery guidelines

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