Most patients focus on what happens after joint replacement surgery. Fewer think carefully about what happens before it — and yet the evidence is consistent: patients who arrive for surgery in better physical and psychological condition recover faster, achieve better functional outcomes, and have fewer complications. This is the principle behind prehabilitation, or prehab.

What Is Prehabilitation?

Prehabilitation refers to preparation undertaken in the weeks or months before surgery with the aim of improving its outcome. In the context of hip and knee replacement, it focuses on physical fitness, muscle strength, cardiovascular health, weight management, and addressing lifestyle factors such as smoking that are known to affect surgical outcomes. Much of it can be done at home without specialist equipment.

Why Muscle Strength Matters

The muscles around the hip and knee are crucial to recovery. After surgery, there will be a period of relative inactivity as the joint heals, and some muscle wasting is inevitable. The stronger those muscles are going into surgery, the more is preserved through early recovery — and the faster functional strength is regained.

For knee replacement patients, the quadriceps are particularly important. For hip replacement, the gluteal muscles and hip abductors play a key role in stability and gait. Targeted strengthening of these muscle groups before surgery has been shown in multiple studies to reduce recovery time.

Cardiovascular Fitness

Patients with better cardiovascular fitness recover more quickly from surgery and anaesthesia. Walking at a comfortable pace is effective for most patients with hip and knee arthritis. Swimming and cycling are excellent alternatives for those whose joint pain limits walking.

Weight Management

Body weight has a direct effect on surgical risk, implant longevity, and recovery. Even a modest reduction in weight before surgery reduces the mechanical load on the new joint, lowers anaesthetic risk, and reduces the likelihood of wound complications. Mr Kosuge discusses weight in the context of surgical planning and can direct patients to appropriate support if needed.

Stopping Smoking

Smoking impairs wound healing, increases infection risk, and affects bone health. The evidence supporting smoking cessation before joint replacement is clear and consistent. Stopping even four to eight weeks before surgery significantly reduces complication rates.

Psychological Readiness

Patients who are well-informed about what surgery involves, what recovery looks like, and what a realistic outcome is tend to manage the post-operative period better. Mr Kosuge's consultation process is designed to ensure you leave with a clear, honest picture of what to expect — which is itself a form of preparation. Mr Kosuge also recommends the ‘Preparing for Surgery’ page on his website, within which you will find excellent resources addressing the above.

To book an appointment with Mr Kosuge at The Rivers Hospital:

• Online booking

• Telephone: 01279 602675

Anxiety about the recovery period is one of the main reasons patients delay knee replacement surgery. The reality is that modern surgical techniques have changed what recovery looks like significantly — and for most patients, the progress within the first three months is far better than they anticipated. Here is a realistic guide to what the first 12 weeks involve.

Days 1 to 3: The Hospital Stay

The typical hospital stay following knee replacement is one to two nights. On the day of surgery, a physiotherapist will help you to stand and begin walking — usually within hours of the procedure. This is a very important part of recovery; early mobilisation is a core principle of modern joint replacement care. It reduces the risk of blood clots, prevents stiffness, and begins the process of restoring movement in the new joint.

Before you are discharged, the physiotherapy team will ensure you can safely get in and out of bed, manage stairs with a walking aid, and understand your home exercise programme. A follow-up plan will be confirmed before you leave.

Weeks 1 to 2: Home Recovery

Once home, the priority is keeping the knee moving while allowing the surrounding tissues to heal. A walking frame or crutches will be needed initially, and you will have specific guidance about what movements to avoid. Ice packs applied to the knee for 15 to 20 minutes several times a day are effective at managing swelling and discomfort.

Your home exercise programme at this stage will focus on regaining range of movement — particularly straightening the knee fully and bending it progressively. These exercises are not optional; the range of movement you establish in the first few weeks has a significant influence on your long-term outcome.

Weeks 3 to 6: Building Strength and Mobility

During this phase, most patients transition from a walking frame to a single crutch or walking stick. Swelling reduces gradually, and movement becomes noticeably easier. The goals are consistent daily walks, a reliable exercise routine, and continuing to increase the bend in the knee.

Most patients are advised not to drive for at least six weeks after knee replacement surgery — Mr Kosuge will confirm when it is safe for you, based on which leg was operated on and your individual recovery progress.

Weeks 6 to 12: Returning to Normal

By the six-week mark, many patients are walking without a walking aid and experiencing a marked reduction in pain compared to before surgery. Mr Kosuge reviews progress at the six-week post-operative appointment and advises on returning to activities including driving, swimming, and gentle recreational exercise.

By 12 weeks, the majority of patients are back to most normal daily activities. The knee continues to improve beyond this point — full recovery typically takes 12 months though.

What Helps Recovery Go Well

Preparation before surgery makes a meaningful difference. Being as physically active as possible beforehand, maintaining a healthy weight, and stopping smoking all contribute to a smoother recovery. Mr Kosuge provides personalised pre-operative guidance as part of your care pathway.

To book an appointment with Mr Kosuge at The Rivers Hospital:

• Online booking

• Telephone: 01279 602675