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:
Telephone: 01279 602675