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

Mr Kosuge occasionally hears the following from patients - "I have been told I am too young for a replacement." Whilst this is a well-intentioned concern, it is one that the evidence has increasingly moved away from. Here is what the current thinking actually says about age and joint replacement.

Where the "Too Young" Idea Comes From

The concern originates in the early history of joint replacement, when implant materials meant that revision surgery was substantially more complex. The logic was: if an implant lasts 10 to 15 years, operating on a 55-year-old would likely mean a second operation in their late 60s. That logic made sense in the 1980s. It is far less applicable today.

Modern Implants Are Significantly More Durable

Advances in implant materials have dramatically extended the working life of joint replacements. Registry data consistently shows that the majority of hip and knee replacements performed today are still functioning well at 20 years or beyond. The question of "when will I need it done again?" is far less pressing than it once was.

The Cost of Waiting Too Long

Delaying joint replacement has real costs. Prolonged severe pain leads to muscle wasting and deconditioning. Patients who compensate for a painful joint often develop secondary problems in other areas of the body. The longer surgery is delayed, the harder rehabilitation tends to be.

There is good evidence that patients who present for surgery in better physical condition — with stronger muscles and better general fitness — recover faster and achieve better functional outcomes. In some patients, waiting too long can work against them.

Quality of Life Matters

The decision to offer joint replacement should be driven by the impact of arthritis on quality of life, not age in isolation. A 52-year-old who cannot sleep, cannot walk without significant pain, and has exhausted conservative treatments is a legitimate surgical candidate. Mr Kosuge takes an individualised approach and gives an honest recommendation based on specific circumstances, not a blanket age threshold.

What About Being "Too Old"?

Age at the other end of the spectrum is also rarely an absolute barrier. Many patients in their 80s do extremely well after hip and knee replacement. Fitness and overall health are more relevant than age alone. Mr Kosuge will discuss any relevant surgical risk at your consultation.

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

• Online booking

• Telephone: 01279 602675