Your complete guide to prehab before surgery and post-operative recovery — designed to help you achieve the best possible outcome from your hip or knee replacement.
Medical Disclaimer: The information on this page is for general guidance only and does not constitute medical advice. Always work with your physiotherapist and surgical team on a rehabilitation plan tailored to your individual needs.
Prehabilitation — exercise and physical conditioning before your operation — is one of the most impactful things you can do to improve your surgical outcome. Patients who are physically stronger before surgery consistently recover faster, experience shorter hospital stays, and regain independence sooner.
Research consistently shows that building baseline muscle mass and cardiovascular fitness before joint replacement:
For hip replacement patients, the key prehab goals are strengthening the muscles that will support the new joint and maintaining range of motion.
These side-hip muscles are critical for walking stability. Side-lying leg raises, clamshells, and resistance band abduction exercises directly target them. Weakness here is the primary cause of the characteristic post-operative limp during early recovery.
A strong core reduces load through the hip joint and improves balance. Exercises include pelvic tilts, abdominal bracing, and bridging — all performed within a pain-free range on both sides.
Maintaining hip extension prevents flexion contractures that limit post-operative walking mechanics. Gentle prone lying, hip flexor stretches, and extension exercises preserve this range before surgery removes the source of restriction.
Knee prehab focuses on two critical areas: quadriceps activation to prevent post-operative extensor lag, and achieving full knee extension before surgery.
Quadriceps weakness is the single biggest barrier to early post-operative walking. Straight-leg raises, quad sets (squeezing the thigh muscle while lying flat), and short arc quads train the muscle to contract reliably — preventing the "extensor lag" (inability to fully straighten the leg) that commonly follows knee surgery.
Tight hamstrings limit knee extension and complicate post-operative rehabilitation. Seated hamstring stretches and lying heel slides should be performed daily in the weeks before your operation.
Entering surgery without full passive knee extension is a significant risk factor for poor outcomes. Prone knee hang exercises and towel rolls placed under the heel encourage the joint to fully straighten during rest periods.
Two often-overlooked elements of prehab that make a real practical difference to your experience of surgery and early recovery:
Post-operative rehabilitation begins the moment you wake up from surgery — not days or weeks later. Early, active participation is the single most important thing you can do in hospital.
You will be encouraged — and expected — to stand and take your first steps on the day of surgery or the morning after. This is not rushed — it is medically essential.
Why move so soon? Remaining in bed after lower-limb surgery dramatically increases the risk of deep vein thrombosis (DVT), pulmonary embolism, chest infection, and joint stiffness. Even a few supervised steps on Day 0 or 1 are the most effective preventive measure available — more protective than any single medication.
Recovery is best understood as a series of milestones rather than a rigid timeline. Everyone progresses at a different rate. Focus on achieving each phase rather than comparing your progress to others.
Preparing your home before surgery is as important as physical preparation. The right adaptations protect you from falls during the vulnerable early recovery period and make daily life significantly more manageable when you return home.
Raised toilet seat — A raised seat (4–6 inches) prevents the deep hip flexion that raises dislocation risk in hip patients during the first 6–12 weeks.
Shower chair or bath board — Standing on one leg in a wet environment is a significant fall risk in early recovery. A shower chair eliminates this hazard.
Remove trip hazards — Secure or remove loose rugs, trailing cables, and low obstacles. Most home falls happen on familiar objects patients stop noticing.
Check stair rails — Ensure bannisters are secure. Ideally have rails on both sides. You will need them when climbing stairs with crutches in early recovery.
Firm chair with armrests — Low, soft sofas are hazardous after joint replacement. You need a high, firm chair with solid armrests you can push off from when standing.
Bedside essentials within reach — Water, phone, medication, a lamp, and a call device should all be accessible from bed without bending or twisting.
Grab rails in the bathroom — Wall-mounted rails near the toilet and in the shower provide critical support for transfers and getting up from seated positions.
Non-slip shower mat — A textured anti-slip mat prevents falls in the wet area — particularly important when you are not yet fully weight-bearing or have reduced sensation.
Your hospital occupational therapist (OT) will assess your specific needs before discharge and can arrange equipment loans or a home visit. An OT referral can also be requested through your GP or social services before your admission date if you would like to start preparing early.
Ready to learn about the operation itself? Read our guides on Hip Replacement Surgery and Knee Replacement Surgery, including detailed information on surgical approaches, implant options, and complications.