Joint replacement preparation often focuses on the operation itself: the implant, the hospital stay and the arrangements needed for recovery at home. But there is another part of preparation worth discussing with your healthcare team: how to maintain your strength and mobility before surgery.
Known as prehabilitation or prehab, this involves preparing physically for an operation through appropriate exercise and other measures. For people awaiting hip or knee replacement, it may include exercises designed to maintain muscle strength, practise everyday movements and help prepare for rehabilitation afterwards.
The right approach depends on your symptoms, mobility, general health and the joint being replaced. A physiotherapist should review and approve any exercise programme before you begin. The examples in this guide are for discussion with your physiotherapist, not instructions to start exercising independently.
What is prehab before joint replacement?
Prehab is preparation before surgery. For people having a hip or knee replacement, it can include strengthening exercises, gentle movement, advice on managing daily activities and guidance on preparing for recovery.
The National Institute for Health and Care Excellence (NICE) recommends that people having hip or knee replacement receive advice on preoperative rehabilitation. This should cover exercises before and after surgery, lifestyle considerations, and ways to maximise independence and quality of life.
The aim is not to eliminate joint pain or make the affected joint work like a healthy one. Instead, an appropriate programme can help you maintain the strength and function you have while preparing for the demands of recovery.
Evidence on prehab is mixed, and the benefits can vary. It should not be presented as a guarantee of a faster recovery or a better surgical outcome.
Why consider exercises before knee replacement?
Knee pain can make everyday activities such as standing up, walking and climbing stairs more difficult. Over time, reduced activity may also affect the strength of the muscles around the knee.
A suitable exercise programme may help you maintain muscle function and practise movements that will be useful during rehabilitation. It can also give you an opportunity to learn techniques you may use after your operation.
Potential aims of prehab include:
- Maintaining muscle strength: particularly in the quadriceps, which help straighten the knee.
- Keeping movement comfortable: within the range your symptoms allow.
- Practising everyday movements: such as sitting down and standing up safely.
- Building familiarity with exercise: so that rehabilitation feels less unfamiliar after surgery.
- Planning for recovery: including how to move safely and use walking aids if needed.
You do not need to push through pain or undertake strenuous workouts to prepare for surgery. A programme should be based on what you can safely manage.
For more information about preparing for an operation, read our guide to Preparing for Knee Surgery.
Exercises to discuss with your physiotherapist before knee replacement
The following are examples of exercises a physiotherapist may consider when planning prehab. Not every exercise is suitable for every person, and the number of repetitions, movement range and level of support should be agreed with your physiotherapist.
1. Quadriceps contractions
The quadriceps are the muscles at the front of your thigh. They help straighten the knee and support activities such as standing and walking.
A physiotherapist may consider a gentle quadriceps contraction exercise, often performed while sitting or lying down. This involves tightening the thigh muscle without forcing the knee into a painful position.
Your physiotherapist can show you how to contract the muscle correctly, how long to hold it and whether this exercise is appropriate for your symptoms.
2. Ankle movements
Gentle ankle movements may be suitable for some people who find larger leg movements uncomfortable. They involve moving the foot up and down within a comfortable range.
Your clinician can advise whether these movements are appropriate for you and how they fit into your wider preparation plan. Do not treat them as a substitute for any specific exercises or circulation advice provided by your healthcare team.
3. Supported sit-to-stand practice
Standing up from a chair uses muscles around the hips and knees. Practising this movement may be useful if getting out of a chair is difficult.
A physiotherapist can assess your balance, chair height and ability to stand safely. They may demonstrate a supported version using a stable chair and armrests, if appropriate.
Do not attempt this exercise alone if you are unsteady, at risk of falling or unable to stand without significant pain.
4. Gentle walking, where appropriate
Some people may be able to maintain activity with short, comfortable walks. Others may need to use a walking aid, reduce the distance or choose a different activity because of pain or mobility limitations.
Your physiotherapist can help you decide whether walking is suitable, how much is manageable and whether you need additional support.
Stop if an exercise causes pain, increases your joint symptoms or makes you feel unwell. Do not try to complete a set of repetitions simply because they are written in a programme. Ask your physiotherapist to review any exercise that causes discomfort.
Prehab before hip replacement: what might help?
Hip pain can affect walking, balance, sleep and the ability to put on shoes or get in and out of a chair. Exercises before hip replacement may focus on maintaining the function of the muscles around the hip while working within your comfortable range of movement.
Depending on your assessment, a physiotherapist may consider gentle muscle contractions, supported standing activities or suitable low-impact movement. They may also advise on managing daily tasks and using equipment to make activities safer.
There is no single exercise routine that everyone awaiting hip replacement should follow. The cause and severity of your symptoms, your current mobility and any other health conditions all matter.
The NHS guide to preparing for a hip replacement explains that preparation may include muscle-strengthening exercises and advice on general health.
You can also read our guide to Preparing for Hip Surgery for more information about getting ready for your procedure.
How often should you exercise before joint surgery?
There is no universal frequency or duration that suits everyone. Your physiotherapist should recommend a programme based on your ability, symptoms and surgical plan.
You may be advised to begin with a small amount of activity and adjust it gradually, depending on how you respond. Rest and recovery are important too, particularly when pain affects your sleep or everyday activities.
Avoid suddenly increasing your exercise levels in an attempt to get stronger before surgery. More exercise is not automatically better, and overdoing it may aggravate your symptoms.
If you are already following an exercise programme, tell your physiotherapist what you do, how often you do it and which movements cause discomfort. They can advise whether it needs to be adapted.
When should you stop exercising?
Exercise should not mean pushing through worsening joint pain. Stop the activity if it causes pain, makes your symptoms noticeably worse or leaves you feeling dizzy, faint or unwell.
Contact your healthcare professional for advice if discomfort persists after stopping or if an exercise repeatedly aggravates your symptoms. Seek urgent medical assessment concerning new symptoms, such as sudden severe joint pain, a newly hot or swollen joint with fever, chest pain or sudden breathlessness. Chest pain and sudden breathlessness require emergency assessment.
Do not start or continue a programme without clinical advice if you have recently experienced a fall or injury, have a new significant change in symptoms or have been told to restrict activity.
Your physiotherapist may need to modify the programme or recommend that you are assessed before exercising again.
What else can help you prepare for joint replacement?
Exercise is only one part of preoperative preparation. Your healthcare team may also discuss:
- General health: following advice on nutrition, weight management where relevant and stopping smoking.
- Medication and medical conditions: telling your clinical team about your medicines, supplements and health conditions, and following their instructions.
- Home arrangements: planning how you will manage meals, washing, stairs and everyday tasks during early recovery.
- Practical support: arranging help from family, friends or carers if you may need it.
- Postoperative rehabilitation: understanding your expected physiotherapy plan and what support will be available.
You should follow the advice given by your own consultant and clinical team, as recommendations may differ according to your procedure and individual circumstances.
Preparing for your recovery with Transform Medical
Preparing for hip or knee replacement involves more than choosing an operation date. Understanding your preoperative advice, knowing what to expect afterwards and planning for rehabilitation can help you approach the process with clearer expectations.
Explore our guides to Preparing for Hip Surgery and Preparing for Knee Surgery for further information about the steps involved.
After surgery, physiotherapy is an important part of rehabilitation. We also have a Physio Referral Network for ongoing physiotherapy care for eligible patients.
To learn more about the joint replacement journey and what to expect during recovery, download the recovery brochure. You can use it to help you prepare questions for your clinical team and plan the practical steps ahead.