Prehabilitation Before Hip or Knee Replacement Surgery

If you are preparing for a hip or knee replacement, much of the focus is understandably on the weeks after surgery: exercises, walking, pain management and rebuilding confidence. Those things matter. Yet recovery can begin earlier than the day after an operation.

Prehabilitation before hip or knee replacement is personalised preparation that aims to protect or improve strength, mobility, fitness, nutrition, sleep and practical readiness before surgery. It does not replace rehabilitation afterwards, but it may give you a better physical and practical starting point for early recovery.

For people in Maidenhead, Windsor and the surrounding Berkshire area, prehab can make the period before a planned operation feel more purposeful. Your operation may happen on one particular day. Your recovery journey can start well before it.

Prehabilitation, often shortened to prehab, is the preparation you do before surgery to improve your readiness for what comes next. It is not a single exercise sheet given to everyone. A useful plan reflects your current pain, mobility, health, home environment and the help you will have after discharge.

Prehab may include physiotherapy, strengthening and mobility work, maintaining cardiovascular fitness, eating well, hydration, sleep, managing existing health conditions and planning the practical details of returning home. Smoking cessation and reducing excessive alcohol intake can also form part of wider surgical preparation where relevant.

The aim is not to become exceptionally fit or to push through a painful joint. It is to enter surgery in the best condition that is realistic and safe for you. The Centre for Perioperative Care's patient guidance describes preparation as more than the operation itself, including activity, nutrition, sleep and wider health.

Hip and knee pain often leads people to become less active over time. Walking distances may shorten, stairs can feel more difficult and getting out of a chair may take more effort. This can contribute to loss of quadriceps, gluteal and general lower-limb strength, reduced balance, lower cardiovascular fitness and less confidence in movement.

This is where the idea of physical reserve can help. If surgery temporarily reduces your strength and function, having more strength and capacity beforehand may mean you have a better starting point from which to recover.

Prehabilitation is often under-emphasised, yet research suggests that improving strength, physical function and general health before surgery may support early recovery and provide patients with a better physical starting point. The evidence is not identical for every programme or every person. Reviews of prehabilitation before joint replacement report variation in exercise plans and study quality, so it would be wrong to promise a particular recovery time or outcome. It is more accurate to see prehab as sensible preparation, not a guarantee.

A physiotherapist can help identify the parts of daily life that are currently most limited and what may be realistic to work on before surgery. This assessment may include your current strength, walking, balance, transfers, stair ability, range of movement, activity level, pain limitations and functional difficulties.

Exercises are commonly chosen to support the muscles and movements you will rely on after surgery. Depending on the individual, this may include the quadriceps at the front of the thigh, gluteal and hip muscles, calf muscles, trunk strength and general lower-limb capacity. The goal is not simply to make a knee or hip bend more. It is to support standing, walking, stairs, balance and everyday independence.

Prehabilitation is not about aggressively exercising through a painful joint. Exercises should be adapted around pain and fatigue. For some people, this may mean seated strengthening, supported exercises, static cycling where tolerated, short walks within tolerable limits, water-based exercise or modified resistance work. Your surgeon or pre-operative team should guide you if there are any activity restrictions related to your health or planned procedure.

For those who need support at home, home visit physiotherapy allows assessment and exercise to be related directly to the way you move around your own space.

A hip or knee operation affects more than the joint. Surgery and early recovery place demands on the whole body, including your heart, lungs, energy levels and ability to tolerate activity.

Maintaining walking tolerance and general activity, at a level that is appropriate for you, can be part of prehabilitation. This does not need to mean strenuous exercise. The right approach depends on your pain, current fitness, medical history and advice from your clinical team. The Royal College of Anaesthetists' Fitter Better Sooner resources also encourage patients to consider activity and general wellbeing in the weeks before surgery.

Nutrition is not separate from rehabilitation. Your body needs adequate energy, protein, vitamins, minerals and fluid to maintain muscle and support tissue repair. This is especially relevant when you are undertaking strengthening exercises before surgery and rebuilding capacity afterwards.

Muscles need both an exercise stimulus and adequate nutrition to maintain and build muscle tissue. Strengthening exercises without sufficient nutritional support may limit the body's ability to respond. A balanced diet with regular sources of protein, fruit and vegetables and good hydration can be a practical starting point for many people.

This is not a reason to follow a restrictive diet or make sudden changes without advice. People with kidney disease, diabetes, swallowing difficulties, unplanned weight loss or other medical dietary restrictions should discuss nutrition with their GP, surgical team or a registered dietitian. The NHS guidance on healthy eating can help with general, evidence-based information.

Sleep supports energy, emotional resilience and the ability to engage with rehabilitation. It is also closely connected with how people experience pain and cope with the practical demands of recovery.

Hip and knee pain can disturb sleep, so poor sleep is not simply a matter of needing more discipline. A realistic routine, a consistent bedtime where possible and discussing severe or persistent sleep disruption with an appropriate healthcare professional may be more helpful than trying to force a perfect night. Building steadier sleep habits before surgery can be one part of feeling more prepared for the period afterwards.

Preparing for surgery also means making sure your general health is as well managed as possible. Diabetes, blood pressure, anaemia, heart conditions, respiratory conditions and medication all need to be considered through the appropriate medical team.

Your GP, surgeon and pre-operative assessment team are the right people to advise on medical optimisation, medication changes, smoking cessation, alcohol reduction and healthy body weight where clinically appropriate. A physiotherapist can contribute by helping you prepare physically and functionally, while staying within their rehabilitation role.

Surgery is a physical event and a psychological one. It is normal to have questions about pain, mobility, dependence on others and how long recovery may take.

Clear information can reduce uncertainty. Understanding that exercises, walking practice and gradual progression will be needed after surgery can make the early days feel less unfamiliar. It can also help to discuss who will be available for practical support and what matters most to you, whether that is getting upstairs, walking to the garden or feeling safe getting out of a chair.

Whole Life Rehab's whole-person approach considers strength and mobility alongside nutrition, hydration, sleep, confidence, emotional wellbeing, health behaviours, family involvement and the home environment. This remains professional rehabilitation, not a generic wellness programme. Rehabilitation should not only ask what needs to be restored after surgery. It should also ask what capacity can be protected or improved before surgery takes place.

Rehabilitation is ultimately about function: the everyday actions that help you live your life. Before surgery, it can be useful to practise or assess getting in and out of a chair, bed transfers, stairs, walking with an aid if this is expected, getting around the home and managing ordinary daily tasks.

Learning some of these skills before surgery may make the first days after discharge less unfamiliar. It also helps identify practical questions in advance, such as where you will sleep, how you will get in and out of the house and whether a family member or carer can assist with meals, shopping or transport.

Small practical changes can make returning home feel more manageable. Before admission, consider chair height, trip hazards, keeping frequently used items within easy reach, meal planning, shopping, transport and who may be available to help. Stairs and your sleeping arrangements are worth discussing early too.

The NHS knee replacement guidance includes advice on planning for the period after surgery. Do not buy or use specific equipment without individual advice. Your hospital team, occupational therapist or physiotherapist can help determine what is appropriate for your procedure and home.

Prehabilitation may be particularly worth considering when an older person has already experienced reduced mobility, muscle weakness, falls, poor balance, frailty, reduced confidence, long periods of inactivity or recent illness or hospitalisation. Programmes should always be tailored.

An older adult living alone in Maidenhead who is already struggling with stairs may need very different preparation from an otherwise active person in Windsor whose main limitation is knee pain. The plan should be built around the person, not the diagnosis alone.

Older adult rehabilitation can focus on meaningful goals such as safe movement at home, building strength, returning to walking and maintaining independence.

Ideally, preparation begins as soon as surgery is likely and your clinical team considers exercise appropriate. Waiting time can become preparation time.

Even a few weeks may provide an opportunity to improve knowledge, maintain strength, review nutrition, plan the home and build confidence. There is no universal number of weeks that guarantees an outcome. Starting point, symptoms, general health and the planned operation all matter.

Prehabilitation happens before surgery. Rehabilitation happens afterwards. Prehab aims to preserve or improve strength, fitness, health and function before the operation. Post-operative rehabilitation then rebuilds movement, strength, walking and everyday function following surgery.

They work best as one continuous pathway: Prepare well. Have your surgery. Recover well. Rebuild your life.

Yes. Prehabilitation does not eliminate the need for post-operative rehabilitation. Your body still needs time to heal, and your movement, walking, strength and confidence need progressive support after a hip or knee replacement.

The value of prehab is that you do not have to think of rehabilitation as something that starts only on the day after surgery. Post-operative rehabilitation for older adults can help people rebuild function safely in the weeks and months that follow.

Whole Life Rehab provides personalised home-based physiotherapy and rehabilitation in Maidenhead, Windsor, Cookham, Marlow, Bray, Ascot, Burnham and surrounding Berkshire areas. This can be useful for people looking for physiotherapy before hip replacement or physiotherapy before knee replacement, as well as for hip or knee replacement rehabilitation afterwards.

Home-based prehabilitation gives a physiotherapist the opportunity to see the actual environment you will return to. Your own stairs, chair height, walking distances, layout and everyday routines can all inform the plan. That makes home rehabilitation in Maidenhead or home physiotherapy in Windsor especially relevant when practical independence is a priority.

If you are looking for prehabilitation in Maidenhead, prehab in Maidenhead, prehabilitation in Windsor, hip replacement physiotherapy in Maidenhead or post-operative rehabilitation in Windsor, the focus should remain personal rather than formulaic. You can also explore the areas we cover to see whether home visits are available where you live.

Whole Life Rehab offers personalised home-based physiotherapy and rehabilitation for adults preparing for, or recovering from, joint replacement surgery. We can assess strength, mobility, walking, balance, functional ability, exercise capacity, your home environment and the practical preparation needed for returning home.

Book a call with Whole Life Rehab to discuss prehabilitation or post-operative rehabilitation at home.

This article provides general health information and does not replace advice from your surgeon, GP, physiotherapist or pre-operative assessment team. Always follow the specific instructions provided by the healthcare professionals responsible for your surgery.

Written by Shena Lee-Anthony, Chartered Rehabilitation Physiotherapist & Health & Wellbeing Coach, Whole Life Rehab.

Reviewed: September 2026