How to Prepare for Knee or Hip Replacement Surgery: A Complete Guide

Joint replacement surgery represents a significant undertaking that benefits from thoughtful preparation. Clinical evidence consistently demonstrates that patients who prepare comprehensively before surgery experience fewer complications, shorter hospital stays, and better overall recovery outcomes. This guide covers what you need to know in the weeks leading up to your procedure.

When Should I Start Preparing?

Begin preparation 4–6 weeks before your scheduled surgery. This timeframe allows sufficient opportunity for pre-operative testing, medical optimisation, physical conditioning, and home preparation. Starting earlier gives you more flexibility to address any issues that arise.

What Medical Preparation Is Required?

Pre-Admission Testing

Schedule your pre-admission testing appointment 1–2 weeks before surgery. During this visit, your team will:

• Draw blood samples to check for anaemia, infection, diabetes control, and organ function
• Perform an electrocardiogram (ECG) to assess heart health
• Obtain a chest X-ray to evaluate baseline lung function
• Conduct urinalysis to screen for urinary tract infections that must be treated before surgery

Your primary care physician should evaluate you and provide surgical clearance, confirming that any chronic conditions are optimally controlled.

Medication Review

Bring a complete list of all medications to your pre-operative appointment, including prescription medications, over-the-counter medications, vitamins, supplements and herbal products, and blood thinners (aspirin, warfarin, clopidogrel) — these often require stopping before surgery.

Your surgical team will provide specific instructions about which medications to continue, which to stop, and exactly when to make these changes.

Dental Care

Complete any needed dental work several weeks before surgery. Bacteria from dental procedures can potentially travel through the bloodstream and infect a new joint implant. After joint replacement, you may need antibiotics before certain dental procedures for the first two years (current guidelines vary — discuss with your surgeon).

How Should I Physically Prepare?

Pre-Operative Exercises

Starting exercises before surgery strengthens the muscles supporting your joint and significantly improves post-operative recovery. Your surgeon may provide a specific exercise programme or refer you to a physiotherapist. Common pre-operative exercises include:

• Quadriceps sets — tighten thigh muscles while lying flat, hold 5–10 seconds
• Straight leg raises — lift leg while keeping knee straight
• Hamstring stretches — gentle stretching of back thigh muscles
• Gluteal strengthening — squeeze buttock muscles, hold and release
• Hip flexion exercises — bring knee toward chest while lying or sitting
• Ankle pumps — move foot up and down to promote circulation

Perform these exercises 2–3 times daily for several weeks before surgery. Patients who enter surgery with stronger muscles recover faster.

Smoking Cessation

If you smoke, stopping at least 4–6 weeks before surgery is among the most important preparation steps you can take. Smoking impairs wound healing, increases infection risk, interferes with bone healing around the implant, and complicates anaesthesia. Clinical evidence demonstrates significantly higher complication rates in patients who continue smoking.

Weight and Nutrition

If overweight, losing even 5–10 pounds before surgery reduces joint stress and improves surgical ease. However, avoid rapid weight loss; aim for 1–2 pounds per week through balanced eating.

Good nutrition supports healing. In the weeks before surgery: eat adequate protein (supports tissue repair), include fruits and vegetables (vitamin C aids wound healing), ensure adequate iron intake (supports healthy blood counts), and stay well-hydrated.

Cardiovascular Conditioning

Low-impact cardiovascular activity — walking, swimming, stationary cycling — improves overall fitness, which aids faster recovery. Gradually work toward 20–30 minutes of activity most days, as tolerated.

How Should I Prepare My Home?

Preparing your home before surgery prevents accidents and makes your recovery more comfortable.

Bathroom Safety

• Install grab bars near the toilet and in the shower or bath
• Place a raised toilet seat (makes sitting and standing easier)
• Use a shower chair or bath bench
• Ensure adequate lighting
• Place non-slip mats in the shower and on bathroom floors

Bedroom and Living Areas

• Ensure your bed is at a height where you can easily sit down and stand up
• Arrange nightstands and essential items within easy reach
• Position phone, water, and medications nearby
• Remove throw rugs, electrical cords, and other tripping hazards
• Clear pathways wide enough for a walker or crutches
• Arrange frequently used items at waist to shoulder height (minimise bending and reaching)

Stair Considerations

If your bedroom is upstairs, consider arranging temporary sleeping quarters on the ground floor during initial recovery. Stairs are challenging in the first weeks after surgery. Ensure stair railings are secure.

What Practical Arrangements Should I Make?

• Transportation — you cannot drive immediately after surgery. Arrange rides home from the hospital and for initial post-operative appointments. Identify backup transportation options in case plans change.
• Time off work — discuss anticipated time away with your employer before surgery. Most people return to desk work 4–6 weeks post-operatively, but jobs requiring standing or physical activity need longer recovery (typically 8–12 weeks or more).
• Home support — having someone available to assist with daily activities during the first 1–2 weeks significantly aids recovery. If family members cannot help, consider arranging home care assistance. Plan meals in advance — preparing and freezing portions before surgery saves effort during recovery.
• Gather equipment — before surgery, obtain and familiarise yourself with: a walker or crutches (your surgical team will typically provide or prescribe these), raised toilet seat, reacher tool for picking up items without bending, long-handled shoehorn, and compression stockings for blood clot prevention (if prescribed).

What Should I Do the Night Before Surgery?

• Follow fasting instructions exactly (typically nothing to eat or drink after midnight)
• Shower using antiseptic soap if provided by your surgical team
• Lay out loose, comfortable clothing for the next morning
• Confirm surgery time, location, and arrival instructions
• Get a good night’s rest — though pre-surgery nerves are normal

What Should I Expect on Surgery Day?

• Take only medications specifically instructed, with small sips of water
• Arrive at the hospital or surgery centre at your scheduled time
• Wear loose, comfortable clothing that is easy to remove
• Leave jewellery, cash, and valuables at home or with a family member
• Avoid makeup, nail polish, and lotions

What Recovery Should I Expect?

Initial Recovery (Weeks 1–2)

• Hospital stay: typically 1 night for hip replacement; knee replacement often allows same-day discharge
• Significant pain and swelling, managed with medications and ice
• Limited mobility using walker or crutches
• Physiotherapy begins immediately, often the day of surgery

Early Recovery (Weeks 2–6)

• Progressive increase in movement and activity
• Physical therapy 2–3 times weekly
• Gradual return to light daily activities
• Continuing medications as needed for pain management

Functional Recovery (Weeks 6–12)

• Substantially increased mobility and independence
• Discharge from formal physical therapy with continued home exercises
• Return to driving and desk work typically possible
• Ongoing strength and range-of-motion improvement

Full Recovery (3–6 Months)

• Most patients return to desired activities
• Continued strength improvement beyond six months
• High-impact activities (running, jumping) typically remain restricted

Expert FAQ

Medical disclaimer: This information is intended for educational purposes and should not replace professional medical advice. Every patient’s condition is unique. Please consult Professor Abdullah Al-Othman or your healthcare provider for preparation instructions specific to your surgery.