Pre-Operative Physiotherapy: Why Pre-Hab Improves Outcomes
Pre-operative physiotherapy, often called "pre-hab," is the practice of undertaking a structured exercise programme in the weeks before joint replacement surgery. Growing evidence shows that patients who are stronger and fitter before surgery recover faster and achieve better outcomes afterwards. If you are waiting for hip or knee replacement, pre-hab is one of the most valuable things you can do.
The rationale for pre-hab is straightforward. Surgery causes acute weakness and inflammation, and patients who start from a stronger baseline recover more quickly. The muscles around the affected joint — particularly the quadriceps for knee replacement and gluteals for hip replacement — are often significantly weakened by arthritis and disuse. Strengthening these muscles before surgery means they are better able to support the new joint during recovery.
Research supports the benefits of pre-hab. Studies have found that patients who complete pre-operative exercise programmes achieve faster recovery of walking ability, better range of motion, shorter hospital stays, and better functional outcomes at three and six months compared to those who do not.
A pre-hab programme typically includes: strengthening exercises targeting the muscles around the affected joint (and the opposite limb, which will bear more load after surgery), range of motion exercises to maintain as much flexibility as possible, aerobic exercise to improve cardiovascular fitness (which supports surgical recovery), and education on what to expect after surgery, including the exercises you will need to do.
Pre-hab is also an opportunity to prepare your home environment. Our physiotherapists can assess your home and recommend modifications — raised chairs, grab rails, repositioned furniture — that will make your post-operative recovery safer and easier.
The ideal time to start pre-hab is six to twelve weeks before surgery, though any exercise is better than none. Even two to three weeks of focused exercise before surgery provides measurable benefit.
Our hip replacement and knee replacement services provide pre-operative assessment and exercise programmes, as well as post-operative rehabilitation. Our home visit physiotherapy service provides general pre-operative conditioning, while our elderly physiotherapy service supports older adults preparing for surgery.