Prehabilitation Exercises: Prepare for Joint Replacement Surgery

Going into surgery stronger means coming out of surgery recovering faster. That's the simple principle behind prehabilitation—a targeted exercise program before surgery that can significantly improve outcomes. Research shows that prehab before joint replacement reduces hospital stay, decreases complication rates, and accelerates return to function.

Why Prehabilitation Matters

The Evidence

Studies on prehab before hip and knee replacement show:

• 30-50% faster functional recovery in first 6 weeks
• Shorter hospital stays (often 1-2 fewer days)
• Less need for inpatient rehabilitation post-surgery
• Lower complication rates including blood clots and infection
• Improved pain management after surgery
• Better long-term outcomes at 6-12 months

Who Benefits Most

Everyone benefits from prehab, but especially:

• Patients with significant weakness
• Those with limited mobility before surgery
• Older adults
• People with multiple health conditions
• Patients with high anxiety about surgery
• Those with longer wait times before surgery

When to Start

Ideally, begin prehab 4-8 weeks before surgery. Even 2-4 weeks provides benefit. If you have longer until surgery, use the time—more preparation means better results.

Hip Replacement Prehabilitation

Goals Before Surgery

• Maximize hip range of motion
• Strengthen hip muscles (especially gluteals)
• Improve core stability
• Practice movements you'll need post-surgery
• Optimize walking ability and endurance

Hip Prehab Exercises

Gluteal Squeezes

1. Lie on back, legs straight
2. Squeeze buttocks together tightly
3. Hold 5 seconds
4. Relax
5. 20 reps, 3 sets daily
6. Purpose: Activates gluteal muscles crucial for hip stability

Hip Abduction (Side-Lying)

1. Lie on uninvolved side
2. Keep involved leg straight
3. Lift leg toward ceiling (12-18 inches)
4. Lower slowly
5. 15 reps, 3 sets
6. Purpose: Strengthens gluteus medius for walking stability

Standing Hip Extension

1. Hold onto stable surface
2. Keep knee straight
3. Move leg backward 6-12 inches
4. Don't arch lower back
5. Return to start
6. 15 reps, 3 sets each leg

Bridges

1. Lie on back, knees bent, feet flat
2. Squeeze glutes and lift hips toward ceiling
3. Hold 5 seconds at top
4. Lower slowly
5. 15 reps, 3 sets
6. Progress: Single-leg bridges when double-leg is easy

Hip Flexor Stretch

1. Kneel on involved knee (pad with pillow)
2. Other foot forward, knee bent
3. Shift weight forward, keeping torso upright
4. Feel stretch in front of hip
5. Hold 30 seconds, 3 reps each side

Seated Marches

1. Sit in chair, feet flat
2. Lift one knee toward chest
3. Lower slowly
4. Alternate legs
5. 15 each leg, 3 sets
6. Purpose: Hip flexor strength for walking, stairs, getting dressed

Post-Surgery Movement Practice

Practice these now so they're familiar after surgery:

Bed Mobility

• Log-rolling technique (turning in bed as a unit)
• Coming to sitting from lying position
• Using arms to assist

Sit-to-Stand

• Scoot to edge of chair
• Feet under knees
• Lean forward and push through legs
• Use armrests if needed

Walking with Assistive Device

• If you'll use a walker or crutches, practice now
• Proper sequence: device, surgical leg, strong leg

Knee Replacement Prehabilitation

Goals Before Surgery

• Maximize knee extension (straightening)
• Improve knee flexion (bending)
• Build quadriceps strength
• Strengthen hip muscles
• Practice post-operative movements
• Improve balance and endurance

Knee Prehab Exercises

Quad Sets

1. Sit or lie with leg straight
2. Push back of knee toward floor
3. Tighten thigh muscle maximally
4. Hold 5 seconds
5. 20 reps, several times daily
6. Critical: This exercise is foundation of post-op rehab—master it now

Straight Leg Raises

1. Lie on back, involved leg straight, other bent
2. Do a quad set first
3. Lift straight leg 6-12 inches
4. Hold 3 seconds
5. Lower slowly
6. 15 reps, 3 sets

Short Arc Quads

1. Place rolled towel under knee
2. Straighten knee, lifting heel off floor
3. Hold 5 seconds
4. Lower slowly
5. 15 reps, 3 sets
6. Purpose: Targets terminal knee extension—often lost after surgery

Heel Slides

1. Lie on back
2. Slide heel toward buttocks, bending knee
3. Go as far as comfortable
4. Slide back straight
5. 15 reps, 3 sets
6. Purpose: Improves knee flexion

Standing Terminal Knee Extension

1. Place resistance band behind knee, anchored low
2. Start with knee slightly bent (30°)
3. Straighten knee against band resistance
4. Hold 3 seconds
5. 15 reps, 3 sets

Step-Ups (if tolerable)

1. Use 4-6 inch step
2. Step up with involved leg
3. Bring other foot up
4. Step down with uninvolved leg first
5. 10 reps, 2 sets each leg

Calf Raises

1. Stand holding support
2. Rise up on toes
3. Lower slowly
4. 15 reps, 3 sets
5. Purpose: Helps prevent blood clots and improves ankle pump

Knee Range of Motion Focus

Extension: Work toward fully straight (0°)

• Prop heel on pillow, let knee sag toward straight
• 10-15 minutes, multiple times daily

Flexion: Work toward 120°+ bending

• Heel slides
• Seated knee flexion with hand assist
• Stationary bike (if possible)

General Prehab Components

Cardiovascular Conditioning

Surgery is physically demanding. Build endurance with:

• Walking program (start at comfortable level, progress)
• Stationary cycling (if tolerated)
• Swimming or water walking (excellent for arthritic joints)
• Seated exercises if mobility is very limited

Goal: 20-30 minutes of sustained activity, 5 days/week

Upper Body Strengthening

You'll rely on arms after surgery (walker, crutches, pushing up from bed).

Seated Rows

1. Use resistance band anchored at chest height
2. Pull elbows back, squeezing shoulder blades
3. 15 reps, 3 sets

Tricep Dips (Modified)

1. Sit on sturdy chair
2. Hands on armrests or seat edge
3. Push up, straightening elbows
4. Lower slowly
5. 10 reps, 3 sets

Bicep Curls

1. Use dumbbells or resistance band
2. Curl toward shoulders
3. Lower slowly
4. 15 reps, 3 sets

Core Stability

Strong core protects your back when using assistive devices.

Abdominal Bracing

1. Lie on back, knees bent
2. Tighten abs as if bracing for punch
3. Hold 10 seconds while breathing normally
4. 10 reps, 3 sets

Dead Bugs

1. Lie on back, arms up, knees bent 90°
2. Lower opposite arm and leg toward floor
3. Keep back flat against floor
4. Alternate sides
5. 10 each side, 2 sets

Balance Training

Reduces fall risk post-surgery.

Single-Leg Stance

1. Stand near support
2. Lift one foot slightly
3. Hold 30 seconds
4. Progress: let go of support, close eyes
5. 3 reps each leg

Lifestyle Preparation

Optimize Medical Conditions

Work with your doctors to:

• Control blood sugar if diabetic
• Manage blood pressure
• Address anemia
• Stabilize heart conditions
• Stop smoking (ideally 4-8 weeks before)

Nutrition

• Adequate protein (0.6-0.8g per pound body weight)
• Stay hydrated
• Consider iron if anemic
• Vitamin D and calcium for bone health
• Lose weight if significantly overweight (reduces surgical stress)

Mental Preparation

• Learn what to expect post-surgery
• Practice relaxation techniques
• Address anxiety proactively
• Set realistic recovery expectations
• Prepare home for post-surgical needs

Home Preparation Checklist

Before Surgery:

• Remove trip hazards (rugs, cords)
• Install grab bars in bathroom
• Raised toilet seat
• Shower chair or bench
• Reacher/grabber tool
• Long-handled shoe horn and sock aid
• Meals prepared and frozen
• Essential items at waist height
• Phone charger accessible
• Recovery area set up on main floor if possible

Sample Weekly Prehab Schedule

Daily (Non-Negotiable):

• Quad sets: 3x20 OR Glute squeezes: 3x20
• Range of motion exercises: 2 sessions
• Walking: 15-30 minutes

Monday, Wednesday, Friday:

• Strengthening circuit: all exercises, 2-3 sets each
• Upper body exercises
• Balance work

Tuesday, Thursday, Saturday:

• Cardiovascular focus: 30 minutes
• Stretching routine
• Light strengthening

Sunday:

• Active recovery: gentle walking, stretching
• Review exercises, ensure proper form

Red Flags to Report

Stop exercising and contact your surgeon if:

• Significant increase in joint pain
• New swelling that doesn't resolve
• Locking or catching in joint
• Signs of infection (fever, redness)
• Numbness or tingling
• Chest pain or shortness of breath during exercise

What to Expect After Surgery

Your prehab work pays off because:

• Day 0-1: You'll already know quad sets/glute squeezes
• Day 1-2: Sit-to-stand and walking will feel familiar
• Week 1: Your baseline strength means faster progress
• Week 2-6: You'll likely meet milestones ahead of schedule
• Month 3+: Better long-term outcomes

Conclusion

The time before surgery is an opportunity, not just a waiting period. Every day of prehab contributes to your recovery. Patients who invest in prehabilitation consistently report easier surgeries, faster recoveries, and better final outcomes.

Start where you are, even if mobility is limited. Some exercise is better than none. Work with your surgical team and physical therapist to customize your program. The goal isn't perfection—it's arriving at surgery as strong and prepared as possible.

Consult your surgeon or physical therapist before starting any prehab program, especially if you have significant pain or mobility limitations.