Most people know they will need rehabilitation after a hip or knee replacement. Fewer realise that rehabilitation can begin before the operation. This is often called prehabilitation, or 'prehab'. The purpose is not to prove that you are fit enough to deserve surgery. It is to help you arrive at surgery better informed and, where possible, physically and practically prepared for what comes afterwards.

What is prehabilitation?

Prehab is preparation for a planned operation. Before hip or knee replacement, it may involve learning postoperative exercises, maintaining or improving strength, discussing walking aids and preparing for daily activities after surgery. It can also include broader health measures such as nutrition, weight management and smoking cessation where appropriate. NICE recommends that people listed for hip or knee replacement receive advice about preoperative rehabilitation, including exercises before and after surgery and ways to maximise independence.

Why train a painful joint before replacing it?

Because the operation does not instantly restore muscle strength or physical confidence. People waiting for joint replacement often reduce activity for months because movement hurts, which can lead to loss of strength and general conditioning. Prehab is not about forcing a severely arthritic joint through painful exercise. A physiotherapist can find movements that maintain useful capacity within what the person can tolerate.

What might prehab include?

A programme may include strengthening major leg muscles, practising sit-to-stand movements, maintaining upper-body strength if crutches or a walker may be needed, improving general cardiovascular capacity where appropriate and practising exercises likely to appear in early postoperative rehabilitation. Revive's knee arthritis guide provides useful context for patients who are managing joint symptoms while waiting for a surgical decision.

Education is part of prehab

Knowing what to expect can remove uncertainty. Patients can learn how they may get in and out of bed, manage stairs, use mobility aids and progressively increase walking after surgery. This also gives families time to think ahead: will the patient need help with shopping, are frequently used items stored on low shelves, and is the route to the bathroom safe? These details can make early recovery more manageable.

Home planning matters

For some patients, postoperative rehabilitation will continue at home. Revive's article on home physiotherapy in Kuwait explains how treatment can be delivered in the environment where a person actually needs to move, which can be particularly useful when travel is difficult immediately after joint replacement. The clinic's physiotherapy services page also provides an overview of postoperative rehabilitation support.

Does prehab guarantee a faster recovery?

No. Recovery after joint replacement depends on the operation, general health, complications, preoperative function and postoperative progress. NICE found that intensive prehabilitation programmes may reduce hospital length of stay in some settings, but that does not mean every programme produces the same result for every patient. It is better to think of prehab as preparation, not a promise.

What if exercise increases pain?

An arthritic hip or knee may not tolerate a conventional gym programme. A physiotherapist can adjust range, resistance, position or volume. Several shorter sessions may be more manageable than one long workout. Water-based exercise or cycling may suit some patients better than prolonged walking. The goal is to protect function without creating repeated major flares.

The practical takeaway

If a joint replacement is scheduled weeks or months away, that period does not have to be passive waiting time. Prehabilitation can help patients arrive at surgery knowing what rehabilitation will involve, having practised key movements and having maintained as much physical independence as reasonably possible. The recovery journey can begin before the operating theatre.

Related Revive resources

• Knee Pain and Arthritis

• Home Physiotherapy in Kuwait

• Physiotherapy Services

Sources

• NICE - Joint replacement (primary): hip, knee and shoulder (NG157)

• NICE Quality Standard QS206 - Preoperative rehabilitation advice

Medical disclaimer: This article is for general informational and educational purposes only. It does not provide a diagnosis or personalised treatment plan and does not replace advice, examination or treatment from a qualified doctor, physiotherapist or other healthcare professional. Seek appropriate medical attention for severe, rapidly worsening, traumatic, neurological or otherwise concerning symptoms.