How to Prepare for Knee Replacement Surgery: PreHab

Knee replacement surgery is a crowning achievement in modern medicine, delivering unmatched relief to patients in need while yielding impressively high success rates. While the ten year success rate for the procedure exceeds an incredible 90%, there are things you should do to ensure your replacement goes off without a hitch.

Did you know that the overall success and recovery time of your knee replacement is largely determined by what you do the weeks before your surgery?

With the demand for knee replacement surgery rising year after year, studies suggest that the total number of replacements will be up 601% by 2030. This leap in knee replacement recipients not only represents a whole lotta metal knees, but also marks an increase in knowledge surrounding the procedure. We know more than ever how to reduce risk and improve the outcome of knee replacements. Actively putting this newfound knowledge to use prior to surgery is something called “PreHab”.

What is PreHab? To put it simply, it’s everything you actively do—mentally and physically—in the 2-8 weeks leading up to a surgery to optimize your health, reduce risk and increase the benefit of that procedure.

PreHab: 6 Must-Do’s To Prepare For Your Knee Replacement

We’ve spent the last year dissecting thousands of pages of medical research and working alongside leading medical professionals to build PeerWell’s PreHab program for joint replacement candidates.

Read on as we share some of our program’s most important take-aways on how to have a better knee replacement surgery with a faster recovery.

1. The Support of Family, Friends and Peers

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In a recent interview with Dr. Nima Mehran, a rising orthopaedic surgeon who has participated in hundreds of knee replacements, he expressed that the support of family and friends is “one of the most important factors” in determining the overall success and recovery time of a knee replacement. Not only will the support of family and friends be of great help post-surgery, it will actually help with physical and mental preparedness in the weeks prior.

Dr. Mehran added that a vital part of overall prehab and pre-op support is being connected with other patients who have recently undergone the surgery. Speaking with those who are a few months ahead of you in the knee replacement surgery and recovery cycle personalizes the procedure, offering a greater level of insight and alleviate anxiety.

Why the Support of Others Matters:

  • If you’re committed to PreHab and are setting goals like eating a nutritionally-rich diet or keeping up with daily exercises in order to reduce your risk and improve your outcome, the support of family, friends and peers is key for accountability.
  • You’re more likely to remain motivated and focused on game-changing PreHab lessons when you have the support of a group.
  • Connecting with knee replacement recipients will encourage you to follow-suit

A community of support—whether it be family and friends, peers who will be undergoing a knee replacement, or those who are in recovery—is at the heart of PeerWell’s Prehab program.

2. Improve Your Diet

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We’ve all heard the saying “you are what you eat” and this can’t be better illustrated than when we’re talking about surgery. If you’re eating foods that are boosting your health before surgery than you’ll be a supercharged healer after surgery. Specifically, eating foods that are rich in protein, fiber, calcium and vitamin C and D, provide your body with the building blocks to promote faster healing after your joint replacement.

What You Should Eat and Why:

  • Calcium and Vitamin D—Calcium is an important part of strong bones and the healing of your bones after surgery. Vitamin D helps your body absorb calcium. What to Eat: Vitamin D fortified yogurt and cheese, fatty fish and whole grain fortified cereals.
  • Iron and Vitamin C—Having a diet rich in Iron and vitamin C will help boost pre-operative red blood cell levels and may reduce postoperative anemia or the need for a blood transfusion. What to Eat: Lean red meat, dark leafy greens, raisins, oranges, tomatoes and strawberries.
  • Protein—Protein is essential for an incision to repair itself and boosts overall healing. What to Eat: Seafood, white meat poultry, eggs, beans, peanut butter and drink Ensure.
  • Fiber—Fiber helps to control blood sugar (which if uncontrolled can increase wound infection, blood clots and lead to the need for revision surgery) and works to counteract the constipating effect of the painkillers prescribed post-surgery. What to Eat: whole grain bread, quinoa or brown rice and vegetables.

3. Exercise the Muscles Around the Knee

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In the weeks leading up to surgery, targeted exercises to build up strength in the muscles surrounding your knee is quite impactful. The stronger and more flexible your surrounding muscles are, the easier it will be to resume your favorite activities after the replacement. In addition to helping you bounce back, these purposeful, low-impact exercises will reduce fatigue, muscle soreness, swelling and the risk of blood clots.

Before surgery, exercises should primarily target your hamstrings and quadriceps.

3 Simple Exercises with Impact

Quad Sets

  1. Lie on your back in bed with your legs straight.
  2. Tighten your thigh muscle by pushing your knee down into the bed. Sometimes placing a small towel under your ankle facilitates this.

10 reps, 2x per day

Sitting Knee Flexion

  1. Sit on a chair with a towel under your surgical leg(s). Your feet should be flat on the floor.
  2. Slide one foot back, bending your surgical knee.
  3. Hold for 5 seconds, the slide your foot forward.

10 reps, 2x per day

Side Leg Raises

  1. Lie on your side in bed with your legs straight.
  2. Keep your knee straight and lift the “up” leg 2-3 inches.
  3. Hold for 5 seconds and then lower the leg in a controlled manner.

10 reps, 2x per day

4. Develop a Pain Plan and Practice Mindfulness

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Naturally, one of the most pressing concerns and drivers of anxiety before surgery is the amount of pain that will be endured. No one wants to be in more pain than absolutely necessary and uncontrolled amounts of pain actually slows down the healing process. Learning about pain management, developing a “pain plan”, and practicing mindfulness before surgery puts your mind at ease and places you back in control.

Important Pain Management To-Do’s:

1. Understand Your Pain Medications

Many patients require medications to minimize pain prior to surgery. These medications come in many varieties and are classified as: 1. Acetaminophen-based (tylenol) 2. Anti-inflammatory based NSAIDs and 3. Narcotic-based.

Anti-inflammatory based medications should be stopped about a week prior to surgery while acetaminophen-based medications can be taken through to surgery day. Since acetaminophen is a common over-the-counter pain reliever as well as a common ingredient in prescribed post-surgery narcotics, you have to be careful not to double-up on acetaminophen-based medications and exceed the maximum daily dose.

During the PreHab period, narcotic-based opioid medications should be stopped as early as possible. Using opioids prior to surgery increases postoperative pain, the length of hospital stay, as well as the need for revision surgery. Narcotic use can also reduce the overall satisfaction with a joint replacement.

2. Saying Yes or No to a Nerve Block

A nerve block (also known as local anesthetic) is a medical procedure that is changing the face of knee replacement surgery. Nerve blocks make it possible for patients to avoid general anesthesia which is riskier and increases surgery recovery time. Evidence shows that patients who forgo general anesthetic in exchange for a nerve block require fewer narcotic painkillers after surgery, have a reduced hospital stay and lower rates of blood clots.

Nerve blocks are becoming an increasingly popular choice for knee replacement patients and is an option you should discuss with your doctor and surgeon in your pre-op visit.

3. Practice Mindfulness

Mindfulness is a simple concept but when exercised effectively, can be used to manage pain, reduce the need for painkillers, and help alleviate feelings of anxiety, depression, frustration and stress.

To put it simply, mindfulness is paying attention to the present moment on purpose and with fresh eyes. When asked about the importance of mindfulness, Dr. Mehran explained, “Mental preparedness is absolutely everything. Patients that go into surgery with positive thinking actually do better.” Studies mimic Dr. Mehran’s observations, showing that knee replacement patients with anxiety or depression during the PreHab period have more complications.

Mindfulness helps put negative and anxious feelings about surgery at bay.

5. Better Your Odds for Success by Controlling What You Can

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The goal of PreHab is to ensure you’re at your physical and mental best before surgery to increase the knee replacements success, benefit, and speed of recovery. Beyond exercising and boosting your body with nutrition that promotes healing, it’s important to go the extra mile to be in the best health possible.

How to Be in Your Best Health

  • Quit Smoking—For smokers, quitting smoking is the single most impactful thing you can do improve your safety and recovery. Smoking is associated with complications like wound infections, pneumonia, stroke and death. If you cannot quit for life, taking a one month time-out from smoking before surgery is the next best thing.
  • Lose Extra Weight—For those overweight, shedding some extra weight before surgery drastically cuts down your risk and improves recovery time.
  • Manage Blood Sugar—Perform extra due-diligence when managing stress levels and blood sugar before surgery. It’s essential for diabetics to form a meal and medication plan for the week leading up to surgery.
  • Avoid Dental Work—Dental work, including cleaning can release bacteria into your bloodstream. This bacteria can increase your chances of infection. It’s best to avoid elective dental work in the weeks before surgery.

6. Be as Prepared as Possible

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Being prepared may seem obvious, but prior to surgery, it’s easy to be overwhelmed and overlook ways to make your knee replacement surgery and recovery more seamless. Beyond the must-do PreHab lessons to boost your mental and physical preparedness and meeting with your medical team to devise your pre-op and game day plan, we suggest really thinking about the future you. Your mobility will be greatly reduced in the days following a knee replacement it’s crucial to plan ahead.

Ways to get prepared:

  • Pre-order and Test Walking Devices—Make sure you’ve ordered mobility equipment to arrive on time for surgery day. While getting adjusted to a walker, crutch or cane is fairly simple, having a test run is ideal.
  • Pack an Overnight Bag—Pack everything you may need for your hospital stay including important documents like Advanced Directives, hand-carry equipment like a reacher and loose clothing.
  • Prepare Your Home—Prep your home by clearing high-traffic “roadways”, removing obstacles like cords or furniture that may get in your way, creating a downstairs living space and installing an elevated toilet seat.

Other things to think about: transportation to and from surgery, collecting mail, arranging meals ahead of time, getting assistance with laundry and general housekeeping.


Knee replacement surgery is quite literally a step toward your new life. Now, more than ever, you have the power to control the outcome of this powerful surgery through the actions you take in the weeks leading up to it.

Sign-up for PeerWell’s PreHab program to gain full access to our scientifically-proven method for increasing joint replacement success. PreHab your way to a better life with a community of peers who will be undergoing a joint replacement at the same time as you.

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Hi, I'm Grace. I write all things surgery for the PeerWell blog. You may remember me from such titles as: "Diabetes & Joint Replacement 101" & "Sex After a Joint Replacement".

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