The six weeks before a joint replacement have a real effect on the six weeks after it. Building strength in the leg, practising with walking aids, setting up the house and knowing what the first fortnight looks like all make the early recovery smoother. Most people can start about four to six weeks before their surgery date.
When a surgeon books you in for a knee or hip replacement, the waiting period is usually treated as dead time. It does not have to be. You recover from wherever you start, and a leg that has been getting steadily weaker for two years while you avoided using it is a harder starting point than one that has had six weeks of work.
Here is what is worth doing with that time.
1. Build strength in the leg you are having operated on
This is the part most people skip, usually because the joint hurts and exercising it feels counterproductive. The evidence points the other way. Pre-operative strength, particularly in the quadriceps for a knee and the hip muscles for a hip, is associated with faster return of function afterwards.
A prehabilitation program is not heavy gym work. It typically involves:
- Quadriceps and glute strengthening in ranges the joint tolerates
- Sit to stand practice, since that is what you will be doing constantly after surgery
- Balance and single leg control, because the other leg is about to do a lot of work
- Walking, in whatever amount is comfortable, to maintain general fitness
- Upper body strength, which sounds irrelevant until you are pushing yourself out of a chair with your arms for a fortnight
Sessions are usually weekly with a home program in between. Where the arthritis makes clinic based exercise difficult, an exercise physiologist can build a program around what the joint will tolerate.
2. Learn to use the crutches or frame before you need them
Almost everybody is handed a walking aid on the ward, shown how to use it once, and sent home. Learning crutch technique and stair technique in advance, without pain, without a fresh wound and without anaesthetic still in your system, is far easier.
Worth practising before surgery: standing up and sitting down with the aid, walking on flat ground, going up and down stairs, and getting in and out of a car.
3. Set the house up
You will be moving slowly and unable to bend the way you normally do. A short checklist:
- Clear walkways. Remove loose rugs, cords and anything you would normally step over.
- Pick a chair with arms, firm, and high enough that you can stand from it without help.
- Arrange a raised toilet seat and shower rails if you need them. Ask your physiotherapist rather than guessing.
- Move kettle, plates and everyday items to bench height so you are not reaching low or high.
- Cook and freeze two weeks of meals.
- Sort out where you will sleep. Some people are more comfortable in a different bed or room for the first fortnight.
- Put a chair in the shower.
4. Organise the help you will need
You will not be driving for several weeks. Line up lifts, shopping and someone to check in for the first two weeks. If you live alone, tell the hospital team early, because it can change the discharge plan.
5. Deal with the general health items
Anything that affects wound healing and anaesthetic risk is worth raising with your GP in advance. That includes smoking, blood sugar control if you have diabetes, iron levels, and dental infections, which some surgeons want cleared before a joint is implanted. These are GP and surgeon conversations, but the weeks before surgery are when there is still time to act on them.
6. Know what the first six weeks after surgery look like
Most of the anxiety before a joint replacement comes from not knowing what normal looks like afterwards. Broadly:
| When | What usually happens |
|---|---|
| Day 0 to 2 | Standing and walking short distances with an aid, often on the day of surgery or the day after. |
| Week 1 to 2 | Home, walking with an aid, working on bend and straightening, managing swelling. Wound review. |
| Week 2 to 6 | Aid gradually reduced, walking distance increases, outpatient physiotherapy two to three times a week early on. Driving often returns in this window with surgeon approval. |
| Month 2 to 6 | Strength work, stairs, slopes, return to golf, bowls, swimming and similar. Knees generally take longer than hips. |
| Month 6 to 12 | Continued improvement in strength and confidence. Many people are still noticing gains at twelve months. |
Swelling that comes and goes for months is normal. So is a knee that feels tight first thing in the morning. Your physiotherapist will tell you which sensations are expected and which ones need reporting.
Joint School
Joint School is a pre-surgical education session run by the orthopaedic group. A Fortius Allied Health physiotherapist presents the rehabilitation part of it.
It covers the day of surgery, pain relief, what the ward will ask you to do, walking aids, the home setup, and the rehabilitation plan through to discharge. Patients bring the person who will be helping them at home, which is usually the more useful attendance of the two.
Places are arranged through your surgeon’s rooms at the time your surgery is booked, not through Fortius Allied Health. If you have a surgery date and have not heard anything about Joint School, ask the rooms that booked your surgery.
Where to start
Fortius Allied Health runs pre-operative and post-operative programs at Birtinya, Caloundra, Noosaville and Gympie. The same physiotherapist who prepares you for surgery can generally take you through the rehabilitation afterwards.
If surgery has not been decided yet, the GLA:D program for knee and hip osteoarthritis is an evidence based non surgical option worth discussing first. There is more on the pre and post-operative physiotherapy page, or you can book an assessment.
Frequently asked questions
Should I do exercises before a knee replacement?
Yes. Strength and movement in the leg before surgery is one of the better predictors of how quickly function returns afterwards, because you recover from a starting point rather than from a deficit. A prehabilitation program usually runs for four to six weeks and focuses on quadriceps and hip strength, walking, and balance.
What is Joint School?
Joint School is a pre-surgical education session run by the orthopaedic group, with a Fortius Allied Health physiotherapist presenting the rehabilitation part of it. It covers what happens on the day of surgery, pain management, what the first weeks at home look like, walking aids, and the rehabilitation plan. Places are arranged through your surgeon’s rooms at the time your surgery is booked.
How long before a joint replacement should I start prehabilitation?
Four to six weeks before surgery is a practical window. That is long enough to build measurable strength and to sort out the home setup and walking aids without rushing. If your surgery is sooner, there is still value in a single session covering crutch technique, home preparation and what to expect.
What should I organise at home before a knee or hip replacement?
Clear walkways and remove loose rugs and cords, set up a firm chair with arms at a height you can stand from, arrange a raised toilet seat and shower rails if needed, move everyday items to bench height, prepare and freeze meals, and organise someone to help with driving and shopping for the first fortnight.
How long does rehabilitation take after a knee replacement?
Most people walk with aids within days and are moving around home independently in the first few weeks. Regaining full knee bend, strength and confidence on stairs and slopes generally takes three to six months, and improvement can continue for up to a year. Hip replacements often feel easier earlier than knees.
Where can I do joint replacement preparation on the Sunshine Coast?
Fortius Allied Health runs pre-operative programs at its Birtinya, Caloundra, Noosaville and Gympie clinics, and its physiotherapists present at Joint School, the pre-surgical education session run by the orthopaedic group. Phone 07 5413 5202 for Birtinya to arrange an assessment once your surgery date is set.
About Fortius Allied Health
This article is general information and is not a substitute for individual clinical advice. Surgical and anaesthetic decisions rest with your surgeon and GP. Fortius Allied Health physiotherapists are registered with the Australian Health Practitioner Regulation Agency.
