Joint Replacement Prehab Checklist: What to Do in the Weeks Before Surgery

Prehab is everything you do between booking a joint replacement and arriving for surgery that makes the operation more likely to go ahead on time and the first weeks easier. Part of it is exercise. Much of it is medical readiness that, if it's missed, can delay the operation. This checklist puts both in date order.

Two kinds of preparation

Body preparation means building strength for walkers and crutches, learning the exercises you'll do after surgery, and dealing with health issues that raise risk. Readiness preparation means the medical clearance, tests, medicine changes and small details, such as a scratch on the leg or a cold the week before, that decide whether surgery happens on the planned day.

The house and the people who'll help you matter just as much, but they have their own guides: the home setup score for the rooms, and the caregiver task map for who does what. This page sticks to you.

The prehab timeline

All of the items below come from AAOS OrthoInfo's preparation guide and its knee and hip replacement pages (2026). Your surgeon's instructions override any general timing.

Build a medicine list the clearance doctor can use

OrthoInfo asks for a list of everything you take, with doses and how often: prescriptions, over-the-counter products, vitamins and minerals. Some may need stopping a week or two before surgery, or swapping for something else. A list scribbled from memory on the morning of the appointment is how things get missed. Build it as a table you can update and hand to every clinician who asks.

That last column is the one that matters on the day. If two clinicians give you different instructions for the same medicine, settle it with the surgical team before the date, not in the admissions queue.

Smoking, weight and alcohol

OrthoInfo is direct about these. Smoking slows healing and may raise the risk of infection, so cutting down or quitting before surgery is recommended. Excess weight puts extra stress on the new joint, and your doctor may suggest a weight-loss programme beforehand. Alcohol should be avoided for at least 48 hours before surgery. None of these is an all-or-nothing test, but each is worth discussing early, because changes take weeks rather than days.

The exercise part

OrthoInfo's prehab advice is practical rather than athletic:

• Upper-body strengthening, because your arms take much of your weight on a walker or crutches in the first days.
• Isometric exercises, where you tighten a muscle without moving the joint, to maintain leg strength.
• Learning the post-operative exercises in advance, so the first therapy sessions are about doing them, not learning them.

Learning them early matters because rehab starts fast. For knee replacement, OrthoInfo says physical therapy begins within hours of surgery. Ask your surgeon or a physical therapist to show you the routine before the operation, and don't start a new strenuous programme on a painful joint without their go-ahead. Practising with a borrowed walker at home, on your actual routes, is part of prehab too.

Hip and knee prehab differ in the details

The broad checklist is the same for both joints, but the emphasis shifts. Before a hip replacement, OrthoInfo's hip guidance points to dressing aids such as a sock aid, a long-handled shoehorn and a reacher. It notes that precautions on sitting, bending and sleeping usually last about six weeks, so it's worth practising the movements you'll use before you have to. Before a knee replacement, the priority is learning the bending and straightening exercises, because therapy starts within hours of the operation. Either way, ask your team which version of the routine applies to you.

Small things that can cancel surgery

These rarely get much attention, but any one of them can push back a carefully planned date.

Skin on the operated limb

OrthoInfo warns that a break in the skin raises the risk of infection and that an infection can cancel surgery. In the run-up, be careful with anything that could nick or scratch that limb, such as gardening without gloves. Report anything you find rather than hoping it heals in time.

Illness the week before

A fever or cold close to the date needs to be reported, not hidden. The team would rather postpone than operate while you're unwell.

Teeth and bladder

Major dental work should be finished before surgery. OrthoInfo also advises avoiding dental work, including routine cleanings, for several weeks afterwards because of infection risk, so book any dental visit early. Recurrent urinary infections, and prostate problems in older men, should be checked and treated first.

If your surgery is abroad, any of these can turn into a cancelled trip. The red-team exercise walks through how to protect bookings against a postponement.

Prehab when the operation is in another country

The CDC Yellow Book (2026) advises medical travellers to talk to their primary care clinician well before travel. It mentions a travel-medicine consultation four to six weeks before departure as an option, and recommends travelling with enough regular medicine for the whole trip. Add these steps to your prehab:

• Ask the destination surgeon which pre-operative tests they'll accept from home, how recent they must be, and which they'll repeat on arrival.
• Send your medicine list and clearance letter ahead, translated if needed.
• Ask for the post-operative exercise sheet before you travel, so you can learn it at home.
• Agree who at home will supervise therapy after you return.

Questions for your pre-operative appointment

1. Which exercises do you want me doing now, and how often?
2. Which of my medicines and supplements do I stop, when, and what replaces them?
3. Which tests do you need, and how recent do they have to be?
4. Do any of my conditions need a specialist review first?
5. What should I do if I get a cut, rash or infection on that limb before the date?
6. Will I see a physical therapist before surgery to learn the routine?

Track the logistics

The checklist below covers the logistics items that usually sit alongside prehab. Tick each one only when it's actually arranged, not just intended.

If your weight or age has come up in the candidacy discussion, the guide to age, BMI and outcomes explains what surgeons look at.

Related joint-replacement guides

Orthopedic lead network