BLOG How exercise before hip and knee surgery improves patient outcomes

Patients in a group prehabilitation class

With 1,498 per 100,000 of the population waiting for orthopaedic surgery, it is vital to help support patients awaiting total hip and knee replacements to improve their health and increase surgery success rates by participating in regular exercise before surgery.

A major reason for the pressure on NHS waiting lists was the Covid-19 pandemic and the drastic changes lockdowns caused to people’s lifestyles. As healthcare services were a focal point in managing Covid-19, patients with long term conditions experienced substantial repercussions including cancelled and postponed surgeries.

One group that is still encountering implications with their medical care is orthopaedic patients. The wait-times for trauma and orthopaedic surgery remains the highest compared to other speciality departments. Delayed surgeries are problematic because patients’ quality of lives and health begin to deteriorate due to their pain and mobility worsening.

Prolonged surgery waiting times have been associated with slower remobilisation and increased pain for patients. These extended periods of immobility in turn can result in muscle disuse and deterioration, causing a decline in quality of life. 

Undergoing surgery with a poor health status increases the chances of complications so it is important to manage and minimise these factors. For example, the higher the body mass index (BMI), the greater the risk of physical and mental consequences of surgery, such as wound infection, longer operative time, longer hospital stay and low mood. Surgery itself can also cause physiological stress for patients and research has found that poor physical fitness is associated with a reduced resilience to surgical physiological stress and increased risk of complications and readmission.


Preparing patients for surgery and intervening during the preoperative period is called prehabilitation and aims to encourage healthy behaviours and lifestyle habits to enhance patients’ health before and after their surgery.

Prehabilitation programmes typically involve education on exercise, nutrition, psychological support, and stopping smoking and alcohol.  

Recent research investigated the effect exercise before surgery had on self-reported and objective measures of function, pain and quality of life. Data was collected before and after completing the exercise intervention and again after surgery. The patients within this research completed structured exercise for six to twelve weeks. Exercises were primarily strength and mobility, with some aerobic, and were completed at home, clinic or community facility.

The research found self-reported quality of life, pain and function to significantly improve before and after surgery in patients who exercised regularly compared to those who did not. The objective measures also revealed improved function in patients who engaged in regular exercise compared to those that did not, suggesting that exercising before surgery can help prevent a decline in patients’ health.   

If more research findings support patients exercising during their preoperative period, it is possible for prehabilitation to be implemented across the UK for all patients undergoing surgery and reduce the duration and complications of surgical procedures and patient aftercare, reducing the demand and cost on healthcare services.

Natasha Hares, Doctoral Researcher

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