Short answerIt may help a little, but the trials do not agree. Some found a shorter hospital stay and some found no clear gain.

Evidence grade

Does not helpNot enough evidenceHelps a littleGood evidence

Not enough evidence yet

What it is

Prehabilitation is a program of exercise and sometimes education that people follow in the weeks before a joint replacement. The aim is to enter surgery stronger and recover sooner.

What the research shows

found that exercise before joint replacement may slightly improve early pain and function after surgery. The effects were too small and too short-lived to matter to patients, and there was no clear effect on length of stay or quality of life.

focused on knee replacement pooled 19 studies with 1,008 people. It found a shorter hospital stay and better knee bending after exercise before surgery. It found no clear difference in pain, walking tests or knee scores that measure function in daily life.

The two reviews differ on the hospital stay. The trials varied a lot in the type, length and supervision of the programs.^1,2

Risks and effort

The programs ask for time and effort in the weeks before surgery. Exercise carries a low risk when it is matched to your condition.

What usually works instead

Many people are asked to stay active, keep their weight steady and treat any anaemia before surgery. Ask your surgical team what they advise. See Total Knee Replacement and Does exercise work for knee arthritis?.

Questions people ask

Should I do it if my surgery is soon?

Exercise that you can do safely is reasonable. The evidence does not show that it is essential.

Does it work better for hips or knees?

The first review found similar effects for hips and knees. The second review looked only at knees.^1,2

Is walking enough?

The trials tested many kinds of exercise. The reviews could not say which kind is best.

Sources

Select a source to read what the study or guideline found, in plain words, with a link to the original.

Sources

Systematic review

1Review of exercise before joint replacement

Who and when. Wang, Lee, Zhang, Moodie, Cheng and Martin, published in BMJ Open in 2016.

What they did. They pooled randomised trials of exercise and rehabilitation before hip or knee replacement.

What they found. Exercise before surgery may slightly improve early pain and function after surgery. The effects were too small and short lived to matter, with no clear effect on hospital stay or quality of life.

What it means. Exercise before surgery may help a little early on, but the benefit is small.

Wang L, Lee M, Zhang Z, Moodie J, Cheng D, Martin J. Does preoperative rehabilitation for patients planning to undergo joint replacement surgery improve outcomes? A systematic review and meta-analysis of randomised controlled trials. BMJ Open. 2016;6(2):e009857. doi:10.1136/bmjopen-2015-009857

Read the review →

Systematic review

2Review of exercise before knee replacement

Who and when. Su, Zhou, Qiu and Wu, published in the Journal of Orthopaedic Surgery and Research in 2022.

What they did. They pooled 19 studies with 1,008 people who exercised before knee replacement.

What they found. Hospital stay was shorter and knee bending better after exercise. There was no clear difference in pain, walking tests or function scores.

What it means. The two reviews differ on hospital stay, and the programs varied a lot in type, length and supervision.

Su W, Zhou Y, Qiu H, Wu H. The effects of preoperative rehabilitation on pain and functional outcome after total knee arthroplasty: a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2022;17:175.