Before having a hip or knee replacement operation

The Hip and Knee Surgery Service provides specialist care for patients undergoing hip and knee replacement procedures. This section contains information to help you understand your treatment journey, from preparing for surgery and hospital admission through to recovery and rehabilitation. Please use the sections below to access information, guidance and resources relevant to each stage of your care.

What is Enhanced Recovery?

Enhanced recovery is a modern, surgically led, evidence-based approach that helps patients undergoing surgery get back to health as soon as possible following their operation.

How does this benefit our patients?

  • Enhanced Recovery ensures that patient’s health is optimised before surgery
  • That patient’s pain is well managed during their hospital stay
  • That mobilisation is achieved early to help reduce risks and complications

Please watch the short video below to provide more information on Enhanced Recovery. Link to Mr Perkins Enhanced Recovery talk

Will every patient be on the Enhanced Recovery pathway?

All patients scheduled for hip or knee replacement surgery will be placed on the Enhanced Recovery Programme. But not all patients will be suitable for early discharge. This will be discussed with your surgeon when you are added to the waiting list.

How long will I be in hospital for after my Hip or Knee Replacement?

You will go home when you are safe, and for many of you that will be on the same day, and for almost all of you it will be within 24 hours of your surgery.

I’ve been added to the waiting list for a hip or knee replacement, what happens next?

Before your operation you will be expected to sign a Consent form and have some up to date x-ray images taken.

You will also be contacted and asked to attend a further two appointments; Joint School and Pre Operative Assessment.

What does Joint School cover?

· How to optimise your health before surgery

· How to prepare before coming in

· The benefits and risks involved with the surgery

· The surgery and anaesthetic

· What to expect from Admission through to Discharge

· What your rehab programme will look like

How long does Joint School last?

Joint school lasts approximately 45-60 minutes. Where possible, the bookings team try and get your consent and x-ray appointment on the same day, but this isn’t always the case. If it is difficult for you to come back again for further appointments speak with the nursing team running Joint School to see if they can help at all.

Will I be given the opportunity to take away elbow crutches to practice with before surgery?

Yes, you absolutely can be measured up for elbow crutches during your joint school appointment. Some people have added anxieties at the thought of using elbow crutches for the first time after their joint replacement.

We recognise this and want to give you the opportunity to take some away with you so that you can practice at home and feel more prepared on the day of your surgery. Please ensure you bring them in with you on admission.

Do I have to attend Joint School if I’ve been before?

It is recommended that if you have been to Joint School before for a previous joint replacement, you should still come as things might have changed since you were last in.

What is Prehab?

Prehabilitation (Prehab) prepares your body for a knee or hip replacement by focusing on building muscle strength. Stronger muscles lead to shorter hospital stays, less pain, and faster recovery.

I’m waiting for a knee replacement, when should I start my Prehab exercises?

If you are waiting for a knee replacement, you want to focus on starting your knee exercises at least 6-8 weeks before surgery. You should focus on building your thighs, hips and upper body.

I’m waiting for a hip replacement, when should I start my Prehab exercises?

If you are waiting for a hip replacement, you want to focus on targeted exercises to build strength in your glutes, quads, and core for 4–6 weeks before surgery.

Why Prehab matters

The waiting list for a hip or a knee replacement is long. During this time, you may find that your legs become weaker and that your mobility reduces. Think of surgery like running a race. You would not run a marathon without training. Prehab trains your body for the stress of surgery. It builds the upper body strength you need to use a walker or crutches after surgery.

Preparation reduces post-operative pain, accelerates functional recovery, and lowers complication risks. A solid program also includes optimising nutrition and keeping hydrated.

Do these exercises 2 to 3 times a day. Only stretch to where it feels uncomfortable, NOT painful.

  • Quad Sets (Thigh Squeezes): Lie flat on your back. Tighten your thigh muscle to push the back of your knee flat into the floor. Hold for 5 seconds. Relax. Do this 10 times.
  •  Straight Leg Raises: Lie on your back. Keep your leg straight. Lift your leg about 12 inches off the floor. Hold for 5 seconds. Slowly lower it. Do this 10 times.
  •  Heel Slides: Lie on your back. Slowly slide your heel toward your bottom, bending your knee. Slide it back down to straighten the leg. Repeat 10 times.
  •  Chair Push-Ups: Sit in a chair with armrests. Place your hands on the armrests. Push down with your arms to lift your bottom off the chair seat. Hold for a second, then lower yourself. Repeat 10 times to build upper body strength.

Prehab should focus on low-impact, controlled strengthening within a pain-free range of motion. Always consult your medical provider before starting any regimen.

  • Sit-to-Stands: Sit in a chair with arms crossed, lean forward, and drive up to a standing position without using your hands. Control your descent back to the seat.
  • Glute Squeezes: Lie on your back with your legs straight, squeeze your bottom muscles together, hold for 5 seconds, and relax.
  • Straight Leg Raises: Lie on your back, keep one leg straight and the other bent. Tighten the thigh muscles of the straight leg, lift it a couple of inches off the floor, and slowly lower it.