Prehab Before Surgery: How to Use the Wait Before a Hip or Knee Replacement
Written by Nicolas Marchant, Registered Physiotherapist. Before founding PhysioHome, I worked as a physiotherapist with Vancouver Coastal Health. Most of the people I met on the ward after a hip or knee replacement had waited a long time for that operation, and had spent the waiting period doing steadily less.
Almost everything about a planned surgery is scheduled by someone else. The consult, the imaging, the date. The months in between get treated as dead time, something to endure until the real event. That is backwards. For most people facing a hip or knee replacement in British Columbia, the wait is the longest uninterrupted block of preparation time they will ever have, and the only part of the process they control. Preparing during that window has a name: prehabilitation, or prehab.
What prehab actually is
Prehab is structured exercise and practical preparation done before a planned operation. For joint replacement that usually means strength work for both legs, general conditioning, balance training, and rehearsal of the tasks you will face in the first week afterwards.
It is not a smaller version of post-op rehab. The goals differ. After surgery you are protecting a healing joint. Before surgery you are building the reserve you will spend during recovery.
What the evidence supports, and what it does not
Worth being straight about this, because prehab gets oversold. The research is genuinely mixed. Some reviews report improvements in function, including a systematic review with meta-analysis in the Journal of Orthopaedic and Sports Physical Therapy titled Prehabilitation Improves Knee Functioning Before and Within the First Year After Total Knee Arthroplasty. Others conclude the trials are too varied and too small to settle the question, particularly for hip replacement and for outcomes measured a year out.
So here is the cautious version, which is also the honest one. Nobody has shown that prehab makes surgery unnecessary, guarantees a shorter hospital stay, or removes the hard part of recovery. What it does is put you into the operation stronger and better rehearsed than you would otherwise be. Everything past that is a reasonable expectation rather than a promise.
The problem prehab actually solves
The thing surgery does not fix is the year before it.
The pattern is familiar. The joint hurts, so you take the stairs less. You park closer. You stop the walk, the garden, the swim. The pain is a legitimate reason, but the cost is quiet and cumulative: the quadriceps and glutes weaken, balance drifts, and cardiovascular fitness drops.
A surgeon replaces the joint. The muscles around it are still the ones you arrived with. Standing up, managing a walker and getting to the bathroom at 3am are all strength and balance tasks, which is why people who go in stronger usually find the early weeks less of a shock.
If your joint pain is still being managed rather than scheduled for surgery, our article on treating osteoarthritis without surgery covers that earlier stage.
What a home prehab program usually includes
Programs are individual, and what follows is a description rather than a prescription. Loads, repetitions and which exercises are safe for you depend on an assessment.
- Strength in both legs. The unoperated side does extra work for weeks after surgery, so it gets trained too, not just the painful one.
- Sit to stand. The most repeated movement of the first post-op week. Practising it from your own chair, sofa and toilet height beats any gym machine.
- Balance and single leg control. Standing, stepping and turning, progressed carefully and with something stable to hold.
- Upper body strength. Crutches and walkers are an arm and shoulder task. This is the part people skip and then regret.
- Conditioning you can tolerate. Walking, a stationary bike, water based activity, whatever the joint allows without a flare that lasts into the next day.
- Working within pain, not through it. Prehab should not leave you worse the following morning.
Rehearse the first week in the actual home
This is where an in-home visit does something a clinic cannot.
Recovery happens in your hallway, not in a treatment room. A home assessment before surgery looks at what decides the first week: the height of your bed and toilet, stairs between the street and the front door, the lip on the shower, whether the bedroom is upstairs, whether your favourite chair has arms, whether a walker fits through the bathroom doorway.
Greater Vancouver housing makes this concrete. Older character homes in Vancouver and New Westminster often have a half flight up to the entrance. North Shore properties get built into slopes, so the garage and the kitchen can be a full storey apart. Apartments in Burnaby, Richmond and the Tri-Cities solve the stairs with an elevator, then hand you a bathroom too tight to turn a walker in.
Equipment matters just as much. A walker, a raised toilet seat, a bath bench and grab bars should be in the house and set to your height before you go in, not ordered in a scramble the week you get home. Our pre-surgery program is built around exactly this combination of training and home setup, and the total knee and hip replacement page covers what happens on the other side of the operation.
Know your own timeline
Planning gets easier when you know roughly how long you have. The Province of British Columbia publishes a surgical wait times tool where you can look up reported waits by procedure, hospital and surgeon, covering Lions Gate, Vancouver General, Burnaby Hospital, Royal Columbian, Eagle Ridge, Surrey Memorial and Richmond Hospital. Waits change, and your surgeon's office remains the authority on your date, so use it for planning rather than predicting.
The same principle applies before spinal, shoulder and many major abdominal procedures: arrive fitter, arrive rehearsed, know what the first week needs. What is safe to train varies by procedure, so the program follows your surgeon's instructions rather than a generic template.
Red flags: when to seek medical care
Prehab supports your medical care, it does not replace it. Contact your doctor, or seek urgent care, if you notice:
- A sudden, significant increase in joint pain, or pain that has changed in character
- Redness, heat, swelling or fever in a joint, which needs prompt assessment
- A joint that gives way, locks, or that you suddenly cannot put weight through
- New numbness, pins and needles, or leg weakness
- Calf pain, swelling or tenderness, particularly one sided
- Chest pain, or breathlessness that is new or out of proportion to what you are doing
- Any fall, or night pain that wakes you regularly, or unexplained weight loss
Anything about your surgical date, your medications, or whether an exercise is safe for your procedure goes to your surgeon or family doctor.
Costs and booking
PhysioHome is a fully mobile practice across Greater Vancouver: Vancouver, North and West Vancouver, Burnaby, New Westminster, Coquitlam, Port Coquitlam, Port Moody, Surrey and Richmond. Visits are $180 for 45 minutes and $210 for 60 minutes, travel included, with kinesiology and rehab assistant visits from $130 for more frequent supervised practice between sessions.
Prehab is generally private pay or extended health benefits, and no referral is needed. Full pricing is on our fees page. Surgery after a work injury runs through WorkSafeBC, and surgery after a motor vehicle accident runs through ICBC, both handled as separate claims. For older adults, the seniors physiotherapy page has more detail, and our guide to total knee replacement recovery at home, week by week shows what you are preparing for.
Book an in-home assessment, call 778-488-5934, or email info@physiohome.ca. We are open Monday to Friday 8am to 7pm and Saturday 9am to 3pm.
Frequently Asked Questions
When should I start prehab before surgery?
As soon as surgery is on the table. A date months away is an advantage rather than wasted time, because strength takes weeks to build. If your date is close, a few sessions on home setup, equipment and rehearsing the first week are still worth doing.
Will prehab mean I can avoid surgery?
No, and anyone promising that is overstating it. Prehab prepares you for an operation that is already planned. If you are earlier in the process and still deciding, that is a different conversation to have with your surgeon.
Can I do prehab if the joint is painful?
Usually yes, with the program built around what the joint tolerates. The rule of thumb is that exercise should not leave you worse the next morning. An assessment sets the starting point.
Do I need a referral for pre-surgery physiotherapy in BC?
No, you can book directly. We do ask about your surgeon's instructions and any restrictions, since those shape what we train.