Preparing for knee replacement: a practical checklist

Knee replacement is usually an elective operation. That is a good thing: it means there is time to prepare properly. The people who tend to do best are not necessarily the ones who are fittest before surgery, but the ones who understand what is coming, have a plan for the first few weeks, and feel supported at home.

This checklist is not a substitute for your surgeon’s instructions. Protocols vary between hospitals and between patients. Use it to know what to ask, what to arrange, and what to expect — not to replace the advice of your surgical team.

Is it the right time?

There is no single X-ray finding that decides when a knee should be replaced. The decision is based on how much the knee affects your life: pain that limits walking, stairs, sleep or daily activities; stiffness that restricts movement; and a failure of sensible non-surgical measures such as activity adjustment, physiotherapy and weight management.

Age matters less than the condition of the knee and the person attached to it. Younger or more active patients may reasonably delay surgery, but delaying is not always protective. Advanced arthritis can also limit function and make later recovery harder. A good surgical conversation should cover the expected benefits, the risks, the alternatives, and what happens if you wait.

Before surgery: health and medication checks

Your surgical team will arrange pre-operative assessment and blood tests, and may ask for an ECG, chest X-ray or specialist review. The aim is to identify and manage anything that could complicate surgery or recovery.

• Diabetes. Good blood glucose control is associated with lower infection risk and better wound healing. Your surgeon may ask for recent readings or an HbA1c.
• Anaemia. Low iron or haemoglobin should be corrected before a planned joint replacement where possible.
• Blood pressure and heart health. Uncontrolled hypertension, recent cardiac events or breathing problems need review.
• Dental and skin health. Active dental infections and skin infections should be treated before surgery. Tell your team about any cuts, boils or rashes near the planned surgical site.
• Medicines. Bring a complete list, including blood thinners, aspirin, diabetes medicines, steroids and supplements. Do not stop any medicine on your own — the team will give specific instructions.
• Smoking and alcohol. Stopping smoking before surgery improves healing. Reduction in alcohol also helps recovery and medication safety.

Setting up your home

A little preparation at home prevents a lot of frustration later. Ask someone to walk through your living space with you and think about the first week after discharge.

• Clear the paths. Remove loose rugs, trailing cables and low furniture from the routes you will use most.
• Set up a recovery station. A firm chair with armrests, a side table for medicines and water, a phone charger, and space to elevate the leg.
• Think about the bathroom. A raised toilet seat, a shower chair and a non-slip mat can make a real difference. Follow your hospital’s advice on showering and wound protection.
• Prepare for stairs. If you have stairs, practise the instruction you will be given: “up with the good leg, down with the operated leg” — but confirm this with your physiotherapist.
• Stock the kitchen. Simple meals, easy-to-reach utensils, and a plan for groceries reduce the need to improvise while using a walker.
• Arrange help. The first one to two weeks are easier with someone who can assist with meals, transport and errands.

Prehabilitation: a little strength goes a long way

“Prehab” does not require a gym. It is a short, regular programme that prepares the muscles around the knee and the rest of the body for the demands of surgery and walking aids.

1. Quadriceps and gluteal strength. Sit-to-stand, straight-leg raises, glute bridges and gentle step-ups, as advised.
2. Upper body. Shoulder and triceps strength help with walkers, crutches and pushing up from a chair.
3. Balance and confidence. Practise standing on one leg near a counter if it is safe for you.
4. Walking aids. Ask for a walker or crutches before surgery and practise adjusting them. Familiarity reduces fear on day one.
5. Breathing exercises. Practise deep breathing and incentive spirometry if instructed; this helps after anaesthesia and pain relief.

The week before surgery

Follow the hospital’s specific instructions, and confirm the practical details in advance:

• Fasting and medicines. Confirm when to stop eating and which medicines to take or pause.
• Skin preparation. Use the prescribed wash or wipes exactly as directed. Avoid shaving the surgical area.
• Packing. Loose clothing, non-slip footwear, toiletries, medicines, reports, phone charger and something to pass the time.
• Transport. Arrange a ride home with enough space for a straight leg, and confirm who will be with you for the first night.
• Contacts. Save the hospital and clinic numbers, and know who to call after hours.

What happens in hospital

The exact pathway varies, but most modern joint replacement programmes aim to get you moving safely within a day of surgery. You may have a spinal or general anaesthetic, often with a nerve block for pain relief. The surgical team will explain the plan.

Expect physiotherapy to start early: sitting up, standing, walking a few steps with a frame, and practicing exercises. Pain relief, blood clot prevention and wound care are managed according to protocol. An X-ray may be taken before discharge. Ask what to expect, who to contact, and which warning signs should prompt a call.

The first six weeks at home

This is the phase where preparation pays off. Swelling and stiffness are common and often fluctuate. The knee may feel warm for several weeks. Progress is rarely a straight line.

• Elevate and ice. Follow your team’s advice on frequency and duration. A cloth barrier protects the skin.
• Keep the wound clean and dry. Follow the specific instructions for dressing changes and showering.
• Do your exercises. Little and often is usually better than one long session. Aim for the range of movement and strength work prescribed.
• Use your walking aid. Do not discard it early because the knee feels better; a limp can slow recovery and strain other joints.
• Manage constipation. Pain medicines, reduced activity and anaesthesia can slow the bowel. Ask about a plan before discharge.
• Sleep. Sleep can be disrupted for several weeks. Naps, comfortable positioning and realistic expectations help.
• Driving and work. Return to driving and work depends on the side operated, your medicines, your control and your surgeon’s clearance. Do not guess.

The longer view

Most people notice meaningful improvement in pain and function over three to six months, with continued gains up to a year and beyond. Strength and confidence often take longer than the wound. Walking, swimming and cycling are generally encouraged; high-impact running and jumping are usually discouraged or discussed individually, because they increase wear on the implant.

Kneeling may remain uncomfortable, and some clicking or stiffness can persist. These are common, but they should be discussed rather than ignored. Regular follow-up allows your surgeon to check alignment, movement and recovery.

Preparation does not guarantee an easy recovery. It does give you the best chance of one — and a clearer sense of what is normal along the way.

A final word

Write down your questions as they come to you, and bring them to your consultation. Ask about the expected hospital stay, pain plan, physiotherapy, follow-up, and what you should not do in the first six weeks. A well-informed patient is not a demanding one; they are simply easier to care for.

This article is general patient education and does not replace an individual consultation or your hospital’s pre-operative instructions. Knee replacement is a major operation, and recommendations vary according to your health, the surgical approach and your surgeon’s protocol.