Preparing for knee replacement surgery starts weeks before your actual procedure date and covers everything from strengthening your leg muscles to rearranging your living space. The more you do ahead of time, the smoother your recovery will be. Most people stay in the hospital for one to two days after surgery, and some go home the same day, so the bulk of your recovery happens at home in a space you’ll need to have ready.
Start Strengthening Your Leg Early
Pre-rehabilitation, or “prehab,” is one of the most valuable things you can do before surgery. A structured program combining muscle strengthening and endurance exercises, started at least three weeks before your procedure, improves outcomes after surgery. The logic is straightforward: the stronger your leg is going in, the faster it bounces back.
Focus on exercises that build your quadriceps (the muscles on the front of your thigh), since those do the heavy lifting during recovery. Straight leg raises, seated knee extensions, and gentle squats are common starting points. Your surgeon or a physical therapist can tailor a routine based on your current pain levels and mobility. Even walking regularly counts. The goal isn’t to push through pain but to keep the muscles around your knee as active as possible so they’re ready to support you post-surgery.
Manage Your Weight If Needed
Body weight plays a real role in surgical risk. Studies show that patients with a BMI above 40 are significantly more likely to experience serious complications both during and after surgery than those with a lower BMI. Because of this, some surgeons, hospitals, and insurance companies set BMI cutoffs between 35 and 40, above which they may recommend delaying surgery until weight loss occurs.
That said, there’s no magic number where risk suddenly spikes or disappears. The American Academy of Orthopaedic Surgeons notes that no BMI guarantees a complication-free surgery. If your weight is a concern, talk to your surgical team early. Even modest weight loss in the months leading up to surgery can reduce stress on the new joint and lower your complication risk.
Quit Smoking Well Before Surgery
If you smoke, stopping before surgery is one of the single biggest things you can do to protect your outcome. Patients who continued smoking leading up to joint replacement had a wound complication or infection rate of 27%, compared to just 5% for those who quit beforehand. That’s a fivefold difference.
On average, patients who successfully quit did so about 45 days before their procedure. Most managed it without quit aids. If you’re struggling, nicotine patches, gums, or prescription options can help, but the key is giving your body enough time to start healing more efficiently before the incision is even made.
Review Your Medications
Several common medications affect your blood’s ability to clot and need to be paused before surgery. The most familiar ones include aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), and celecoxib (Celebrex). These are all either anti-inflammatory drugs or blood thinners that can increase bleeding risk during the procedure.
Your surgeon’s office will give you a specific timeline for when to stop each medication. Don’t make changes on your own, especially if you take blood thinners for a heart condition or other reason. Bring a complete list of everything you take, including supplements and over-the-counter products, to your pre-operative appointment. Some herbal supplements like fish oil, vitamin E, and ginkgo can also thin the blood.
Complete Pre-Operative Testing
Within 30 days of your surgery, you’ll have a pre-operative testing appointment. This typically includes a medical evaluation, blood work, an electrocardiogram (which checks your heart rhythm), a chest X-ray, and a urine sample. Depending on your health history, you may also need a stress test.
These tests confirm that your body can safely handle anesthesia and surgery. If anything comes back abnormal, like an irregular heart rhythm or signs of infection, your team can address it before you’re on the operating table. This appointment is also a good time to ask every logistical question you have: what time to arrive, when to stop eating and drinking, and what to bring to the hospital.
Set Up Your Home for Recovery
You’ll be on your feet with a walker or crutches soon after surgery, but bending, reaching, and navigating tight spaces will be difficult for weeks. Preparing your home before you leave for the hospital saves you real frustration later.
Start with the bathroom, where most falls happen. Install grab bars secured vertically or horizontally to the wall (never diagonally, and never rely on towel racks, which can’t support your weight). You’ll need two: one to help you get in and out of the tub, and another to help you stand from a sitting position. Add non-slip suction mats or silicone decals inside the tub and a non-skid bath mat outside it. A shower chair with rubber-tipped legs lets you bathe safely without standing on a wet surface.
Raise your toilet seat height with an elevated seat cover or a toilet safety frame. This keeps you from bending your knee too deeply when sitting down or standing up, which matters a lot in the first weeks of recovery. A bedside commode is another option if your bathroom is far from where you’ll sleep.
Throughout the rest of your home, clear walkways of throw rugs, electrical cords, and clutter. Move the items you use daily, like dishes, snacks, and medications, to counter height so you don’t have to reach up or bend down. If your bedroom is upstairs, consider setting up a temporary sleeping area on the main floor.
Gather Recovery Equipment
A few inexpensive tools make the first weeks of recovery dramatically easier:
- Walker, cane, or crutches: Your surgical team will tell you which to use. Attach a small bag or basket to your walker to carry your phone, water, and medications from room to room.
- Reacher/grabber tool: Helps you pick things up from the floor, pull on pants, and remove socks without bending.
- Sock aid: A simple device that lets you put on socks without reaching your feet.
- Long-handled shoehorn: Gets your foot into shoes without deep bending.
- Long-handled shower sponge: Lets you wash your lower legs and feet without straining.
- Raised toilet seat: Prevents excessive knee flexion when using the bathroom.
You can buy most of these items at a pharmacy or online for relatively little. Some insurance plans or hospital programs provide a walker and other basics, so ask before you purchase.
Plan Your First Days After Surgery
Most people spend one to two nights in the hospital, though same-day discharge is increasingly common for patients who are otherwise healthy. Before you’re cleared to leave, you’ll need to demonstrate a few milestones: getting in and out of bed and chairs without help, bending your knee close to 90 degrees, walking on a flat surface with a walker or crutches, and managing a few stairs with assistance.
Line up someone to drive you home and stay with you for at least the first few days. You won’t be able to drive for several weeks, so arrange help with groceries, meals, and any errands. Prepare and freeze meals ahead of time, or set up a meal delivery schedule. Stock your fridge and pantry with easy options that don’t require much standing or cooking.
Physical therapy usually begins within a day or two of surgery and continues for weeks afterward, either at home or at an outpatient clinic. Knowing your therapy schedule in advance helps you plan rides and set realistic expectations for how your days will look during recovery. The first two weeks are the most physically demanding, but having your home, supplies, and support system ready before surgery day takes a huge amount of stress off that period.