Arthritis Today

Pre-hab for Surgery

Getting in shape prior to surgery can make recovery easier.


You’ve scheduled your joint replacement surgery. You’ve taken the pre-surgery class at the hospital, read all you can and talked to others who have had surgery. Still, you may feel anxious. Will you bounce back quickly or struggle to get on your feet again? Those are good questions. If you want to improve the odds of a successful outcome, getting in shape before your surgery will help

“Fifty percent of outcome success is due to the surgeon, and the other 50 percent is due to the patient’s commitment to recovery – starting with pre-hab,” says Vonda Wright, MD, assistant professor of orthopedic surgery at the University of Pittsburgh’s Center for Sports Medicine.

Rehabilitation is an exercise and therapy program performed for up to three months after surgery, and most joint-replacement patients know to expect it. Pre-habilitation – “pre-hab” for short – is an exercise therapy program started at least six weeks (and preferably longer) before surgery. It’s a new concept to many.

“Pre-hab makes a huge difference in our patients’ outcomes,” says orthopedic surgeon Hal Crane, MD, founding medical director of the Rose Institute for Joint Replacement at the Rose Medical Center in Denver. “They get vertical sooner and recover faster.”

Effectiveness of Pre-hab

A study by researchers at New England Baptist Hospital, Beth Israel Deaconess Medical Center and Harvard Medical School, all based in Boston, found that knee and hip replacement surgery patients who had participated in water- and land-based strength training, and aerobic and flexibility exercises for six weeks prior to their surgeries reduced their odds of needing inpatient rehabilitation by 73 percent.

“Even in a fairly brief time period, the exercise paid off for the participants,” says lead study author Daniel Rooks, PHD, former clinical research investigator and professor of medicine at Harvard Medical School. “Their level of function and pain stabilized prior to surgery, whereas those who did not exercise got worse. The benefits of exercise before surgery are very clear.”

Back on Your Feet Faster

The rewards of pre-hab show in 24 hours after surgery. After knee-replacement surgery, for example, patients are expected to be walking (using crutches or a walker) to the bathroom or in the hallway the day after. They generally must be able to go up and down two to four steps and walk 50 to 100 feet before leaving the hospital (usually in three to five days). The improved strength that people gain from pre-hab can help them achieve some of those milestones in less time, says Dr. Crane.  

Patients who are more fit prior to surgery may have shorter hospital stays and may be discharged and sent to outpatient rehab, rather than to a rehab facility for inpatient therapy. They also have fewer outpatient rehab sessions, says physical therapist Steve Sylvester, PhD, assistant professor of health and human performance at Palm Beach Atlantic Univer­sity in West Palm Beach, Fla. “Patients can more quickly do recommended exercises at home, with follow-up on an as-needed basis, whereas those who haven’t had pre-hab need more hands-on sessions,” he says.

How to Get Pre-hab

The best approach to pre-hab is having individual sessions with a physical therapist, but that can be costly. Despite the proven benefits of pre-hab, not all insurance pays for it.

“Insurance can be one of the most difficult obstacles for pre-hab patients,” says Sylvester. “Physical therapy coverage often is limited to six weeks total – including pre-hab and rehab – or pre-hab may not be covered.” If your insurance doesn’t cover pre-hab, talk to your doctor. Some hospitals offer pre-hab as part of a free pre-surgery education course. Or you might be able to schedule just one or two appointments with a physical therapist who can review – and possibly adapt – a regimen for you to do on your own.