Preparing for knee replacement surgery does not require turning the weeks before surgery into a full-time project. Your time and energy are better directed toward a few foundations that support everyday movement: usable leg strength, muscle activation, walking capacity, and consistent participation.
In Episode 36 of the Total Knee Success Podcast, Michelle Losurdo, PT, DPT, OCS, explains which physical abilities deserve attention before surgery and why trying to perfect every measurement is usually unnecessary. This is Part 1 of a two-part discussion about preparing without becoming buried in a long list of tasks.
Preparing for knee replacement surgery starts with function
Preparation is not about fixing every weakness or reaching an arbitrary fitness level. It is about improving or preserving the abilities you will use immediately after surgery.
Those abilities include standing from a chair, walking several short distances throughout the day, managing steps when necessary, and participating in the activities selected by your healthcare team. Each task requires a combination of strength, balance, endurance, coordination, and confidence.
Your current abilities provide a starting point. They are not a prediction of everything you will be able to accomplish afterward. They simply help your surgeon and physical therapist understand what support and preparation may be useful.
Useful preparation focuses on the physical abilities you will need, not on completing the longest possible exercise list.
This distinction can reduce unnecessary pressure. A short, individualized program performed regularly may be more useful than an ambitious program that leaves you exhausted, increases symptoms substantially, or becomes impossible to continue.
Build usable leg strength
Your quadriceps help control your knee when you stand, walk, and use stairs. Your hip muscles also contribute to balance and lower-body control. Entering surgery with more usable strength can make early mobility tasks less physically demanding.
A 2022 systematic review and meta-analysis found that exercise-based prehabilitation improved knee function before total knee replacement and during the first three months afterward. The certainty of the evidence was low to very low, and differences were not significant at six to twelve months. This is important context. Prehabilitation may provide an early functional advantage, but it does not guarantee a particular long-term result.
Strengthening also needs to fit your current condition. More resistance is not automatically better. Exercise selection, resistance, repetitions, and progression should reflect your symptoms, health history, balance, and the guidance you have received from your physical therapist or surgeon.
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If resistance exercises are already part of your clinician-approved program, these resistance bands with multiple resistance levels can provide a convenient way to progress selected exercises at home. They are tools, not a complete prehabilitation program, and the appropriate exercises will differ from one person to another.
Strength depends on muscle activation
A muscle can appear weak because it has lost force-producing capacity, because it is not being recruited effectively, or because both are occurring. Long-standing pain and swelling can interfere with quadriceps activation. After surgery, swelling and discomfort can temporarily make that inhibition more pronounced.
Neuromuscular electrical stimulation, commonly called NMES, may be useful for selected people when voluntary quadriceps contraction is limited. It is not a shortcut and is not appropriate for everyone. Electrode placement, intensity, contraindications, and timing require professional guidance. A person considering NMES should discuss it with their physical therapist rather than selecting and using a device without instruction.
Before surgery, the practical goal is not merely to possess muscle tissue. It is to maintain your ability to recruit your muscles during functional movement. Sit-to-stand performance, walking, and clinician-selected strengthening activities provide more useful information than appearance alone.
Preserve walking capacity without chasing step counts
Walking brings several physical abilities together. It requires leg strength, balance, endurance, coordination, and sufficient confidence to accept weight through your affected leg.
If knee pain has reduced walking to the minimum required to get through the day, your healthcare team may recommend gradually rebuilding tolerance before surgery. That does not mean forcing a prescribed number of steps or pushing through severe symptoms. The appropriate amount depends on your current function and how your symptoms respond.
For people who already use step data as part of a clinician-approved plan, a Fitbit activity tracker can provide a record of daily activity patterns. The useful information is not whether you reached a generic goal. It is whether your activity is stable, gradually increasing, or steadily narrowing over time.
The upcoming Knee Replacement Game Plan provides a structured way to assess your starting point and organize your preparation before surgery. You can visit the page now and sign up to be notified when the book becomes available.
Range of motion is one part of the picture
Range of motion is relevant, particularly when your ability to straighten your knee is substantially limited. Severe stiffness should be discussed with your surgeon and physical therapist because it can affect walking and other daily activities.
However, pursuing a perfect bending measurement before surgery may not be the best use of limited time and energy. One number does not represent your complete physical status. Strength, walking ability, balance, endurance, and performance of everyday tasks provide additional information.
This does not mean range of motion should be ignored. It means it should be considered alongside function rather than treated as the only measure of successful preparation.
Exercise does not automatically damage an arthritic knee
Some people reduce movement because they believe exercise will accelerate joint damage. A 2025 clinical commentary reviewing the research found that appropriately prescribed exercise therapy does not appear to damage knee cartilage in people with or at risk for knee osteoarthritis.
Symptoms can still change during or after activity. That response can help a physical therapist adjust the type, amount, or progression of exercise. Pain is real, but it does not provide a direct measurement of cartilage damage during every movement.
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Consistency usually beats occasional intensity
Preparation works best when it can fit into your actual life. Repeatedly doing a manageable program allows your body to adapt and gives you opportunities to practice the routines you may continue after surgery.
A pattern of doing too much on one day, becoming significantly aggravated, and then stopping for several days can make progress harder to evaluate. Your physical therapist can help you establish a dose that is challenging enough to support improvement without relying on repeated bursts of excessive effort.
The central priorities are straightforward: preserve usable strength, maintain muscle activation, continue safe walking and everyday movement, and build a routine you can perform consistently. Part 2 examines several concerns that often consume time and attention without providing the same practical value.
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References
- Gränicher P, Mulder L, Lenssen T, Scherr J, Swanenburg J, de Bie R. Prehabilitation improves knee functioning before and within the first year after total knee arthroplasty: a systematic review with meta-analysis. J Orthop Sports Phys Ther. 2022;52(11):709-725. doi:10.2519/jospt.2022.11160
- Minick KI, Hunter DJ, Moffet H, et al. Improved outcomes following a care guideline implementation: part 1 of an analysis of 12,355 patients after total knee arthroplasty. J Orthop Sports Phys Ther. 2023;53(3):143-155.
- Arhos EK, Stevens-Lapsley JE, Schmitt LC. Who’s afraid of electrical stimulation? Let’s revisit the application of NMES at the knee. J Orthop Sports Phys Ther. 2024;54(2):72-83. doi:10.2519/jospt.2023.12028
- Bricca A, Roos EM, Juhl CB, et al. Exercise therapy “wears down” my knee joint: myth or reality? J Orthop Sports Phys Ther. 2025;55(7):1-5. doi:10.2519/jospt.2025.13069
- Konnyu KJ, Thoma LM, Bhuma MR, et al. Prehabilitation for total knee or total hip arthroplasty: a systematic review. Am J Phys Med Rehabil. 2023;102(1):1-10. doi:10.1097/PHM.0000000000002006
Educational disclaimer: This article provides general educational information and does not constitute medical advice, diagnosis, or treatment. Exercise, walking, NMES, and surgical preparation should be discussed with your surgeon, physical therapist, and other qualified healthcare professionals who know your individual circumstances.