Preparing for a Knee Replacement: A Woman's Checklist

The most useful preparation for a knee replacement happens in the weeks before you go in: building the muscle that will carry you afterward, setting up a home you can move through on one leg, and sorting the medication and bone-health details that are easy to overlook. The surgery is the short, busy part. The preparation is where you quietly shape how the first weeks home will feel.

I had months of warning before my own operation and wasted some of it worrying. What helped, in the end, was treating the lead-up as a project with a checklist, not a countdown to dread. Here is that checklist, in the order it tends to matter.

Build the muscle now: prehab

Start strengthening your leg before surgery, because the muscle you bring in is the muscle you recover with. The thigh muscles (the quadriceps) waste quickly around a painful knee, and a knee replacement does not put them back. People who go in stronger tend to stand, walk and bend sooner afterward. A Cochrane review of preoperative exercise before knee and hip replacement found small benefits, including a modest head start on early function and pain. ¹

You do not need a gym. A physiotherapist can set a safe routine of straight-leg raises, sit-to-stands from a firm chair, gentle knee bends and short walks. Exercise is also the backbone of osteoarthritis care generally, with benefits on pain and function comparable to many medicines and far fewer harms. ² The bonus is familiarity: the moves you practise now are the same ones a nurse or physiotherapist will ask for on day one, so they feel routine instead of alarming.

Get your weight and general health in shape

Treat the lead-up as a window to improve the things that make surgery and recovery easier, without doing anything drastic. Weight is the single biggest modifiable load on the knee: each kilogram you carry transmits several times its weight across the joint when you walk, and losing even 5 to 10% of body weight reduces knee load and eases symptoms. ³ If your surgeon has set a weight target before operating, ask exactly what it is and why, rather than guessing.

This is also the time to stabilise blood pressure and blood sugar, stop smoking if you can (it slows wound healing), and mention any anaemia or recurrent infections. None of this is about being a perfect patient. It is about removing avoidable obstacles before they meet a fresh surgical wound.

Sort medications, hormones and supplements

Give your surgical team a complete, honest list of everything you take, then follow their instructions on timing. This includes prescriptions, over-the-counter painkillers, blood thinners, supplements and any hormone therapy. Some are paused before surgery and some continue, and the timing is specific to you, so never stop a prescribed medicine on your own.

Two items women often forget to mention: anti-inflammatory tablets and supplements. Glucosamine, chondroitin, collagen and high-dose fish oil all belong on the list even though the evidence does not support routine use of joint supplements. ³ If you use menopausal hormone therapy, raise it specifically, because your team will advise on how to handle it around the operation. The point is simple: they can only plan safely around what they know about.

Check your bones (a women’s-specific step)

If you are a woman over 50, ask whether your bone density should be checked before surgery, because the implant is anchored into bone. Osteoporosis, where bone becomes thinner and more fragile, is considerably more common in women after menopause, and weaker bone can affect how an implant is fixed and the risk of fracture around it. The standard test is a DEXA (DXA) scan, a quick, low-dose X-ray of the hip and spine. ⁴

A scan does not usually delay surgery. It simply lets your surgeon plan with full information and lets you start treating low bone density if it turns up, which matters for the rest of your life, not just this operation. This is one of the clearest examples of why the same surgery deserves slightly different preparation in a woman’s body.

Set up your home for week one

Prepare your home now for the days when you will be moving slowly on one strong leg. Most people are walking with aids the same or next day and are off those aids by around 4 to 6 weeks, so set up for that window rather than for the day you walk back through the door. ²

Walk through your home and fix the obvious hazards. Clear loose rugs and trailing cables. Move everyday items to between waist and shoulder height so you are not bending or reaching. Put a firm chair with armrests where you spend most of your day, because low, soft sofas are hard to rise from with a new knee. Sort the bathroom: a non-slip mat, and a raised toilet seat or grab rail if your team suggests one. If your bedroom is upstairs, plan how you will manage stairs, or set up a temporary bed downstairs for the first week.

Plan your support and your supplies

Arrange real human help for the first 1 to 2 weeks, because this is the step that quietly protects all the others. You will need someone to drive you home, and driving yourself usually does not resume until around 4 to 6 weeks, when control and reaction times are safe. ² Line up help with shopping, cooking and anything heavy.

Many women run households and caregiving routines that simply do not pause for surgery, so name those tasks out loud and hand them off in advance: meals cooked and frozen, pet care covered, anyone you care for looked after. Prepare a few easy meals, keep a water bottle and your phone within reach of your chair, and lay out the loose clothing and flat, supportive shoes you will live in for a while. None of this is glamorous. All of it is what lets you spend your energy on healing instead of scrambling.

A short word before the day

Preparing well does not guarantee a perfect recovery, and it is normal to feel nervous. Around 8 to 9 in 10 total knee replacements last 20 years or more, and most people are satisfied, though about 1 in 5 report some residual stiffness or pain, an honest figure worth holding alongside the hopeful ones. ² Go in strong, go in organised, and let the rest be the surgeon’s job.

When you are ready, the next things to understand are what the operation itself involves and the realistic recovery timeline you are preparing for.

This article is general information, not medical advice. Your preparation should be planned with your own surgeon and care team, who can examine you and review your imaging; see a qualified clinician for guidance on your situation.