Preparing for Knee Replacement Surgery
Preparing for knee replacement is not limited to booking a hospital and completing blood tests. It involves confirming that replacement is the correct treatment, selecting the appropriate procedure and implant, optimising medical risks, understanding anaesthesia and pain control, strengthening before surgery, preventing infection, preparing the home and arranging support for recovery.
Good preparation cannot remove every surgical risk or guarantee a fixed recovery timeline, but it can identify avoidable problems, reduce last-minute cancellation, improve confidence and make early rehabilitation safer. Instructions must be individualised because diabetes, heart disease, kidney disease, anticoagulants, anaemia, obesity, sleep apnoea and previous infection change the plan.
For the overall operation and consultation pathway, read Knee Replacement Surgery in Mumbai.
Quick Answer: How Should I Prepare for Knee Replacement?
Confirm the indication and procedure, complete the prescribed medical and anaesthetic assessment, obtain individual instructions for every medicine, report infections or new illness, practise suitable preoperative exercises, stop smoking, optimise diabetes, anaemia and nutrition where needed, prepare a safe home, arrange a responsible caregiver and follow the hospital’s exact fasting and admission instructions.
Confirm That Knee Replacement Is the Correct Treatment
Before fixing the date, the diagnosis should match the symptoms and functional limitation. Knee replacement is generally considered when confirmed arthritis causes substantial pain, stiffness, deformity or loss of function and suitable non-surgical treatment is ineffective or unsuitable. An X-ray grade alone is not enough.
The discussion should review walking, stairs, sleep, chair rise, work, independence, previous treatment, expectations and alternatives. Read When Does Knee Arthritis Need Replacement?.
Clarify the Planned Procedure
Which knee and which diagnosis are being treated?
Is the plan total, partial, bilateral or revision replacement?
Why is the proposed implant design and fixation appropriate?
Will robotic assistance be used, and does the platform require a CT scan?
Which surgical approach is planned, and is mini-subvastus access suitable?
What benefits, limitations, risks and recovery range are realistic?
Total versus partial replacement depends on arthritis distribution, ligaments, alignment and symptoms. Robotic assistance supports planning and execution; the mini-subvastus approach concerns surgical access. These are related but separate decisions. Read Total vs Partial Knee Replacement and Robotic vs Conventional Knee Replacement.
Preoperative Medical and Anaesthetic Assessment
The purpose of preoperative assessment is to identify conditions that could affect anaesthesia, bleeding, wound healing, infection, blood clots, kidney function, mobility or rehabilitation. Age alone does not decide fitness. Functional capacity, heart and lung health, diabetes, blood pressure, kidney and liver disease, anaemia, sleep apnoea, nutrition, previous clots and frailty are more relevant.
Tests are individualised
Possible tests include blood count, kidney and liver function, glucose or HbA1c, blood group, coagulation studies, ECG, urine testing and additional heart, lung or vascular investigations when indicated. Not every patient needs every test. Abnormal results should be interpreted in context rather than treated as automatic cancellation.
Specialist review when required
Cardiology, nephrology, pulmonology, diabetology, haematology or other review may be required when the medical history, symptoms or tests indicate additional risk. The purpose is to optimise and plan care, not to obtain a meaningless universal clearance certificate.
Bring a Complete Medicine and Allergy List
List prescription medicines, over-the-counter pain medicines, inhalers, insulin and diabetes tablets, blood thinners, steroids, osteoporosis medicines, supplements, herbal products and previous drug reactions. Include the dose and timing when possible. The surgical and anaesthetic teams decide what should continue, pause or change.
Blood thinners
Aspirin, clopidogrel, warfarin, heparin and direct oral anticoagulants require an individual plan based on why they are prescribed, kidney function, bleeding risk, clotting risk and anaesthesia. Do not stop them without instructions from the responsible clinicians.
Diabetes medicines and insulin
Fasting and surgical stress alter glucose control. Insulin, metformin, SGLT2 inhibitors, GLP-1 medicines and other drugs may need specific timing changes. Follow the written plan from the anaesthesia, diabetes and surgical teams rather than copying another patient’s instructions.
Supplements and herbal products
Some supplements can affect bleeding, blood pressure, glucose or anaesthesia. Report everything being taken, even when it is labelled natural. Do not begin a new supplement immediately before surgery without discussion.
Optimise Diabetes, Anaemia, Blood Pressure and Nutrition
Poorly controlled diabetes can increase infection and wound risk. Significant anaemia can increase fatigue, transfusion risk and delayed rehabilitation. Very high blood pressure, active cardiac symptoms, kidney dysfunction and malnutrition may also require treatment before elective surgery. Targets should be individual and should balance risk reduction against worsening disability from indefinite delay.
Balanced meals, adequate protein, hydration and correction of documented deficiencies support healing. Extreme dieting immediately before surgery can reduce muscle and nutrition. Patients with kidney disease, diabetes or heart failure need condition-specific dietary advice.
Prevent Infection Before Surgery
Report fever, cough, urinary symptoms, diarrhoea or a new general illness
Report boils, ulcers, infected wounds, rashes or fungal infection near the feet or leg
Treat an active dental abscess or significant oral infection before elective implantation
Do not shave the operative leg with a razor unless the hospital instructs you
Follow the prescribed bathing or antiseptic-wash instructions
Do not apply unapproved creams, oils or traditional products near the operative area
Routine dental clearance is not identical for every patient, but active infection or an urgent dental problem should be disclosed. The surgeon should know about recent antibiotics, hospitalisation and previous resistant infections.
Prehabilitation: Exercise Before Surgery
NICE recommends advice on exercises before and after hip or knee replacement, lifestyle and maximising independence. Prehabilitation aims to preserve strength, movement, balance and confidence. It cannot reverse advanced arthritis and should not create a prolonged flare immediately before surgery.
Quadriceps activation and progressive strengthening
Hip and calf strengthening
Gentle knee extension and bending within tolerance
Sit-to-stand, balance and safe walking practice
Low-impact aerobic activity such as cycling or short walking intervals
Practice with the walker, crutches or stick expected after surgery
Smoking, Alcohol, Weight and Sleep Apnoea
Smoking increases wound and infection risk; stopping before surgery is beneficial. Heavy alcohol use can affect withdrawal risk, liver function, nutrition, falls and medicine interactions and should be disclosed honestly. Obesity influences anaesthetic, wound, infection and rehabilitation risk but should prompt individual optimisation rather than automatic dismissal.
Patients with known or suspected obstructive sleep apnoea should inform the anaesthetist and bring their prescribed CPAP equipment if instructed. Snoring, daytime sleepiness and previous breathing problems after anaesthesia are relevant.
Prepare the Home and Caregiver Plan
Remove loose rugs, cords and clutter from walking routes
Improve lighting, bathroom access and stair safety
Arrange a stable chair with armrests and a suitable bed height
Place frequently used items within easy reach
Arrange meals, transport, shopping, medication support and follow-up visits
Confirm who will stay with or check on the patient during early recovery
Plan pet care and prevent animals from contacting the wound or walking path
Documents and Items to Take to Hospital
Identification, admission, insurance and payment documents
Current reports, X-rays, scans and specialist opinions
Medicine and allergy list, including last doses taken
CPAP, inhalers, hearing aids, glasses and other prescribed devices
Loose clothing and secure flat footwear
Previous operative notes and implant records for revision surgery
The Day Before and Morning of Surgery
Follow the hospital’s written instructions for reporting time, fasting, clear fluids, approved morning medicines, bathing, jewellery, nail products and transport. Fasting rules vary with the anaesthetic plan and local policy. Do not use a generic internet schedule in place of the treating team’s instructions.
Do not eat, drink, chew gum, smoke or take an unapproved medicine after the stated cut-off. If instructions were not understood or fasting was accidentally broken, tell the hospital rather than concealing it. The operation may need to be delayed for safety.
Reasons Elective Surgery May Be Postponed
Active infection, fever or significant acute illness
Open wound, ulcer or significant skin problem near the operative limb
Uncontrolled diabetes, severe anaemia or unstable heart or lung disease
Incorrect anticoagulant or medicine preparation
Failure to follow fasting instructions
A new medical event, fall, clot, stroke or hospital admission requiring reassessment
Postponement is a risk–benefit decision, not a punishment. The reason, corrective plan and expected reassessment should be explained whenever possible.
Mental Preparation and Realistic Expectations
Anxiety before surgery is common. Patients should understand that early pain, swelling, weakness, sleep disturbance and walking-aid use are expected to varying degrees. The goal is controlled recovery, not a completely painless first week. Ask who to contact, how medicines will be used, when walking begins and which warning signs require urgent review.
Questions Patients Commonly Ask
How early should preparation begin?
Begin when surgery becomes a serious option. Medical optimisation, smoking cessation, strength and insurance planning may require several weeks or longer.
Do all patients need cardiac clearance?
No. Cardiology assessment is based on symptoms, history, functional capacity, examination, tests and anaesthetic risk.
Do I need a dental check before every knee replacement?
Not every patient needs identical dental clearance, but active dental infection, abscess or urgent dental treatment should be disclosed and managed.
Should I stop aspirin or blood thinners?
Only according to an individual written plan. Stopping without advice can cause clotting, stroke or cardiac risk.
Should I stop diabetes medicines?
Some require timing changes, but the plan depends on the medicine and fasting schedule. Follow the anaesthesia and diabetes instructions.
Can I continue pain medicines before surgery?
Some can continue and others may affect bleeding, kidneys or anaesthesia. Provide the exact product and follow the prescribed plan.
Should I lose weight before surgery?
Sustainable loss may reduce symptoms and risk for some patients, but targets should be realistic and should not become an unexplained indefinite barrier to assessment.
How long should I stop smoking?
Stopping as early as possible is beneficial. The treating team or cessation service should provide a practical plan rather than relying on one universal duration.
Can I exercise if the knee is painful?
Yes, with a suitable dose and range. Avoid producing a major flare or injury immediately before surgery.
Does robotic surgery need special preparation?
Medical preparation is similar. A CT scan or platform-specific imaging and planning may be required for some systems.
Should I shave the leg before admission?
No, unless specifically instructed. Razor shaving can damage skin and increase infection risk.
What if I develop a cold or fever?
Inform the surgical team promptly. They will decide whether surgery can proceed safely or needs reassessment.
Do I need someone at home after discharge?
Many patients benefit from help with transport, meals, medicines, stairs and household tasks during early recovery. The amount depends on function and home setup.
Can surgery be cancelled on the day?
Yes, if a new medical, infection, fasting, medicine, equipment or safety problem makes proceeding inappropriate.
What should I ask before signing consent?
Ask about the diagnosis, alternatives, procedure, implant, anaesthesia, expected benefits, material risks, recovery, limitations and possibility of further surgery.
What happens after I arrive at hospital?
Identity, side, consent, fasting, medicines and health are rechecked before anaesthesia and surgery. Read Knee Replacement Surgery Day.
Clinical References and Further Reading
NICE NG157: Shared decision-making and preoperative rehabilitation for joint replacement
AAOS OrthoInfo: Total Knee Replacement—Preparing for Surgery
CDC: Surgical Site Infection Basics and Risk Reduction
About Dr. Mayur Rabhadiya
Dr. Mayur Rabhadiya is an Orthopedic and Joint Replacement Surgeon in Mumbai. His focused knee practice includes diagnosis-first assessment, total and partial replacement, minimally invasive mini-subvastus robotic knee replacement, bilateral planning, revision assessment and surgical second opinions. His qualifications are MBBS, D’Ortho, DNB (Orthopedics), MNAMS (Orthopedics) and FIJR (Robotic & Navigation).
Last medically reviewed: 24 July 2026. Medical reviewer: Dr. Mayur Rabhadiya.
Book a Knee Replacement Preparation Consultation
Patients who have been advised knee replacement, need a second opinion or require clarity about medical optimisation, robotic planning, implants or home preparation can consult Dr. Mayur Rabhadiya in Ghatkopar East or Ghatkopar West, Mumbai. Call or WhatsApp +91 84249 03913 or +91 96113 30063, or use the orthopedic appointment page.
Medical Disclaimer
This guide provides general education and does not replace individual medical, surgical or anaesthetic advice. Tests, medicine changes, fasting, infection precautions and admission plans vary by health, procedure, anaesthesia and hospital protocol. Follow the treating team’s written instructions.