Before getting hip or knee replacement surgery, doctors could help patients get healthier to recover better. A new survey asked 64 surgeons across the United States what they’re doing to prepare patients before surgery. The results show that while some doctors use nutrition plans, most don’t check if patients are strong enough or have healthy bones before operating. Even though research shows these preparation steps help, many surgeons face challenges like getting patients to follow the plan and figuring out how to fit it into their busy schedules. This study reveals a gap between what science says works and what doctors are actually doing.

The Quick Take

  • What they studied: How many surgeons are preparing patients before hip and knee replacement surgery by improving their nutrition, strength, and bone health
  • Who participated: 64 orthopedic surgeons from across the United States who perform joint replacement surgeries, spread across different regions (Midwest, Northeast, Southeast, and West)
  • Key finding: Only 46% of surgeons have a formal nutrition plan in place, 75% don’t assess patient strength before surgery, and 87% won’t delay surgery to improve bone health—even though research shows these steps help patients recover better
  • What it means for you: If you’re facing joint replacement surgery, you might want to ask your surgeon about nutrition support and strength training before your operation. These steps may help you recover faster and have fewer complications, though not all surgeons currently offer them

The Research Details

Researchers created a 28-question survey and sent it to orthopedic surgeons who specialize in hip and knee replacements. The survey asked about their current practices and beliefs regarding preparing patients before surgery through nutrition, exercise, and bone health checks. Sixty-four surgeons completed the anonymous survey, representing different parts of the country. The researchers then analyzed the answers to see what percentage of surgeons were doing each type of preparation.

This type of study is called a cross-sectional survey, which means it takes a snapshot of what’s happening at one point in time. It’s useful for understanding current practices and identifying gaps between what research recommends and what doctors actually do in their offices.

Understanding what surgeons are currently doing helps identify where improvements can be made. If most surgeons aren’t preparing patients before surgery, even though research shows it helps, that’s a problem worth investigating. This study helps explain why some patients might not be getting the best possible preparation before their operation.

This study has some important limitations to keep in mind. The sample size of 64 surgeons is relatively small, so the results may not represent all surgeons nationwide. The survey was voluntary, which means surgeons who responded might have different practices than those who didn’t answer. Additionally, the study only asked what surgeons said they do—it didn’t verify whether they actually follow these practices. The study doesn’t have a comparison group, so we can’t compare these surgeons to a control group.

What the Results Show

Less than half of the surgeons surveyed (46%) reported having a formal nutrition optimization plan in place before surgery. This is surprising because research supports the benefits of good nutrition before joint replacement. Even more concerning, 14% of surgeons doubted whether nutrition optimization even helps patients.

When it comes to checking patient strength and function before surgery, the situation is worse. Seventy-five percent of surgeons reported they don’t have any formal system to assess how strong or mobile their patients are before the operation. Of those who do check, only 38% start by looking at whether patients can walk independently.

Bone health screening was the least common preparation step. Only 13% of surgeons routinely ordered bone density scans to check for osteoporosis (weak bones) before surgery. Even more striking, 87% of surgeons said they would not delay surgery to give patients time to improve their bone health, even if problems were found.

When surgeons did use nutrition interventions, their main goals were reducing complications and helping patients lose weight. However, the survey revealed that the biggest obstacles to implementing these preparation programs were patient compliance (getting patients to follow the plan) and logistical challenges (figuring out how to fit it into their practice). The geographic distribution of responses was fairly balanced, with surgeons from all regions showing similar patterns.

This survey reveals a significant gap between what medical literature recommends and what surgeons are actually doing. Previous research has shown that patients who are better nourished, stronger, and have healthier bones before joint replacement tend to have better outcomes, fewer complications, and faster recovery times. However, this survey shows that many surgeons either aren’t aware of this evidence or face barriers to implementing these practices.

The study only surveyed 64 surgeons, which is a small sample that may not represent all surgeons in the country. The survey was voluntary, so surgeons who responded might be different from those who didn’t answer. The study only asked what surgeons reported doing, not what they actually do in practice. There’s no way to verify if surgeons’ answers match their real behavior. The study doesn’t explain why surgeons aren’t implementing these protocols or what specific barriers they face beyond general mentions of compliance and logistics. Finally, the study doesn’t measure patient outcomes, so we can’t see if the surgeons who do implement these protocols actually get better results.

The Bottom Line

If you’re scheduled for hip or knee replacement surgery, ask your surgeon about nutrition support and pre-surgery strength training. Research suggests these steps may help you recover better and have fewer problems after surgery. If your surgeon doesn’t offer these services, ask for a referral to a nutritionist or physical therapist. However, remember that not all surgeons currently use these approaches, and more research is needed to understand the best way to implement them. Confidence level: Moderate—research supports these practices, but this survey shows they’re not yet standard care.

Anyone scheduled for hip or knee replacement surgery should care about this research. Patients who are overweight, have weak muscles, or have concerns about bone health may benefit most from pre-surgery preparation. Surgeons and hospital administrators should care because this research shows an opportunity to improve patient outcomes. Family members helping with surgery preparation should also understand these options.

Ideally, pre-surgery preparation should begin 4-8 weeks before your scheduled operation, though even shorter timeframes can help. You might notice improved strength and energy within 2-3 weeks of starting an exercise program. Better nutrition can help your body heal faster after surgery, with most patients noticing improved recovery within the first 2-4 weeks post-operation.

Want to Apply This Research?

  • Track pre-surgery nutrition intake by logging daily protein consumption (goal: 1.2-1.6 grams per kilogram of body weight), calorie intake, and micronutrient sources. Set a target of 7-10 servings of fruits and vegetables daily.
  • Use the app to schedule and complete pre-surgery strength exercises 3-4 times per week, focusing on leg exercises, balance work, and functional movements like sit-to-stand. Set reminders for nutrition goals and track compliance with any nutrition plan your doctor recommends.
  • Monitor weekly progress with metrics like exercise completion rate, nutrition compliance percentage, and subjective strength improvements. Track any changes in energy levels, mobility, or pain. Share weekly summaries with your surgical team to maintain accountability and adjust the plan if needed.

This research describes current surgical practices and does not constitute medical advice. Before joint replacement surgery, consult with your orthopedic surgeon about appropriate pre-surgery preparation, including nutrition, exercise, and bone health screening. Individual recommendations should be based on your specific health conditions, medications, and surgical plan. Do not delay or refuse recommended surgery based on this information. Always follow your surgeon’s specific instructions for pre-operative preparation.