Why Muscle Matters After Surgery
Your muscles aren’t just for movement; they’re critical to your recovery, stability, and long-term independence. After orthopedic surgery, especially hip or knee replacement, preserving and rebuilding muscle plays a crucial role in:
- Eventually, walking without assistance
- Regaining balance and preventing falls
- Completing physical therapy successfully
- Avoiding hospital readmissions
- Extending overall healthspan ( the period of life in which a person is free from significant chronic disease and disability)
But here’s the challenge: most patients lose significant muscle mass in the first few weeks after surgery, especially in the operated leg.
The Reality: Muscle Loss Happens Fast
Postoperative muscle loss isn’t just a long-term concern; it starts almost immediately.
- Patients experience a 62% decrease in quadriceps strength and 10% loss in muscle cross-sectional area within 27 days after total knee arthroplasty (Mizner et al., 2005).
- A catabolic state induced by surgical stress leads to accelerated protein breakdown.
- Reduced mobility and undernutrition can exacerbate this effect, particularly in older adults with already low baseline muscle mass.
How to Reduce Muscle Loss Before and After Surgery
The good news? Muscle loss is not inevitable, especially if you take action before and after surgery.
1. Prioritize Protein and Essential Amino Acids (EAAs)
Protein is the building block of muscle recovery. After a hard day of lifting weights, your muscles are broken down to build them back stronger; the same mechanism goes for surgery.
- Protein-based perioperative nutrition (approximately 0.9g of protein per lb of body weight each day), including essential amino acids and whey protein, has been shown to reduce muscle atrophy and improve strength after total joint surgeries like total knee and hip arthroplasty (Witard & Hughes, 2025).
- Supplementing with essential amino acids (especially leucine) helps stimulate muscle protein synthesis.
- Studies show EAAs reduce muscle atrophy and improve postoperative strength and function.
When to Start: Begin supplementation 30–60 days before surgery, and continue for at least 2–4 weeks post-op.
2. Start Prehabilitation (Prehab) Exercises
Prehab builds a reserve of strength before surgery.
- Even 2–6 weeks of targeted exercises can improve post-op recovery speed and reduce complications.
- Focus on the quads, hamstrings, glutes, and hip stabilizers using low-impact movements, such as resistance bands, sit-to-stand drills, or seated leg raises.
Consistency matters more than intensity; just 10–15 minutes daily helps.
3. Don’t Delay Postoperative Movement
Early mobilization makes a huge difference.
- Mobilizing patients on the same day as surgery (post-op day 0) significantly reduces hospital length of stay and increases the likelihood of discharge to home rather than a rehab facility after total knee arthroplasty (Yakkanti et al., 2019).
- Small actions like sitting up in bed, ankle pumps, or light leg raises promote muscle engagement.
Action tip: Ask your care team what safe movements you can begin on Day 1 post-op.
4. Stay Hydrated and Support Metabolism
Muscles don’t function in isolation; they rely on nutrients and hydration for performance and recovery.
- Micronutrients like vitamin D, magnesium, B12, and zinc support energy metabolism and muscle signaling.
- Dehydration is linked with increased fatigue and slower wound healing.
Hydration tip: Include electrolytes (especially after anesthesia or fasting) to optimize muscle and nerve recovery.
5. Track Progress & Set Milestones
Tracking helps maintain motivation and reveals early signs of decline.
- Use a simple checklist: protein intake, walking distance, PT sessions completed, and ability to stand/sit unassisted.
- Celebrate milestones like “first stairs” or “walking without a walker.”
Even a daily journal can reinforce habits and keep you proactive.
Final Takeaway
Muscle preservation is a critical but often overlooked part of recovery after orthopedic surgery. By addressing nutrition, exercise, and early mobilization with evidence-backed strategies, you can significantly reduce muscle loss and recover stronger.
You can’t avoid every challenge during recovery. But losing muscle doesn’t have to be one of them.
By taking action now, fueling your body, moving daily, and following a structured plan, you’ll be stronger, safer, and more confident on the road to recovery.