If you’re preparing for a major orthopedic surgery (spine procedure, hip or knee replacement, or foot/ankle surgery), you’re probably focused on the obvious risks: anesthesia, infection, blood clots, pain, and rehab.
There’s another risk that is far more common (and far more fixable) but rarely explained clearly to patients: malnutrition and “nutritional risk.” In orthopedics, it is very common for patients to show up for surgery under-nourished, under-protected, and under-prepared at the cellular level (Tedescro et al., 2024).
And the part that surprises most people: you can be “well fed” and still be malnourished.
Why does “I generally eat healthy. I watch what I eat.” not mean that you’re well nourished and prepared for recovery?
Malnutrition is not just being “too thin” or “not eating enough.” It can also look like over-nutrition, getting plenty of calories but not enough of the specific nutrients your body needs to heal. Before and after surgery, your body requires the right balance of macronutrients and micronutrients to support wound healing, immune defense, and muscle preservation. When even one key building block is low, surgical risk rises and recovery becomes harder than it needs to be.
And this is common in orthopedics: the literature estimates that up to 50% of orthopedic surgery patients are at risk for malnutrition heading into surgery (Phillips et al., 2023).
In other words, many patients are getting plenty of food, but not enough of what matters most for surgery: high-quality protein, essential amino acids, and key macro- and micronutrients.
The uncomfortable truth: malnutrition can change your surgical outcome
Orthopedic surgery is controlled trauma to the body. Your body will immediately demand raw materials to:
- rebuild tissues and close wounds
- fight bacteria
- preserve muscle and strength
- repair bone and connective tissue
- tolerate the inflammatory stress response
When you don’t have those raw materials available, the data is not subtle.
When vital nutrients are low, the difference in outcomes can be striking:
- Up to 7× higher wound problems have been reported in patients with low nutrient reserves before orthopedic surgery (Williams et al., 2020).
- In total hip and knee replacement, a systematic review found about double the risk of postoperative complications when key nutrition markers are low before surgery (Mbagwu et al., 2020).
- Studies in hip and knee replacement also link low fuel reserves with a substantially higher risk of serious outcomes, including death (Tedesco et al., 2024).
Bottom line: these aren’t “rare edge cases.” If your body goes into surgery and recovery without enough nutritional reserve, the odds of a smoother recovery can drop fast.
The severity of muscle loss after surgery and the difficulties of preserving it
Most patients think recovery is mainly about pain tolerance and physical therapy. But there is a biological reality that PT cannot fully “outwork” if you are under-nourished: muscle-loss. Studies have show that after major orthopedic surgeries like a total knee replacement, leg muscle volume can drop as much as 14% within the first two weeks after the operation (Weijzen et al., 2019).
That early muscle loss is one reason patients struggle with stairs, transfers, balance, and confidence for months after their surgery.
Nutrition (especially protein and essential amino acids) is one of the few levers you can pull before and after surgery to reduce how severe this loss is.
Older adults commonly under-eat protein in the perioperative window. One paper on elective hip/knee arthroplasty patients reports protein intake around 0.59 g/kg/day pre-op and ~0.50 g/kg/day post-op (Weijzen et al., 2019), levels far below what many experts recommend during acute stress and recovery.
Your Recommended Target: 1g protein per lb of lean body mass per day
To build a serious “recovery reserve,” many patients need substantially more than they are currently getting.
A simple (and eye-opening) target we use is: Up to 1 gram of protein per pound of lean body mass per day.
Calculate your lean body mass here. (Use the Boer Formula Output).
For many patients, that can be up to 150+ grams/day.
To put that in real food terms:
- 1 large egg has ~6g protein.
- 150g protein ≈ 25 eggs (more than two dozen) in a day.
Most people are not coming close, especially when appetite drops, pain increases, and meal quality deteriorates after surgery.
And it’s not just about how much protein you get, it’s also about quality. Different protein sources have different amino acid profiles and muscle-building (“anabolic”) effects. That’s why the best approach is to combine high-quality, whole-food protein with convenient options (like shakes and supplements) that are truly high quality and formulated to deliver the amino acids your body needs for surgery and recovery.
Micronutrients: a hidden wound-healing bottleneck
Protein (and the amino acids it’s made of) gets most of the attention—and it should. But micronutrient gaps can quietly sabotage recovery, because they support the systems you rely on most after surgery: immune defense, collagen formation, and your body’s ability to manage oxidative stress. During the inflammatory surgical period, micronutrient and antioxidant levels can decline, which is exactly when your body needs them most (Barker et al., 2021).
Start with these “high-impact” micronutrients
Below are the most common nutrients tied to surgical healing demands, along with practical food sources:
- Vitamin C (collagen/tissue repair): citrus, berries, kiwi, bell peppers, broccoli
- Zinc (immune function/wound healing): shellfish, poultry, beef, pumpkin seeds, beans, nuts
- Vitamin A (skin and tissue integrity): sweet potato, carrots, spinach, kale, eggs
- Vitamin D (immune + muscle support): fatty fish, eggs, fortified dairy/alternatives (and safe sun exposure when appropriate)
- B vitamins (cell energy + red blood cell support): meat, eggs, dairy, legumes, leafy greens, fortified grains
- Iron (oxygen delivery for healing tissues): lean red meat (if you tolerate it), poultry, lentils, spinach (pair plant sources with Vitamin C for better absorption)
- Selenium (antioxidant defenses): Brazil nuts, fish, eggs, poultry
An easy “insurance policy”: a multivitamin, but choose carefully
One of the simplest ways to help cover these bases consistently is a daily multivitamin, especially when appetite, meal quality, and consistency aren’t perfect.
But here’s the catch: not all multivitamins are the same. Formulations can differ dramatically in what they include; some are broad, while others omit nutrients that matter.
And the use of multivitamins isn’t just theoretical. In a controlled, clinical trial of knee arthroplasty patients, appropriate multivitamin supplementation increased antioxidant vitamin levels and reduced the inflammatory cytokine ratio after surgery (Barker et al., 2021). This matters because the surgical stress response can temporarily deplete micronutrients and antioxidants right when demand is highest, potentially leaving your body with less capacity to manage oxidative stress and inflammation during the critical healing windows.
Bottom line: Food should be your foundation for micronutrient intake, but a high-quality multivitamin, designed to meet healing requirements, can be a practical way to ensure you’re not missing key building blocks right when your body needs them most.
What to avoid in the weeks before and after surgery
In the weeks before surgery, and the first few weeks after, your goal is simple: every bite should help you heal. That means avoiding foods and habits that spike inflammation, destabilize blood sugar, dehydrate you, or crowd out the nutrients your body needs most.
Avoid or sharply limit these (and why)
-
Sugary foods and sweet drinks (soda, juice, candy, pastries, “dessert” shakes)
Why it matters: High sugar intake can cause sharp blood sugar spikes that can increase inflammatory signaling and cravings. It also replaces calories that should be going toward protein and nutrient-dense foods, so you feel “fed,” but you’re not actually building healing capacity. -
Refined “white” carbs as the main part of meals (white bread, crackers, chips, cereal, pasta-heavy plates)
Why it matters: These digest fast and often lead to blood sugar swings, which can contribute to a more inflammatory internal environment and energy crashes. They also fill you up before you’ve eaten enough protein and micronutrients. -
Ultra-processed convenience foods (fast food, packaged snacks, frozen pizza, processed meats)
Why it matters: These foods tend to be low in micronutrients and fiber, and higher in additives/sodium/poor-quality fats. That combination can promote systemic inflammation, worsen water retention, and leave you undernourished even when you’re eating plenty of calories. -
Fried foods and heavy, greasy meals
Why it matters: Fried/greasy foods are often cooked in oils that don’t hold up well to high heat, and they can increase the body’s oxidative stress burden. Practically, they also worsen reflux/nausea and make it harder to consistently hit your protein targets, especially post-op. -
Excess saturated fat and processed meats (bacon, sausage, hot dogs; large fatty cuts)
Why it matters: Heavy saturated-fat meals can increase a “post-meal inflammatory response” in some people and can crowd out lean proteins and plant foods that provide antioxidants and fiber, both helpful for keeping inflammation more controlled. -
Alcohol (best avoided in the peri-op window)
Why it matters: Alcohol can worsen sleep quality, hydration, and inflammation, and it lowers follow-through on healthy habits. It’s one of the easiest ways to sabotage recovery consistency in the exact window when consistency matters most.
Simple tips that make this practical
- Build every meal around protein first (then add colorful produce + a high-fiber carb if you want it).
- Drink high-quality calories (e.g., a high-quality protein shake), not sugar.
- Choose “whole-food defaults”: lean proteins, eggs, Greek yogurt/cottage cheese, beans/lentils, fruits/vegetables, nuts/seeds, and minimally processed grains.
Post-op reality check: the “pudding and crackers trap.”
After surgery, many patients drift toward easy carbs because their appetite is low and chewing/cooking feels hard. That’s exactly when you need protein and micronutrients the most. If you’re not intentional, it becomes very easy to feel full while still missing the nutrients required for healing and strength.
Bottom line: In the month before and after surgery, you want your calories to work for you, not just fill you up.
The four things our team of expert dietitians and surgeons recommends you focus on:
- Hit your protein target every day to create a nutritional reserve and stave off muscle loss and weakness
- Cover micronutrients consistently to maintain immunity and healing capacity
- Hydrate consistently and increase your fluid intake the week before and after surgery
- Avoid anything that can induce inflammation (systemic inflammation leads to swelling, swelling leads to pain, and slower recoveries)
Why most patients don’t succeed with food alone (and why SurgicalRx exists)
Even when patients want to do the right thing, they hit predictable barriers:
- appetite and meal prep issues
- confusion about “how much protein is enough”
- inconsistent quality of protein sources
- “multivitamins” that don’t meaningfully cover what matters
- compliance falling apart during pain, stress, and pre-op logistics
The 30-Day OrthoRx Bundle was built to make the evidence-based path simple, consistent, and doable during a time when most patients are overwhelmed. It’s designed to support a full 30-day perioperative window, ideally 15 days before surgery and 15 days after, or (if you’re too close to surgery) 30 days focused entirely on recovery.
It includes:
- Prepair Protein: A practical way to hit high-quality daily protein targets without trying to “eat 25 eggs a day.”
- Essential Nutrients: A comprehensive formula built to help cover key micronutrients tied to surgical healing, going beyond many generic, off-the-shelf multivitamins that leave important gaps.
- Amino Plus+: Supports muscle-preserving amino acid intake and daily hydration, two areas that commonly slip when pain, appetite changes, and stress are highest.
This is your window to act. Nutrition is one of the only levers you can pull before surgery that is high-impact, low-downside, and entirely under your control. Don’t leave your recovery to “good enough.”
Start the 30-Day OrthoRx Bundle now.
Important Safety Note
If you have kidney disease (including chronic kidney disease), liver disease, diabetes, or any other metabolic condition—or if you take prescription medications that affect fluid/electrolyte balance—talk with your surgeon or primary care clinician before making major diet changes or starting any new nutrition regimen. They can confirm the right protein target and supplement plan for your situation.
Sources
Barker, Tom, et al. “Multi-Vitamin Supplementation Blunts the Circulating IL-6/IL-10 Ratio Increase After Knee Arthroplasty: A Randomized, Double-Blind, Placebo Controlled Study.” Cytokine, vol. 140, 2021, article 155435. https://doi.org/10.1016/j.cyto.2021.155435.
Ihle, Carsten, et al. “Interview-Based Malnutrition Assessment Can Predict Adverse Events Within 6 Months After Primary and Revision Arthroplasty: A Prospective Observational Study of 351 Patients.” BMC Musculoskeletal Disorders, vol. 19, 2018, article 83. https://doi.org/10.1186/s12891-018-2004-z.
Khalooeifard, Maghsoud, et al. “Protein Supplement and Enhanced Recovery After Posterior Spine Fusion Surgery: A Randomized Placebo-Controlled Trial.” Clinical Spine Surgery, vol. 35, no. 3, Apr. 2022, pp. E356–E362.
Mbagwu, Chibugo, Kevin J. Bozic, and James L. Blevins. “Is Preoperative Serum Albumin, Transferrin, and Total Lymphocyte Count a Risk Marker for Postoperative Complications Following Total Joint Arthroplasty? A Systematic Review.” JAAOS Global Research & Reviews, vol. 4, no. 5, May 2020, e19.00057. https://doi.org/10.5435/JAAOSGlobal-D-19-00057.
Phillips, William J., et al. “Screening and Management of Malnutrition in Total Joint Arthroplasty: A Practical Guide.” Journal of the American Academy of Orthopaedic Surgeons, vol. 31, no. 7, 1 Apr. 2023, pp. 319–325. https://doi.org/10.5435/JAAOS-D-22-01035.
Saleh, Hesham, Tyler K. Williamson, and Peter G. Passias. “Perioperative Nutritional Supplementation Decreases Wound Healing Complications Following Elective Lumbar Spine Surgery: A Randomized Controlled Trial.” Spine, vol. 48, 2023, pp. 376–383. https://doi.org/10.1097/BRS.0000000000004522.
Schroer, William C., et al. “The Ranawat Award: Assessing the Value of Nutrition Interventions on Malnutrition in Total Joint Arthroplasty.” The Bone & Joint Journal, vol. 101-B, no. 7 Suppl C, 2019, pp. 17–21. https://doi.org/10.1302/0301-620X.101B7.BJJ-2018-1510.R1.
Tedesco, Lawrence J., et al. “The Role of Perioperative Nutritional Status and Supplementation in Orthopaedic Surgery.” JBJS Reviews, vol. 12, no. 4, Apr. 2024, e23.00242. https://doi.org/10.2106/JBJS.RVW.23.00242.
Weijzen, M. E. G., et al. “Protein Intake Falls Below 0.6 g·kg−1·d−1 in Patients Prior to Total Hip and Total Knee Arthroplasty.” The Journal of Nutrition, Health & Aging, vol. 23, no. 3, Feb. 2019, pp. 299–305. https://doi.org/10.1007/s12603-019-1157-2.
Williams, Daniel G., and Paul E. Wischmeyer. “Nutrition Care of the Orthopedic Surgery Patient.” Techniques in Orthopaedics, vol. 35, no. 1, Mar. 2020, pp. 15–18. https://doi.org/10.1097/BTO.0000000000000412.