Person confidently walking a path of recovery, supported by strength and medical team.

Stronger Before Surgery: How Strength Training Can Improve Your Knee Replacement Outcome

Lena Kashyap in Health & Wellness July 2025 • 4 min read.

"Preoperative strength training can significantly improve postural control and speed up recovery after total knee arthroplasty (TKA)."

Knee osteoarthritis (OA) is a common issue that leads to pain and limited movement, especially as people get older. Total knee arthroplasty (TKA), or knee replacement surgery, is often the solution. But what if you could go into surgery stronger and better prepared? Research suggests that focusing on strength training before surgery can make a significant difference in your recovery and overall results.

Typically, recovery after TKA involves physical therapy aimed at restoring movement and strength. However, a recent study investigated whether a high-intensity strength training program before surgery could improve postural control—your body's ability to maintain balance—both before and after the procedure.

This article will break down the study's findings, explaining how pre-operative strength training, with a focus on lower limb strength, not only enhances postural control but also contributes to a speedier and more effective recovery after TKA. Let's explore the power of preparation!

The Power of Pre-Surgery Strength: What the Research Shows

Person confidently walking a path of recovery, supported by strength and medical team.

The study, published in Knee Surgery, Sports Traumatology, Arthroscopy, involved 44 participants scheduled for TKA due to osteoarthritis. The key was to assess postural control through Romberg tests (standing balance tests with eyes open and closed) at four points: before training, after 8 weeks of training, one month after TKA, and three months after TKA. The group that underwent an 8-week high-intensity strength training program prior to surgery showed remarkable improvements compared to the control group that received no intervention.

Here's a summary of the key benefits observed in the intervention group:

Improved Balance: Participants demonstrated better balance, indicated by a lower Center of Pressure area (COP), at all follow-up points (T2, T3, and T4).
Enhanced Stability: They exhibited reduced sway in both anteroposterior and medial-lateral directions.
Faster Recovery: The training benefits extended beyond the surgery, contributing to quicker postural control recovery.

These findings underscore that pre-operative strength training is not just about building muscle; it's about optimizing your body's stability and paving the way for a smoother recovery journey. The study challenges the conventional focus on balance training alone, suggesting that strength training plays a vital role in enhancing postural control both before and after TKA.

Making Strides: The Future of TKA Recovery

The study's conclusion is clear: incorporating high-intensity strength training into pre-operative care can significantly enhance postural control and accelerate recovery following TKA. This approach equips patients with a solid foundation of strength and stability, setting the stage for improved outcomes.

These findings advocate for a shift in TKA preparation, emphasizing the inclusion of strength training programs. Healthcare providers should consider integrating such programs into their standard pre-operative protocols to optimize patient recovery.

If you or a loved one are considering TKA, talk to your doctor or physical therapist about incorporating a strength training regimen into your pre-operative plan. By taking proactive steps to build strength and stability before surgery, you can improve your chances of a successful and speedy recovery, getting you back on your feet and enjoying life to the fullest!

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1007/s00167-018-5246-2, Alternate LINK

Title: Preoperative High-Intensity Strength Training Improves Postural Control After Tka: Randomized-Controlled Trial

Subject: Orthopedics and Sports Medicine

Journal: Knee Surgery, Sports Traumatology, Arthroscopy

Publisher: Springer Science and Business Media LLC

Authors: José Casaña, Joaquín Calatayud, Yasmín Ezzatvar, Jonas Vinstrup, Josep Benítez, Lars L. Andersen

Published: 2018-10-25

Everything You Need To Know

What is preoperative strength training?

Preoperative strength training involves engaging in high-intensity exercises before undergoing Total Knee Arthroplasty (TKA), also known as knee replacement surgery. This typically focuses on strengthening the lower limbs. The goal is to build muscle and improve postural control, which is the body's ability to maintain balance. This preparation aims to optimize the patient's physical condition before surgery, setting the stage for a smoother and more effective recovery.

Why is postural control important?

Postural control is crucial because it is your body's ability to maintain balance. In the context of Total Knee Arthroplasty (TKA), improved postural control, achieved through preoperative strength training, leads to faster recovery and better overall outcomes. The study, which used Romberg tests, demonstrated that patients with enhanced postural control experienced reduced sway and better balance. This reduces the risk of falls and allows for a quicker return to normal activities.

What is Total Knee Arthroplasty (TKA), and why is it necessary?

Total Knee Arthroplasty (TKA) is a surgical procedure to replace a damaged knee joint. Knee Osteoarthritis (OA) is a common condition where the cartilage in the knee deteriorates. TKA becomes a necessary intervention when the pain and loss of mobility caused by OA significantly impact a person's quality of life. Preoperative strength training prepares the body for the stress of the surgery and the subsequent rehabilitation, leading to better outcomes after the TKA.

What did the study show regarding preoperative strength training?

The study highlights the significance of strength training *before* Total Knee Arthroplasty (TKA) by demonstrating its positive impact on recovery. Specifically, patients who participated in an 8-week high-intensity strength training program showed significant improvements in balance and stability, as measured by the Center of Pressure area (COP) and sway reduction. These enhancements translated into faster recovery and better outcomes following surgery compared to the control group, which received no such intervention. The research emphasizes that strength training is a vital component to recovery beyond traditional physical therapy.

What are the implications of these findings?

The study's findings suggest that incorporating high-intensity strength training into pre-operative care for Total Knee Arthroplasty (TKA) can significantly improve recovery. These exercises focus on lower limb strength and enhance postural control. Enhanced postural control, in turn, leads to better balance, reduced sway, and faster recovery. The implications include a potential shift in how patients are prepared for surgery, focusing not just on post-operative rehabilitation, but on pre-operative optimization to enhance outcomes and overall well-being.