Nutrition before joint replacement gets discussed in two unhelpful registers. One is the supplement aisle, which promises cartilage regeneration and does not deliver it. The other is silence, which is what most people get. The useful version sits in between and it is narrower and more boring than either.
The short form: what you eat will not repair an arthritic joint, and there is no evidence that it can. What it will do is change how well you tolerate a major operation and how well the wound heals afterwards. Those are worth doing something about, and the window to do it is the weeks before surgery, not the weeks after.
Protein.
This is the one that matters most and is missed most often. A joint replacement is a catabolic event: for a period afterwards the body breaks down more protein than it builds, at exactly the moment it needs to heal a wound and rebuild the muscle around a joint that has been guarding for years.
Older adults commonly eat less protein than they need even before that. Consensus recommendations for healthy older people sit at around 1.0 to 1.2 grams per kilogram of body weight per day, higher than the general adult figure and higher again in illness or after surgery.1 For a 75 kilogram person that is roughly 75 to 90 grams a day, spread across meals rather than concentrated in the evening.
The practical version: protein at breakfast, which is the meal where most people have almost none. Eggs, dairy, fish, meat, legumes. If appetite is poor, which it often is after an operation, this is where a dietitian is genuinely useful rather than a formality.
Albumin, and why the blood test matters.
Serum albumin is a crude marker of nutritional state and it is one of the more reliable predictors of trouble after joint replacement. In a large analysis of joint replacement patients, low albumin was independently associated with surgical site infection, pneumonia, longer stay and readmission.2 It is a marker rather than a cause, but it is a marker that gets measured, and a low result before an elective operation is a reason to pause and address it rather than proceed.
Iron and anaemia.
Going into a joint replacement anaemic is one of the clearest modifiable risks there is. It increases the likelihood of needing a transfusion, and it makes the first fortnight of recovery harder in a way that is difficult to distinguish from the operation itself: people describe it as exhaustion and assume it is normal.
Anaemia is checked before surgery, and if it is found, the reason for it is worth establishing rather than simply correcting. Iron deficiency in an adult is a finding that sometimes needs investigating in its own right. Where iron is the issue, oral or intravenous replacement takes weeks, which is another argument for the pre-admission appointment happening early rather than the week before.
Vitamin D.
Deficiency is common in Australia despite the climate, particularly in people whose knee or hip has kept them indoors for a year or two, and it is easy and cheap to correct. The evidence that correcting it improves joint replacement outcomes specifically is not strong. The evidence that deficiency is associated with poorer muscle function and falls in older adults is better, and both matter in the first six weeks after an operation. It is checked and corrected because the cost of doing so is close to nothing.
Blood sugar.
If you have diabetes, glycaemic control before elective joint replacement is one of the most important things on this page. Poorly controlled blood sugar is associated with higher rates of wound complications and infection, which is the complication you least want after a joint replacement because it is the hardest to treat. This is worked through with your GP or endocrinologist before a date is set, and it is a legitimate reason to defer an operation by a few months.
Weight.
Weight is the part of this conversation that most often goes badly, usually because it is delivered as a judgement rather than as information. So, the information. Higher body weight is associated in registry and cohort data with higher rates of wound complications, infection and revision after joint replacement.3 That association is real and it is not disputed.
What is disputed is what to do about it. Hard BMI thresholds that refuse surgery above a number are used in some systems and are contested, because they also deny a reliable operation to people whose weight is partly a consequence of a joint that stopped them moving. Losing weight with an arthritic hip or knee is genuinely harder than losing it without one, and pretending otherwise helps nobody.
The position taken here is that weight is one factor among several, that any reduction before surgery is worth having even if it does not reach a target, and that the conversation belongs in the consultation rather than in a policy. If weight is the main obstacle, it is worth discussing directly rather than being quietly deferred.
What the evidence does not support.
Glucosamine and chondroitin have been studied extensively in osteoarthritis. Trial results are inconsistent, effect sizes where present are small, and there is no good evidence that either changes the structure of an arthritic joint or alters what happens at surgery. They are not dangerous and some people report symptomatic benefit. They are not a treatment for arthritis and they are not preparation for an operation.
Collagen supplements, turmeric preparations and the broader category of joint supplements sit in similar territory: a mix of small symptomatic trials, considerable marketing, and no evidence of structural effect. If you take them and find them helpful, there is no reason from a surgical point of view to stop. There is also no reason to start.
One practical caution. Fish oil at high dose, and several herbal preparations, can affect bleeding. Everything you take, including supplements you would not describe as medication, should be on the list you give the pre-admission clinic.
Where this actually gets done.
The pre-admission appointment is where the bloods are checked and where anaemia, blood sugar and nutritional state get identified and acted on. It is the appointment people are most inclined to treat as a formality, particularly when it involves a drive, and it is the one with the most direct effect on how the first fortnight goes. See what to try before knee surgery and is it time for a hip replacement for how the rest of the preparation fits together.
References.
- Bauer J, Biolo G, Cederholm T, et al. Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. J Am Med Dir Assoc. 2013;14(8):542-559.
- Bohl DD, Shen MR, Kayupov E, Della Valle CJ. Hypoalbuminemia independently predicts surgical site infection, pneumonia, length of stay, and readmission after total joint arthroplasty. J Arthroplasty. 2016;31(1):15-21.
- Australian Orthopaedic Association National Joint Replacement Registry. Hip, Knee & Shoulder Arthroplasty Annual Report. Adelaide: AOA.
This page provides general information about a medical condition and a surgical procedure. It is not individual medical advice and does not replace consultation with a qualified practitioner. Outcomes vary between individuals and all surgery carries risk. A referral is needed for a consultation with Professor Daevyd Rodda; without one, you can start with the practice nurse practitioner, who can provide it.