Nutrition Before and After Joint Replacement Surgery

Nutrition is one of the most underestimated factors in surgical recovery. Patients who go into hip or knee replacement surgery well-nourished tend to heal faster, experience fewer complications, and regain strength more efficiently than those who are nutritionally depleted. Yet it is rarely discussed in as much detail as the procedure itself.

This guide covers the key nutritional principles before and after joint replacement surgery — practical, evidence-based information to help you prepare your body and support your recovery.

Before surgery: building the best foundation

The weeks leading up to surgery are an opportunity to prepare your body for the physical demands of the procedure and the recovery that follows. Even modest improvements in nutritional status before surgery can make a meaningful difference to outcomes.

Protein

Protein is the most critical nutrient in the surgical context. Your body uses it to repair tissue, maintain muscle mass, and support immune function. Surgery places high metabolic demands on the body, and patients who enter surgery with adequate protein reserves tend to preserve muscle mass better during the post-operative period when mobility is restricted.

Aim to include a quality protein source at every meal in the weeks before surgery. Good sources include lean meat, poultry, fish, eggs, dairy, legumes, and tofu. If your appetite is limited due to pain or reduced mobility, a protein supplement (such as a whey or plant-based protein powder) can help bridge the gap — discuss this with your GP or a dietitian.

Iron

Low iron levels before surgery increase the risk of requiring a blood transfusion and can slow recovery. Your surgical team will typically check your haemoglobin before the procedure. If levels are low, your GP may recommend iron supplementation — ideally starting several weeks before the operation to allow time for levels to improve. Iron-rich foods include red meat, leafy green vegetables, legumes, and fortified cereals.

Vitamin D and calcium

Bone health matters not just at the time of surgery but throughout recovery. Vitamin D supports calcium absorption and bone remodelling around the implant. Many Australians — particularly those who spend limited time outdoors — have lower vitamin D levels than ideal. Ask your GP to check your vitamin D level before surgery and supplement if needed.

Vitamin C

Vitamin C plays a central role in collagen synthesis — the structural protein that holds tissue together and is essential for wound healing. Citrus fruits, kiwi fruit, capsicum, strawberries, and broccoli are all excellent sources.

Blood sugar control

If you have type 2 diabetes or pre-diabetes, optimising blood sugar control before surgery is important. Elevated blood glucose impairs wound healing and increases infection risk. Work with your GP or endocrinologist in the lead-up to surgery to ensure your levels are as well-managed as possible.

What to reduce or avoid

Alcohol impairs wound healing and interacts with anaesthetic and post-operative medications. It is advisable to minimise or avoid alcohol for at least two weeks before surgery. Smoking significantly impairs tissue oxygenation and healing — if you smoke, speak with your GP about cessation support well before your procedure.

The day before and day of surgery: fasting guidelines

Your surgical team will provide specific fasting instructions. As a general guide, most modern surgical protocols allow clear fluids up until two hours before the procedure and light food up until six hours before. Older protocols required fasting from midnight, but current evidence supports the shorter fasting windows for most patients.

Some hospitals use pre-operative carbohydrate drinks as part of an Enhanced Recovery After Surgery (ERAS) programme. These are specially formulated drinks taken the evening before and the morning of surgery, which help reduce the metabolic stress of fasting and support a faster recovery. If Dr Mooney's team uses an ERAS protocol, you will be given specific instructions.

Always follow the specific fasting instructions provided by your surgical team. These take precedence over any general guidance.

After surgery: supporting healing and strength

The post-operative period places high nutritional demands on the body. Surgery triggers an inflammatory response, and the body works hard to repair tissue, remodel bone around the implant, and gradually restore muscle function. Nutrition plays a direct role in how efficiently this happens.

Protein — even more important after surgery

Protein requirements increase after major surgery. Muscle loss during the early recovery period — when mobility is limited — can be significant, and adequate protein intake helps minimise this. Try to include protein at every meal and snack. If your appetite is suppressed in the first few days (common after anaesthetic), small frequent meals and protein-rich drinks can help maintain intake.

Anti-inflammatory foods

Some degree of post-operative inflammation is normal and necessary for healing. However, a diet rich in anti-inflammatory foods can support a more controlled recovery. Focus on oily fish (salmon, sardines, mackerel), olive oil, colourful vegetables and fruits, nuts, and wholegrains. Highly processed foods, refined sugars, and seed oils are worth limiting during recovery.

Calcium and vitamin D — bone remodelling

After joint replacement, bone gradually grows into and around the implant in a process called osseointegration. Adequate calcium and vitamin D support this process. Continue to prioritise dairy foods, leafy greens, and either sunlight exposure or a vitamin D supplement (as directed by your GP) throughout the recovery period.

Iron recovery

Joint replacement surgery involves a degree of blood loss, and haemoglobin levels often drop in the days following the procedure. If your iron levels were low before surgery or if you experience significant fatigue in recovery, speak with your GP about iron supplementation. Pairing iron-rich foods with vitamin C (such as a glass of orange juice with a meal) improves absorption.

Hydration and managing constipation

Staying well hydrated supports every aspect of recovery. It also helps manage one of the most common and uncomfortable side effects of the post-operative period: constipation. Opioid pain relief, reduced mobility, and dietary changes all contribute to constipation in the first week or two. Adequate fluid intake, fibre-rich foods (fruits, vegetables, wholegrains), and mobilising as soon as cleared by your physiotherapist all help. If constipation is significant, your team will advise on appropriate laxatives.

Practical tips for the recovery period

• Prepare meals in advance — cook and freeze nutritious meals in the weeks before surgery so you have easy options when cooking is difficult after discharge.
• Keep snacks accessible — yoghurt, boiled eggs, nuts, cheese, and protein bars are easy high-protein options that require minimal preparation.
• Don't skip meals — even if your appetite is reduced, regular eating supports blood sugar stability and healing.
• Consider a multivitamin — a general multivitamin in the weeks surrounding surgery can help fill gaps, though it is not a substitute for a balanced diet. Discuss with your GP or pharmacist.
• Involve your GP or a dietitian — if you have underlying conditions (diabetes, kidney disease, inflammatory bowel disease, or a history of poor nutrition), personalised dietary advice from a dietitian is strongly recommended.

A note on weight and joint replacement

Many patients undergoing hip or knee replacement carry excess weight, which has typically contributed to the joint wear in the first place. If weight loss is appropriate for you, the period before surgery can be a motivated time to make dietary changes. However, severe caloric restriction in the weeks immediately before surgery is not recommended, as it can deplete the protein and micronutrient reserves needed for healing. A gradual, sustainable approach is better — and your GP can refer you to a dietitian if you would like structured support.