Digital Prehabilitation Before Hip and Knee Surgery

By Annabelle Emery • September 10, 2025

Hip and knee replacements transform lives, but most patients reach surgery after months, or even years [1], of worsening pain, mobility, and mental wellbeing, often due to increasingly long waiting lists [2]. Declining fitness, poor mobility, and lifestyle habits can significantly impact postoperative recovery.

Digital prehabilitation, structured exercise and lifestyle changes before surgery, is proving to be a powerful tool to improve surgical outcomes and accelerate recovery [3-5].

In 2024, PreActiv conducted a clinical trial at the Royal United Hospitals, Bath, evaluating the feasibility of its digital prehabilitation platform. This article presents a focused sub-analysis of patients awaiting orthopaedic surgery, and will explore how individualised digital prehabilitation can be applied to this surgical population.

Orthopaedic Case Series: Hip and Knee Surgery Patients

From the wider feasibility cohort, we examined a subset of patients scheduled for hip or knee replacements (including revision procedures). These cases represent a cross-section of typical orthopaedic surgical candidates:

• Participants’ ages ranged from 59-86 years old, with an average age of 77.
• All patients reported either ‘moderate’ or ‘severe’ pain, and ‘slight’ to ‘severe’ problems with mobility in their entry questionnaire

Individualised Digital Prehabilitation in Practice

PreActiv generated individualised and dynamic digital prehabilitation programmes, tailored to patients mobility and fitness levels. Programmes adapted to patient feedback and fitness tests throughout the course.

Baseline fitness and mobility was established through a comprehensive health questionnaire combined with a verified fitness test. The programme was accessible for patients with limited mobility. Within the cohort:

• 13% needed mobility support while exercising
• 50% required a seated programme

This demonstrates the accessibility of PreActiv’s digital prehabilitation across abilities in patients waiting for hip and knee surgery.

Engagement and Adherence

• 93% of all available sessions were completed
• 99% of cardio exercises were performed at high intensity
• 100% of muscle-strengthening exercises were performed at high intensity

This data highlights excellent patient engagement in an older surgical population. Despite being at higher risk of digital exclusion, patients were able to participate successfully. Traditional models of prehabilitation requiring regular hospital visits may not have been accessible to people with limited time or transportation, or caring responsibilities.

Outcomes of Digital Prehabilitation

• At baseline: 75% low fitness, 13% medium, 13% high
• Post-programme: 100% of participants initially assessed as low or medium fitness advanced to a higher group

Health and fitness testing conducted by the University of Bath revealed measurable improvements following the PreActiv programme:

• Overall functional capacity increased by 50–100%
• VO₂peak increased by 4%
• Peak cycling resistance achieved increased by 10%

Patient-Reported Outcomes

• Average anxiety score reduced from mild (9/21) to normal (7/21)
• There were also examples within the group where pain levels improved from ‘severe’ to ‘moderate’, and ‘severe’ problems with usual activities were completely resolved.
• Participants agreed or strongly agreed that the exercises in their programme were appropriate for their needs, and that the programme helped them prepare for surgery.
• All participants would recommend the programme to a friend having surgery.

 “I thought the programme was very innovative and easy to follow. The work I did will help me for my op and recovery process.
“I have always been a keep fit person and this innovation will help keep my enthusiasm up which can be difficult with the oncoming years.” PreActiv user.

Clinical Relevance for Orthopedic Surgery

This sub-analysis demonstrates that:

• Digital prehabilitation is feasible and acceptable in orthopaedic patients with significant baseline impairments.
• Adherence is high, with >90% session completion and near-universal high-intensity performance.
• Clinical outcomes are meaningful, including measurable improvements in functional capacity, VO₂peak, pain, and anxiety.
• Adaptability is key, programmes can overcome barriers such as travel limitations, mobility restrictions, and caring responsibilities.

Conclusion: Supporting Hip and Knee Surgery Through Digital Prehabilitation

This sub-analysis illustrates how targeted digital prehabilitation, such as PreActiv’s platform, can enhance the perioperative pathway for orthopaedic surgery. Even patients with significant pain and mobility limitations safely engaged, progressed, and benefited from the programme.

These findings reinforce the role of prehabilitation as a valuable intervention, and underscore the potential of digital platforms, like PreActiv, in providing accessible, evidence-based, and individualised digital prehabilitation prior to hip and knee surgery.

 

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