Nutrition in knee surgery
Surgery is not the only variable in your recovery. What you eat in the weeks before and after your operation can be just as important as the procedure itself, and the evidence for this is increasingly hard to ignore.
As an orthopaedic surgeon, I see patients every week who have prepared meticulously for their operation. They have completed their pre-operative physiotherapy, arranged their home, organised time off work. But very few have given serious thought to what they are eating. That is a missed opportunity, and one that I want to address directly.
The problem is bigger than most people realise
Research shows that up to 50% of patients undergoing orthopaedic surgery have some degree of pre-operative malnutrition, and most of them have no idea. This is not about being underweight. It includes deficiencies in specific vitamins, minerals, and proteins that are critical to tissue repair, immune function, and muscle recovery. These gaps are often silent, with no obvious symptoms, yet they significantly raise the risk of wound infection, prolonged hospital stay, and a slower return to normal life.
Vitamin D deficiency is perhaps the most striking example. It is present in 63% of patients undergoing joint replacement, and has been directly linked to higher infection rates, worse pain scores, and a greater likelihood of needing manipulation under anaesthesia. And yet it is easily detected with a simple blood test and straightforward to correct before your operation date.
What targeted nutrition can actually do
The evidence base for perioperative nutritional support has grown substantially in recent years. We now have solid randomised controlled trial data showing that the right interventions, started at the right time, can produce real and measurable improvements in how patients recover. Some of the most compelling findings include:
- Essential amino acid supplementation preserves quadriceps muscle mass after knee surgery, speeds up return to daily activities, and maintains strength gains at two-year follow-up.
- MPFF, a natural citrus-derived compound, significantly reduces post-operative swelling and pain after knee replacement in two independent randomised trials, with faster restoration of knee bending.
- Vitamin C reduces inflammatory markers, lowers pain scores, and cuts the risk of complex regional pain syndrome, which can be a serious and prolonged complication after knee surgery.
- Pre-operative carbohydrate loading, taken two to three hours before anaesthesia, blunts the surge in insulin resistance that surgery triggers, and is safe even in patients with well-controlled type 2 diabetes.
Part of a bigger picture
My approach has always been that surgery is one part of a patient's journey, not the whole of it. Preparing well means optimising every aspect of your health that you can actually influence - fitness, medical conditions, psychological readiness, and nutrition. The aim is not simply to get through the procedure safely. It is to get you back to the activities and quality of life that matter to you.
To support that aim, I have put together a comprehensive perioperative nutrition guide for my patients. It covers everything from which blood tests to ask about at your pre-operative assessment, to a clear week-by-week plan of what to take and when. There are visual guides on building the right recovery plate, evidence-based supplement recommendations, and a straightforward list of what to avoid and why.
The full guide includes:
A week-by-week nutrition timeline · Supplement guide with evidence ratings · Pre-operative blood test checklist · Recovery plate diagram · Protein guide · Foods to avoid · 18 peer-reviewed references
Whether you are preparing for a knee replacement, hip replacement, ACL reconstruction, or another major orthopaedic procedure, the principles apply broadly. As always, please discuss any supplements with your surgical team before starting, particularly if you have other medical conditions or take regular medications.
Read the Full Nutrition Guide
Evidence-based, patient-friendly, and free to access. Explore the complete perioperative nutrition resource or download a copy to keep.
This article is for general educational purposes and does not constitute individualised medical advice. Please speak with your surgical team before making any changes to your diet or starting a supplementation programme.
