Introduction

Facing the prospect of hip or knee replacement surgery can stir a mixture of hope and nervousness. These operations are among the most common and successful orthopaedic procedures, offering relief from pain and improved mobility. Yet, it’s completely normal to feel anxious before surgery.

Preoperative anxiety is a natural reaction that deserves attention because it can affect recovery. Studies show that “preoperative anxiety is a common phenomenon affecting 60–80% of surgical patients, with potential implications for surgical outcomes” (Shebl et al., 2025). This article highlights how anxiety influences recovery and why it’s important to prepare both mentally and physically.

The Nature and Prevalence of Preoperative Anxiety in Joint Replacement

Many patients awaiting hip or knee replacement experience feelings of worry or unease. These can arise from fears about pain, uncertainty about the results, or concerns about regaining independence after surgery. Anxiety is common in both hip and knee replacement candidates, though it might be slightly higher before knee surgery due to longer rehabilitation times.

Research confirms that “preoperative anxiety is considered a common part of the surgical experience and can be associated with serious postoperative side effects” for both hip and knee patients (Çalışkan & Aksoy, 2024). Leading British orthopaedic societies fully recognise these concerns, emphasising the need to address emotional wellbeing alongside physical care.

Evidence: How Anxiety Impacts Surgical Outcomes

Extensive research confirms that preoperative anxiety can affect how well patients recover. One review found “significant associations [exist] between preoperative anxiety and increased anaesthetic requirements and analgesic requirements” (Shebl et al., 2025). Patients with higher anxiety before surgery tend to experience more pain after, slower recovery, and longer hospital stays. The same study noted that “preoperative anxiety was associated with prolonged time to reach Modified Aldrete Score of 9 and extubation time” (Shebl et al., 2025), stressing how mental health can influence physical healing.

More specific to joint replacement, another study discovered a “moderate positive correlation between anxiety scores and pain levels at several points in the first 36 hours post-surgery” (Çalışkan & Aksoy, 2024). Simply put, higher anxiety before surgery is linked to greater pain during the initial recovery period. They also concluded that “high preoperative state anxiety was associated with early postoperative pain outcomes, especially within the first six hours” (Çalışkan & Aksoy, 2024).

Looking beyond orthopaedics, research from minimally invasive lung surgery supports these findings: patients with anxiety experienced “longer hospital stays” and “more issues with sleep quality, pain, nausea and vomiting” after surgery (Chen et al., 2024). While the operations are different, the message is clear—anxiety consistently impacts recovery across surgical specialties.

Anxiety can trigger the body’s stress response, which may slow healing or complicate rehabilitation. Although some patients, such as those requiring bone cement for trauma or cancer cases, receive specialised care, optimising outcomes by managing anxiety is important for all patients.

At our Klinik, we use uncemented implants as standard, which supports strong and reliable recovery following best practice.

The Importance of Psychological Readiness and Support

Successfully managing preoperative anxiety isn’t just about physical preparation — psychological readiness plays a vital role too. The evidence underlines “the need for routine preoperative anxiety screening and the development of targeted interventions” (Shebl et al., 2025). Patient education, counselling, and clear communication with your healthcare team can all help reduce anxiety.

British orthopaedic organisations advocate for care that integrates these aspects. Patients treated by experts like Professor Paul Lee, a Cartilage Expert and Regional Surgical Ambassador, benefit from his vast experience in orthopaedics and rehabilitation. Alongside the MSK Doctors team, Professor Lee leads compassionate, expert care focused on your whole wellbeing.

They provide a professional, supportive environment dedicated to guiding patients through their surgical journey with confidence—without promising outcomes but with a firm commitment to best practice.

Practical Tips to Manage Preoperative Anxiety

If you’re feeling anxious before surgery, here are some helpful steps you can take:

• Try relaxation techniques such as deep breathing, meditation, or gentle yoga.
• Consider joining support groups where you can share experiences and feel understood.
• Talk openly with your surgeon and physiotherapist—ask questions and clarify any concerns you have about the procedure or recovery.
• Set real, achievable recovery goals with guidance from your healthcare team to maintain a positive mindset.

Remember, at our Klinik, support is personalised for each patient to balance both emotional wellbeing and physical recovery for the best possible results.

Conclusion

Preoperative anxiety is a real and important factor in hip and knee replacement recovery. Recognising this early and addressing it can improve how patients cope and heal after surgery. Patients and their families should know their feelings are completely valid and that experts are here to help.

With constantly improving standards and a caring orthopaedic community led by professionals like Professor Paul Lee and the MSK Doctors team, you can approach your surgery with confidence and optimism for a positive recovery.

References

• Shebl, M. A., Toraih, E., Shebl, M., Tolba, A. M., Ahmed, P., Banga, H. S., Orz, M., Tammam, M., Saadalla, K., Elsayed, M. H., Kamal, M., Abdulla, M., Eldessouky, A. I., Moustafa, Y. T., Mohamed, O. A., & Aiash, H. (2025). Preoperative anxiety and its impact on surgical outcomes: A systematic review and meta-analysis. Clinical and Translational Science. https://doi.org/10.1017/cts.2025.6
• Chen, M., Huang, Y., Zhang, J., Wu, Z., Lin, C., Zheng, B., Chen, C., & Li, W. (2024). Impact of preoperative anxiety on postoperative outcomes in patients undergoing minimally invasive thoracoscopic surgery: A prospective cohort study. European Journal of Surgical Oncology. https://doi.org/10.1016/j.ejso.2024.108605
• Çalışkan, E., & Aksoy, N. (2024). The relationship between preoperative anxiety level and postoperative pain outcomes in total hip and knee replacement surgery: A cross-sectional study. Journal of Perianesthesia Nursing. https://doi.org/10.1016/j.jopan.2024.03.010