Can protein and exercise improve early recovery after hip arthroplasty?
Journal of Orthopaedic Surgery and Research · 18 Oct 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Prehabilitation and nutritional optimisation before joint replacement are common enhanced-recovery topics, and this trial suggests a cheap, simple protein-plus-exercise bundle may speed early recovery after THA.
The evidence
This single-centre randomised trial tested a 14-day home programme of daily whey protein (25 g) plus low-intensity exercise before total hip arthroplasty against standard preoperative care in 71 adults aged 50 to 70. On postoperative day 5 the prehabilitation group scored higher on the Barthel Index of daily-living independence (71.4 vs 54.7; mean difference 16.7 points, 95% CI 11.7 to 21.7) and went home about 1.8 days sooner. However, the intervention group was younger and healthier at baseline, and only patients who completed the protocol were analysed.
Functional independence (Barthel Index total score on postoperative Day 5): Mean difference 16.68 (95% CI 11.66 to 21.7; Barthel Index). The interval favours the first group; the size of the benefit needs clinical interpretation.
Why this rigour score?
RCTDesign starting point: 59.5
Raised the score
- Blinded outcome assessment+6.8
- Adequately powered+6
Lowered the score
- Per-protocol analysis only−6
- A positive result from only 71 patients−3.4
Methods at a glance
Recorded assessment- Outcome assessors blindedMet
- Allocation concealedMet
- Random sequence generatedMet
- Intention-to-treat analysisNot met
- Adequate statistical powerMet
- Prospective registrationMet
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 59.5
- Concealed allocation
- +5.1
- Random sequence generation
- +2.5
- Blinded outcome assessment
- +6.8
- Per-protocol analysis only
- −6
- 0% loss to follow-up
- +1.7
- Adequately powered
- +6
- Prospectively registered
- +5.1
- A positive result from only 71 patients
- −3.4
- Final rigour score rounded
- 77 / 100
Study design sets the starting point and a ceiling of 96. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.Which patients scheduled for THA, for example older, frail, or low-protein-intake patients, would you prioritise for a two-week whey protein and home exercise programme, and which would you not bother with?
2.If a short prehabilitation bundle shortens hospital stay by about two days, how would you counsel patients in clinic about starting it, and what follow-up would you use to check adherence before surgery?
Original publication title
Preoperative whey protein and exercise ımprove early recovery after total hip arthroplasty: a randomized controlled trial