The Joint Replacement Podcast | Episode 60 | Hosted by Dr. Matthew Sloan
Can what you eat before surgery influence how well you recover afterward?
When patients prepare for hip or knee replacement surgery, they often focus on choosing the right surgeon, understanding the surgical procedure, and planning their physical therapy. But one important aspect of recovery may receive surprisingly little attention: nutrition.
In Episode 60 of The Joint Replacement Podcast, I sat down with Dr. Sagar Desai, a Toronto-based orthopedic surgeon specializing in foot and ankle reconstruction, sports injuries, and trauma. Dr. Desai is also the founder of Proven Therapeutics, a company focused on nutritional supplementation surrounding surgery.
We explored the science behind perioperative nutrition, why maintaining muscle mass matters during recovery, whether supplements actually improve outcomes, and how traditional fasting instructions may be evolving.
We also discussed total ankle replacement, ankle fusion, Achilles tendon ruptures, minimally invasive bunion surgery, and what it takes to care for professional athletes.
Why Nutrition Matters Before Joint Replacement Surgery
Joint replacement surgery places significant physiological demands on the body.
Even when surgery goes perfectly, patients experience an inflammatory and metabolic stress response. The body needs energy and nutrients to support tissue healing, immune function, and recovery.
One particular concern is muscle loss.
Patients undergoing knee or hip replacement may lose muscle mass during the postoperative period because of surgical stress, reduced activity, and changes in muscle metabolism.
For someone recovering from knee replacement, maintaining quadriceps muscle strength is particularly important for walking, climbing stairs, balance, and returning to normal activities.
Dr. Desai emphasizes that nutritional preparation should be considered alongside physical and psychological preparation.
He explains that comprehensive prehabilitation programs combining exercise, nutrition, and psychological support may be beneficial, but they can be difficult to deliver consistently in everyday clinical practice.
Improving nutrition, however, may be a relatively accessible intervention for many patients.
What Should You Eat Before Hip or Knee Replacement Surgery?
When I asked Dr. Desai what patients should prioritize in the weeks leading up to surgery, his answer was straightforward: adequate high-quality protein and hydration.
Protein supplies amino acids needed for muscle maintenance and tissue repair.
Common protein sources include:
- Chicken, fish, and lean meats
- Eggs and dairy products
- Greek yogurt and cottage cheese
- Beans, lentils, tofu, and soy products
- Whey or other protein supplements when appropriate
Patients should also aim for a balanced diet that includes vegetables, fruits, whole grains, and healthy fats.
The goal is not simply to eat more food. It is to enter surgery with adequate nutritional reserves and avoid unnecessary muscle loss during recovery.
How Much Protein Do You Need Before Surgery?
This is a surprisingly complicated question.
In our conversation, Dr. Desai acknowledged that there is limited high-quality evidence establishing one ideal preoperative protein target specifically for joint replacement patients.
He described relatively high protein targets from his experience with fitness and athletic populations, but those should not automatically be applied to every older surgical patient.
An important distinction is that protein requirements depend on age, body weight, nutritional status, kidney function, and other medical conditions.
Research involving older adults and surgical patients often considers protein intake above the standard adult recommended dietary allowance of 0.8 grams per kilogram of body weight per day.
However, patients should discuss individualized nutritional goals with their healthcare team, particularly if they have kidney disease or other medical conditions.
Can Protein Supplements Reduce Muscle Loss After Joint Replacement?
This is where the scientific evidence becomes especially interesting.
A 2025 systematic review and meta-analysis published in the Journal of Orthopaedic Surgery and Research evaluated protein and amino acid supplementation in patients undergoing hip or knee replacement.
The review included 19 studies involving 903 patients.
Researchers found that essential amino acid supplementation was associated with reduced quadriceps and hamstring muscle atrophy.
However, improvements in muscle strength were less consistent.
These findings suggest that targeted nutritional supplementation may help preserve muscle mass after surgery, but more research is needed to determine whether those changes consistently translate into faster walking, less pain, fewer complications, or better long-term outcomes.
Preserving muscle tissue and improving functional recovery are related goals, but they are not necessarily the same outcome.
The takeaway: Adequate protein intake makes physiological sense, and some supplementation strategies show promise, but nutrition should complement rather than replace rehabilitation and other proven aspects of joint replacement recovery.
What Is Immunonutrition?
One of the central topics of our discussion was immunonutrition.
Immunonutrition refers to nutritional formulas containing specific ingredients intended to influence immune function, inflammation, and the metabolic response to surgery.
Depending on the formulation, these may include nutrients such as:
- Arginine and other amino acids
- Omega-3 fatty acids
- Certain vitamins and minerals
- Other components intended to support nutritional status
Dr. Desai explained that immunonutrition has been studied for decades, initially gaining attention in general surgery before being explored in other surgical specialties.
Some studies in selected surgical populations have reported fewer infections or other postoperative complications.
However, there is an important distinction between evidence supporting particular formulations in particular types of surgery and evidence proving that every immunonutrition product improves outcomes after hip or knee replacement.
The benefits observed in general abdominal surgery, for example, cannot automatically be assumed to apply to orthopedic surgery.
Why Dr. Desai Founded Proven Therapeutics
Dr. Desai described how his interest in perioperative nutrition grew out of his surgical practice.
Over time, he began recommending different nutrients to patients but found that taking multiple separate supplements was inconvenient.
He eventually collaborated with an anesthesiologist and food science professionals to develop a nutritional formulation intended for perioperative use.
In the episode, he explains the practical difficulties of creating a supplement, including ingredient sourcing, product stability, taste, manufacturing, regulatory requirements, and third-party testing.
The company he founded, Proven Therapeutics, now markets a nutritional product designed around the perioperative period.
Dr. Desai also openly acknowledges an important limitation: his company has not yet completed its own clinical trials demonstrating improved surgical outcomes with its finished product.
Its rationale draws from existing research on individual nutrients and related nutritional formulations.
That distinction is important when evaluating any surgical supplement.
A biologically plausible formulation, ingredient-level research, third-party quality certification, and direct clinical evidence demonstrating improved patient outcomes are different forms of evidence.
Should You Stop Vitamins and Omega-3 Supplements Before Surgery?
This was one of the most provocative parts of our conversation.
Many surgical patients receive instructions to stop vitamins, herbal supplements, and other over-the-counter products before an operation.
Dr. Desai questions whether blanket recommendations to discontinue every supplement are always appropriate.
Omega-3 fatty acids are a particularly interesting example.
Historically, concerns about platelet function led some clinicians to recommend stopping fish oil before surgery.
However, a 2024 systematic review and meta-analysis involving more than 120,000 participants found no significant increase in overall bleeding events with omega-3 supplementation. The analysis did identify a modest increase in bleeding risk with high-dose purified EPA.
This suggests that the relationship between omega-3 supplementation and bleeding is more nuanced than commonly assumed.
Nevertheless, patients should not disregard their surgeon’s or anesthesiologist’s medication and supplement instructions.
Some supplements may interact with prescription medications, influence anesthesia, or introduce other safety concerns. Decisions should be individualized.
A useful step before surgery is to provide your surgical team with a complete list of everything you take, including vitamins, herbal products, nutritional powders, and over-the-counter medications.
Do You Really Need to Fast From Midnight Before Surgery?
Traditional instructions to avoid all food and drink after midnight are another subject of debate.
Dr. Desai expressed concern that unnecessarily prolonged fasting may be physiologically undesirable, especially for patients scheduled for surgery late in the afternoon.
Modern anesthesia guidelines are more nuanced than a universal midnight cutoff.
For appropriately selected healthy adults, American Society of Anesthesiologists guidelines support certain clear liquids until two hours before elective anesthesia.
However, this does not mean patients can consume any beverage until two hours before surgery.
The type of liquid, the patient’s medical history, the planned anesthetic, and the hospital’s protocols all matter.
Patients taking GLP-1 medications, such as semaglutide or tirzepatide, may require additional assessment because these drugs can affect gastric emptying.
The most important practical advice is to follow the specific fasting instructions provided by your surgical and anesthesia teams, rather than applying generalized advice from the internet.
Can You Replace an Arthritic Ankle Instead of Fusing It?
In the second half of our conversation, we shifted to Dr. Desai’s clinical specialty: foot and ankle surgery.
While most people are familiar with hip and knee replacement, many patients do not realize that total ankle replacement is also an option for advanced arthritis.
Unlike hip and knee osteoarthritis, ankle arthritis frequently develops after previous injuries.
A severe ankle sprain, fracture, or other traumatic injury may damage cartilage and lead to symptoms decades later.
When nonsurgical treatments no longer provide adequate relief, patients may be candidates for either ankle fusion or total ankle replacement.
Ankle Fusion Versus Ankle Replacement
Ankle fusion eliminates movement at the arthritic joint by surgically joining the bones together.
Total ankle replacement removes damaged joint surfaces and replaces them with artificial components designed to preserve some ankle motion.
Both procedures can relieve pain and improve function.
The major advantages and tradeoffs include:
Ankle fusion
- Reliable pain relief in appropriately selected patients
- Eliminates motion through the fused ankle joint
- Requires bone healing
- May increase stress on neighboring joints
Total ankle replacement
- Preserves some ankle motion
- May allow a different postoperative weight-bearing and recovery experience
- Requires sufficient bone and soft tissue support
- Carries risks of implant wear, loosening, or eventual revision surgery
Dr. Desai emphasizes that ankle fusion remains a good operation, even as total ankle replacement technology has improved.
The best choice depends on patient age, activity level, deformity, bone quality, and personal goals.
How Long Does an Ankle Replacement Last?
Ankle replacement longevity is an especially important issue for younger patients.
Modern hip and knee implants have demonstrated increasingly favorable long-term durability, but ankle replacements present different biomechanical and clinical challenges.
Dr. Desai uses approximately ten years as a simplified counseling example to illustrate why younger patients may face multiple revision procedures over their lifetimes.
That is not a universal expiration date: actual implant survival varies considerably, and many ankle replacements last longer.
He described his experience treating patients across a wide age range, including one remarkable 94-year-old who regained enough mobility after ankle replacement to return to independent living.
The story highlights an important principle of orthopedic surgery:
The patient’s overall health, functional goals, and quality of life may matter more than age alone.
Achilles Tendon Rupture: Is Surgery Better Than Nonsurgical Treatment?
Achilles tendon rupture treatment remains an active topic of debate among orthopedic surgeons.
Dr. Desai treats a substantial number of athletes and explains why he often favors surgical repair for selected patients.
He emphasizes the importance of rerupture risk, strength, return to activity, and the patient’s athletic demands.
However, treatment should not be determined by any single outcome.
For example, a professional athlete hoping to return to high-level competition may make a different decision than a recreational athlete who prioritizes avoiding an operation.
The quality and timing of nonsurgical functional rehabilitation also matter.
The central question is not simply whether surgery produces a statistically significant improvement in a study.
It is whether the expected difference is meaningful enough