VO2 max before and after hip and knee replacement surgery for osteoarthritis patients: a narrative review

This narrative review investigates cardiovascular fitness in patients undergoing hip and knee replacement for osteoarthritis (OA), with a focus on changes in VO 2 max before and after surgery. VO 2 max is a key physiological marker of aerobic capacity that is associated with post-operative outcomes and long-term health. For nurses involved in orthopaedic care, understanding how VO 2 max is affected by surgery and rehabilitation can inform patient education, discharge planning, and postoperative recovery strategies. Patients scheduled for total knee or hip replacement commonly present with low preoperative VO 2 max compared to matched healthy controls. While some studies hypothesise that this is due to reduced physical activity, direct measurement of activity levels or multivariate adjustment was generally lacking. Postoperatively, structured rehabilitation programmes may lead to improvements in VO 2 max, although findings vary based on the type, intensity, and duration of the intervention. Low-frequency or home-based exercise showed small improvements, while more intensive programmes, such as high-intensity interval training, had greater effects. However, many studies excluded patients with common comorbidities, limiting generalisability. Hip and knee replacement surgery may provide a critical window for improving cardiovascular fitness, especially when accompanied by targeted rehabilitation. These findings have important implications for nursing practice. Nurses can play a pivotal role in promoting structured aerobic exercise, supporting use of wearable technologies, and ensuring recovery pathways address cardiorespiratory health alongside joint mobility. Further research is needed to determine optimal rehabilitation strategies, improve inclusivity in VO 2 assessment, and evaluate long-term outcomes in diverse patient populations.