Nutrition for Recovery After Hip and Knee Injury or Surgery

A Clinician-Reviewed Guide to Nutrition That Supports Healing, Muscle Recovery, and Return to Function

Patients often focus on physical therapy after injury or surgery, but nutrition plays an equally important role in recovery. In this guide, I explain the evidence behind nutrition, protein, hydration, and supplementation strategies that help support healing, preserve muscle, and optimize recovery after hip and knee injury or surgery.

–Dr. Ramkumar

Why Nutrition Matters After Hip and Knee Injury or Surgery

Key nutrients are used daily to assist muscle growth, recovery, and repair. However, during a period of injury, nutrition becomes an even more vital component of the post-injury and rehabilitation period. Having the proper nutritional components, in conjunction with proper therapy and re-training, can get you back in the game stronger and faster!

Nutrition Goals During Recovery

I believe nutrition during injury and surgery is an underrated subject matter and warrants consideration to recover smartly and rapidly.

Although it may seem common practice to believe that your energy needs will decrease during injury as a result of decreased activity, that is actually not the case. Energy needs are slightly higher during injury to assist with the healing process. Depending on severity, resting energy expenditure (calories burned) can increase by 20%. Furthermore, immobilization of lower extremities and use of crutches can increase expenditure 2–3 fold. It is more important to achieve energy balance during the time of injury healing to ensure your body has sufficient calories and nutrients to attenuate muscle loss.

Key Nutrients That Support Recovery

I. Protein: Preserving Muscle and Supporting Healing

During the immobilization phase, muscle loss is greater, which can in turn lead to decreased strength. Athletes already have an increased protein need without injury. Therefore, the importance of protein during injury is even more vital. Although protein needs are highly individualized, a good rule of thumb during injury is 1.7 – 2.0 g/kg daily. Protein should be included at every meal and snack, and spread out evenly throughout the day to ensure maximum absorption. Once the rehabilitation phase begins, protein should also be included following rehabilitation sessions.

II. Anti-Inflammatory Foods That Support Recovery

• Role: reduce inflammation, speed recovery time, support lean body mass
  • Omega-3 Fatty Acids
    ◦ Sources: Salmon, Tuna, Mackerel, Nuts/Seeds, Whole Eggs
    ◦ Tip: Choose Salmon over Chicken for your protein source at meals
  • Flavonoids
    ◦ Sources: Berries, Cocoa, Onions, Kale, Broccoli, Citrus Fruits & Juices, Soybeans, Legumes
    ◦ Consume multiple times per day
  • Proteases
    ◦ Sources: Pineapple, Papaya, Cheese, Whole Grains
    ◦ At least once daily
  • Spices
    ◦ Sources: Turmeric/Curcumin, Parsley, Thyme, Garlic
    ◦ Tip: Use these spices when cooking meats and starches

III. Antioxidants That Support Tissue Repair

• Role: wound and bone healing, synthesizing new collagen, tissue repair
  • Vitamin C
    • Sources: Bell Peppers, Citrus Fruits, Leafy Greens, Broccoli, Strawberries, Asparagus
    • Vitamin C + Collagen before pre-loading activities to increase collagen synthesis
  • Zinc
    • Sources: Grass-fed Beef, Hummus, Yogurt, Cashews, Pumpkin Seeds, Mushrooms
  • Calcium
    • Sources: Dairy Products, Kale, Canned Salmon/Sardines (with bones), Okra, Almonds

IV. Branched-Chain Amino Acids (BCAAs) for Recovery

Performance and recovery is a very important subject to me and many of my patients. In the context of hip and knee surgery less is known and understood about this in comparison to his athletes recovering from less invasive, sports medicine procedures. With that being said, I do not want you to take the first two weeks after injury or surgery slowly to maintain safety, control your pain, and minimize persistent swelling. Taking it slow does not mean you are compromising your performance! You can recover smart, and if feasible, please consider purchasing the below to take 5 days before surgery and 25 days after surgery with water.

XTEND Original BCAA Powder

The above recommendation is backed by science, and you can read more about it in the Journal of Bone and Joint Surgery here and here.

V. Creatine for Strength and Muscle Recovery

Similarly, I recommend creatine monohydrate as well. Approximately half of the body’s creatine is obtained through dietary intake, primarily from meat and fish, while the remaining half is synthesized endogenously from amino acids. Creatine supplementation during rehabilitation has been shown to accelerate recovery of muscle mass and strength after immobilization compared with placebo, suggesting a potential benefit in the setting of disuse atrophy and subsequent physical therapy. Starting with 20 g/day during the loading phase for 5 to 7 days followed by a 3 to 5 g/day maintenance dose has been shown to be helpful.

Creatine Monohydrate

(There also exists fascinating early data that suggests creatine may even help prevent Alzheimer’s disease!)

The above nutrition recommendations are backed by science, and you can read more about it in this Journal of Bone and Joint Surgery article.

Foods and Habits That Can Slow Recovery

• Alcohol, Marijuana, and Nicotine
• Can negatively impact cell signaling and protein synthesis, which are important for recovery and maintaining lean body mass
• Processed/Refined Foods
• Can increase the body’s inflammation levels and provide nutrient-poor sources of calories
• Examples: packaged foods, refined oils, sugar

Sample Recovery Nutrition Plan

I recommend following the Athlete’s Plate model as a daily guide:

Evidence-Based Supplementation Protocol

I recommend the following supplementation protocol to support your recovery:

Key Takeaways for Recovery Nutrition

✓ Protein at Every Meal   ✓ Stay Hydrated   ✓ Antioxidants + Anti-Inflammatories ✓ Follow Supplementation Protocol   ✓ Heal