The effect of pre-operative physiotherapy for total hip and knee arthroplasty candidates has been controversial, despite its widespread practice in major orthopaedic hospitals in the US, a review study in 2004 found inadequate evidence to support the use of pre-op physiotherapy . A more recent review paper  published 2013, however indicates that pre-operative physiotherapy, including strengthening, stretching, and functional activities improved; patient satisfaction, pain reduction and reduced the likelihood of the patient needing discharge to a rehabilitation facility post-op.
In an Irish context, pre-assessment clinic prior to elective total knee or hip replacement surgery is commonplace but, structured pre-op physiotherapy is virtually non-existent. An extremely important outcome measure in the recent review highlights the effect of pre-operative physiotherapy on discharge destination following total hip and knee arthroplasty. Pre-op physiotherapy significantly reduced the numbers of patients requiring “step down care” at a rehabilitation facility post-op. In practice this means that, having undergone their programme of rehabilitation prior to their surgeries, patients were speedier in their post-op recovery and were more likely to be discharged straight home or back to the same level care facility that they were admitted from. If six weeks, or whatever the predetermined optimum programme length, of class based structured exercises overseen by a chartered physiotherapy saved even one admission per cohort from a two week stay in a rehabilitation facility, it would surely be financially sustainable?
This is to make no mention of the conclusions that patients reported greater levels of satisfaction with their outcomes when they had completed pre-operative physiotherapy or that they reported less post-operative pain. There appears to be little by way of logical argument to not offer pre-operative physiotherapy to elective orthopaedic patients, neither a financial case nor a case in terms of patient outcomes or satisfaction levels.
 Ackerman IN., Bennell KL. Does pre-operative physiotherapy improve outcomes from lower limb joint replacement surgery? A systematic review. Australian Journal of Physiotherapy 2004;50:25-30.
 Gawel, JA., Brown, SE., Collins JC., McCallum, C. Does pre-operative physical therapy improve post-surgical outcomes of patients undergoing a total knee and/or total hip arthroplasty? A systematic review. Physiotherapy Practice and Research 2013;34:9-20.