Muscle Loss and Surgery: Protecting Your Strength During Recovery

The Hidden Risk to Strength During Surgical Recovery

Orthopaedic surgery is a primary step toward reclaiming your lifestyle, but there is a hidden challenge that many patients don’t notice until they are back home: the rapid loss of muscle. While the goal of surgery is to restore your mobility, the procedure and the recovery period can act as a drain on your physical strength as your body works to recover and rebalance itself.

Fortunately, just by learning this, you have taken the first step to help prevent major loss of muscle and strength with your procedure. There are strategies you can use to help support your strength and make it easier to return to the activities you love. But first, let's breakdown muscle loss, sarcopenia, why they happen, and why it matters to you.

What Is Sarcopenia?

In the medical world, the loss of muscle mass, strength, and function is known as sarcopenia. While we often think of this as a slow process that happens over decades, surgery can cause a sudden, sharp decline in muscle during a short period of time.
Several factors come together during surgery to accelerate this breakdown:

Elevated Resource Requirements: As your body initiates its surgical stress response to heal, the demand for energy sky-rockets. To find the building blocks (amino acids) needed to repair tissue and create energy, the body may need to break down its own muscle.
Higher Inactivity: During bed rest and inactivity, your body does not get the signals it needs to continue to build muscle, so muscle loss occurs.
Reduced Appetite: Post-surgery you may experience a reduced appetite or difficulty eating. If you don't consume enough protein to meet the body's elevated needs, your recovery period can be prolonged.

Why Does Muscle Loss Matter?

Muscle is important to your body before, during, and after surgery, so it is essential to try to preserve as much as possible.
Before Surgery: It can be helpful to view your muscle as a protein bank. Protein consumption and physical activity are ways to input resources into your account, so it is best to try to fill up your account before the high costs of surgery and resulting inactivity are charged. This will help reduce muscle loss during surgery as the body will better be able to meet increased amino acid needs.
During Surgery: The only way amino acids in your body can be stored is in your muscle. So, if you have low amounts of muscle going into surgery, this makes it harder for the body to support itself through the surgical stress response. Surgery is energetically expensive and will withdraw resources from your muscle, breaking it down in order to gather the materials needed to support wound healing and energy production.
After Surgery: Having sarcopenia or low muscle mass/protein reserves leads to more muscle loss with surgery, which can translate into major impacts on your lifestyle and quality of life after surgery. Sarcopenia increases risk of falls, fractures, and can lead to longer hospital stays. This is why preserving muscle is so key for surgical patients and to a successful recovery.

Who Is Most at Risk?

While every surgical patient will be affected by muscle loss, the effect can be more pronounced in certain cases.

Older Adults: Because of a blunted response to protein (called anabolic resistance), older patients often need more protein than younger ones just to maintain the same amount of muscle. Additionally, older adults can lose muscle significantly faster during bed rest compared to younger individuals (1). In some cases, ten days of hospital inactivity can lead to two or three times the muscle loss seen in younger individuals over a much longer period (1).
Frailty: If you are managing frailty - a condition where the body has a harder time bouncing back from minor stressors - the impact of surgery can feel more significant.
Malnutrition: Many older surgical patients may only be hitting about 22–36% of their actual protein requirements before they even get to the hospital (2). This means that the costs of the surgical stress response will hit the body even harder due to lower reserves.
Inactivity Prior to Surgery: If joint pain has kept you inactive leading up to your procedure, your amount of muscle might be lower than ideal.

How to Mitigate Muscle Loss Before and After Surgery

The good news is that muscle loss is not an "all or nothing" situation. You can help dampen these effects by taking proactive steps to support your "Muscle Protein Synthesis" (the process of building muscle).

Build Muscle: Work on building muscle through diet and exercise- the more muscle you have going into surgery, the more you have to draw from during recovery.
Increase Protein Intake: Aim for roughly 1.2 to 2 grams of protein per kilogram of body weight per day to help provide the raw materials your body needs. Focus on proteins rich in leucine, an amino acid that acts like a start button for muscle building.
Spread Your Protein Out: Your body can't store protein for later. Instead of a large dinner, try to get 25–30g of protein at each meal. This keeps the muscle building signal active throughout the entire day.
Early and Safe Mobilization: As soon as your surgical team gives the okay, start moving. Even simple movements signal to your body that its muscle tissue is still needed and should be preserved.
Creatine Supplementation: Creatine monohydrate is a nutrient that helps your body create more energy. This can support you when becoming physically active and provide more energy to support strength building.

Nutrition and exercise are both key to your recovery. They work together and enhance each other's benefits to increase muscle building and even to reduce muscle breakdown in times when you are not eating (3).

Rebuilding Is Part of Recovery

Many people view recovery as a period of pure rest, but it is actually a critical window of active rebuilding. Prioritizing nutrition and exercise is a proven way to build the muscle you need for the surgical recovery process. By treating your muscles as a vital resource that needs protection, you support your independence, mobility, and longevity.

Scientific References:

Mamerow MM et al. Dietary Protein Distribution Positively Influences 24-h Muscle Protein Synthesis in Healthy Adults. J Nutr. 2014;144(6):876-880.
Hirsch KR, Wolfe RR, Ferrando AA. Pre- and Post-Surgical Nutrition for Preservation of Muscle Mass, Strength, and Functionality Following Orthopedic Surgery. Nutrients. 2021;13(5):1675.
Churchward-Venne TA, Burd NA, Phillips SM. Nutritional regulation of muscle protein synthesis with resistance exercise: strategies to enhance anabolism. Nutr Metab. 2012;9(40).
Arentson-Lantz E et al. Important Concepts in Protein Nutrition, Aging, and Skeletal Muscle: Honoring Dr Douglas Paddon-Jones (1969–2021) by Highlighting His Research Contributions. J Nutr. 2023;153(3):615-621.

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