Skip to content
K. Dean Olsen, M.D. · TRIA Orthopedics Burnsville · Shakopee · Bloomington, MN
Request an Appointment
Home › The Quiet Knee Protocol › Protein & Nutrition
Before and After Surgery

Protein & Nutrition

The one part of the protocol that starts before you ever get to the operating room.

After major surgery, your body starts breaking down your own muscle to fuel the healing. You can blunt that — but you have to start before the surgery, not after.

What is actually happening

Major surgery puts your body into what is called a catabolic state. It needs a great deal of energy to heal, and if you do not supply that energy, it takes it from the most convenient source available: your own muscle tissue.1,2

This is not a small effect, and it works directly against everything else in the protocol. Losing muscle in the weeks around surgery makes you weaker at exactly the moment you need to be doing the work that determines your result.

What adequate protein does

  • Preserves muscle mass through the recovery period.3–6
  • Reduces complications. Patients who maintain adequate protein levels tend to have fewer problems after surgery.7

The plan

An additional 25 to 30 grams of protein, twice a day:

This is on top of what you normally eat — not instead of it.
WhenWhat to do
2 weeks BEFORE surgery25–30 g of protein, twice a day
2 weeks AFTER surgery25–30 g of protein, twice a day
Low muscle mass?Start once a day now — do not wait for the two-week window

If you take a GLP-1 medication

This applies to you more than to anyone else. If you take Ozempic, Wegovy, Zepbound or a similar medication, protein matters even more. These medications blunt appetite so much that most people on them eat far too little protein: in a 2026 study of 387 adults taking them, average protein intake was about 33 grams a day, and fewer than one in ten met the recommended amount.11 They also accelerate the loss of muscle along with fat.12–14

Protein supplementation is not optional preparation for you — it is a vital part of it. Make sure the office knows you are taking one of these. It affects more than your nutrition plan.

What to buy

There are several good options, and the right one depends on your taste, your budget, and any dietary restrictions you have. You do not need a specific brand. The downloadable guide below lists the products my patients have had the best results with, including a dairy-free option, one selected for purity from heavy metal contaminants, and a Wisconsin-made whey protein isolate.

One practical note: many patients can use HSA or FSA funds for protein supplements. Check with your plan administrator.

Protein Supplementation for Surgery Recovery

The full guide, with specific products and where to buy them. PDF · 2 pages

English Español

Before you start. This is general guidance for surgical recovery, not individualized nutrition advice. If you have kidney disease, liver disease, or any condition that requires a protein-restricted diet, do not start a protein supplement without talking to us — or to the physician who manages that condition — first. If you are not sure, call the office and ask.

Sources

The amounts and timing above are my protocol. The references below are the published evidence behind the reasoning; the numbers in the text point to them.

  1. Schricker T, Lattermann R. Perioperative catabolism. Can J Anaesth. 2015;62(2):182-193. doi.org/10.1007/s12630-014-0274-y (opens in a new tab)
    Surgery switches the body to breaking down its own protein; a healthy adult can lose one to two kilograms of muscle after a major elective operation.
  2. Ferrando AA, Wolfe RR, Hirsch KR, et al. Pre- and post-surgical nutrition for preservation of muscle mass, strength, and functionality following orthopedic surgery. Nutrients. 2021;13(5):1675. doi.org/10.3390/nu13051675 (opens in a new tab)
    After knee replacement, thigh muscle can shrink by up to 18% within six weeks, most of it in the first two.
  3. Dreyer HC, Strycker LA, Senesac HA, et al. Essential amino acid supplementation in patients following total knee arthroplasty. J Clin Invest. 2013;123(11):4654-4666. doi.org/10.1172/JCI70160 (opens in a new tab)
    Randomized trial: 20 g of essential amino acids twice a day cut thigh-muscle loss from 14% to 3% at two weeks and from 18% to 6% at six weeks, with better mobility.
  4. Dreyer HC, Owen EC, Strycker LA, et al. Essential amino acid supplementation mitigates muscle atrophy after total knee arthroplasty: a randomized, double-blind, placebo-controlled trial. JBJS Open Access. 2018;3(2):e0006. doi.org/10.2106/JBJS.OA.18.00006 (opens in a new tab)
    Confirmatory randomized trial: less thigh-muscle loss with supplementation, and no safety problems.
  5. Ueyama H, Kanemoto N, Minoda Y, et al. Perioperative essential amino acid supplementation suppresses rectus femoris muscle atrophy and accelerates early functional recovery following total knee arthroplasty. Bone Joint J. 2020;102-B(6 Suppl A):10-18. doi.org/10.1302/0301-620X.102B6.BJJ-2019-1370.R1 (opens in a new tab)
    Randomized trial: 9 g a day of amino acids from one week before to two weeks after surgery preserved thigh muscle and sped the return to daily activities.
  6. Khani A, et al. Peri-operative protein or amino acid supplementation for total joint arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res. 2025. doi.org/10.1186/s13018-025-05847-4 (opens in a new tab)
    Review of 19 studies and 903 patients: supplementation around joint replacement reduces thigh-muscle loss.
  7. Tischler EH, et al. Hypoalbuminemia associated perioperative mortality, reoperation, and readmission rates among total joint arthroplasty procedures: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol. 2025. doi.org/10.1007/s00590-025-04468-1 (opens in a new tab)
    Review of 21 studies and more than 600,000 patients: low blood protein before surgery roughly doubles the chance of a repeat operation or readmission.
  8. Arapovic AE, Nham FH, Darwiche H, El-Othmani M. Nutritional considerations in hip and knee arthroplasty: a critical analysis of current evidence. JBJS Rev. 2024;12(8). doi.org/10.2106/JBJS.RVW.24.00033 (opens in a new tab)
    Recommends protein supplementation to a goal of 1.2-1.9 g per kilogram of body weight a day around hip and knee replacement, especially for people with low muscle mass.
  9. Coletta G, Jakubowski JS, Phillips SM, et al. Prevalence of sarcopenia indicators and sub-optimal protein intake among elective total joint replacement patients. Appl Physiol Nutr Metab. 2023;48(7):498-506. doi.org/10.1139/apnm-2022-0125 (opens in a new tab)
    Three-quarters of people awaiting joint replacement ate less than 1.2 g of protein per kilogram per day; those who ate more were stronger.
  10. Weimann A, Braga M, Carli F, et al. ESPEN practical guideline: clinical nutrition in surgery. Clin Nutr. 2021;40(7):4745-4761. doi.org/10.1016/j.clnu.2021.03.031 (opens in a new tab)
    The European surgical-nutrition guideline: surgical patients need about 1.5 g of protein per kilogram per day, and poor nutrition raises the risk of complications.
  11. Korus S, Cembrowska-Lech D, Kłoda K, Stachowska E. Dietary intake patterns and nutritional adequacy among adults with overweight or obesity treated with GLP-1 or dual GIP/GLP-1 receptor agonists. J Transl Med. 2026;24:532. doi.org/10.1186/s12967-026-07702-4 (opens in a new tab)
    387 adults on once-weekly GLP-1 or GIP/GLP-1 medications: average intake 753 calories and 33 g of protein a day; fewer than one in ten met the protein recommendation.
  12. Neeland IJ, et al. Changes in lean body mass with glucagon-like peptide-1-based therapies and mitigation strategies. Diabetes Obes Metab. 2024. doi.org/10.1111/dom.15728 (opens in a new tab)
    Review: lean tissue makes up a substantial share of the weight lost on these medications; protein and resistance exercise protect it.
  13. Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity (STEP 1). N Engl J Med. 2021;384(11):989-1002. doi.org/10.1056/NEJMoa2032183 (opens in a new tab)
    Body-composition substudy: lean mass fell 9.7% alongside fat mass.
  14. Look M, et al. Body composition changes during weight reduction with tirzepatide in the SURMOUNT-1 study. Diabetes Obes Metab. 2025. doi.org/10.1111/dom.16275 (opens in a new tab)
    About a quarter of the weight lost on tirzepatide was lean mass.