The long-term outcomes following primary TJA for OA are favorable. However, surgery alone fails to fully restore physical function and address longstanding impairments associated with chronic joint disease. Older adults undergoing TJA can gain similar benefits as those who are younger; however, the elderly are at increased risk for adverse events. Frailty, more so than age, is related to suboptimal outcomes. To what extent appropriate and sufficient rehabilitation can further improve health outcomes including activity and participation and positively impact prosthesis survival and need for revision is still unclear. There is evidence to suggest that evaluation and management of perioperative psychosocial and other patient factors are important in enhancing outcomes after TJA. Further, there is a growing body of research that points to the importance of progressive resistance training after TJA to address the muscle weakness associated with aging and end-stage hip and knee OA, and secondary to the surgery itself, and to optimize functional outcomes. With the projected increases in number of individuals undergoing TJA over the next two decades, it becomes even more critical to develop cost-effective rehabilitation strategies and identify individuals who would most benefit from such interventions.