Pre-operative Inspiratory Muscle Strength Training in Total Joint Surgery

This study tests whether a breathing exercise program — called inspiratory muscle training (IMT) — done before hip or knee replacement surgery can reduce the risk of lung complications after the operation. This is especially important for patients who smoke or have lung conditions. You may be eligible if: - You are 18 or older and scheduled for total joint (hip or knee) replacement surgery - You have a current or past history of tobacco use (including vaping with nicotine) - You have one or more risk factors for post-surgery lung problems (e.g., lung disease, shortness of breath, or weak respiratory muscles) - Your surgery is expected to take more than 30 minutes - You are able to follow instructions for the breathing exercises You may NOT be eligible if: - Your health status is classified as ASA physical status 4 or higher (very severe systemic disease) - You had pneumonia or a lower respiratory infection in the past two weeks - You currently depend on continuous supplemental oxygen - You need positive pressure breathing support while awake (night-time CPAP is allowed) - You have a neurological condition such as MS, ALS, Parkinson's, or prior stroke - You are already in a pulmonary rehabilitation program - You have severe COPD (GOLD stage 3 or higher, FEV1 < 50% predicted) - You have an active infectious disease requiring isolation (e.g., COVID-19) Talk to your doctor to see if this trial is right for you.