This randomized controlled trial aims to evaluate the role of preoperative respiratory exercises in reducing postoperative pulmonary complications (PPCs) such as atelectasis, pneumonia, and hypoxia, and in shortening the hospital stay in surgical patients. A total of 126 adult patients (>40 years), scheduled for total knee or hip replacement surgeries at Horizon Hospital Lahore, will be randomly assigned into two groups: the intervention group and the control group.

The intervention group will receive preoperative respiratory exercises including incentive spirometry, deep breathing exercises, and chest physiotherapy, one day before surgery. The control group will receive standard preoperative care without any respiratory exercises. Clinical assessments post-surgery will determine the presence of PPCs and hospital stay duration.

Inclusion Criteria:

• Adults aged over 40 years.
• Scheduled for total knee replacement (TKR) or total hip replacement (THR) surgery.
• Able to understand and follow instructions (cognitively intact).
• Provide informed consent to participate.

Exclusion Criteria:

• Patients will be excluded from the study if they meet any of the following conditions:
• Age below 40 years.
• Pregnancy.
• Edentulous patients (patients with no teeth).
• Patients with spinal or backbone injuries.
• Patients with contraindications to incentive spirometry or chest physiotherapy (e.g., recent eye surgery, rib fractures).
• Patients with impaired cognitive function who are unable to perform respiratory exercises correctly.