Rehabilitation after total hip and knee arthroplasty is a rapidly expanding discipline. With the introduction of minimally invasive techniques and the pressure of insurance regulations, postoperative rehabilitation has been placed on an accelerated track. As surgeons turn to more aggressive postoperative protocols and early entry into outpatient therapies, we introduce a pre- and postoperative program involving the Pilates method. Renewed patient interest in the use of Pilates for postoperative rehabilitation has led to the development of safe and modified exercises for patients undergoing total hip or knee arthroplasty. While this technique appears safe and effective anecdotally, further controlled trials are necessary to prove its validity.