Researchers analyzed 45 immune biomarkers in 152 adults aged 60+ undergoing knee replacement surgery, finding that preoperative blood profiles predicted 12-24% of variance in postoperative resilience outcomes. Key predictive markers included LBP, leptin, TNFR1, CD30, and LIF, measured both in plasma and through stimulated blood samples. Notably, pain recovery showed distinct immune signatures from functional recovery—pain predictors mapped to local inflammatory and neuroimmune pathways, while functional recovery correlated with systemic inflammatory load and cytokine signaling. This divergence suggests biologically separate mechanisms govern different aspects of surgical recovery. The findings could revolutionize perioperative care by enabling personalized risk assessment and targeted interventions based on individual immune profiles. However, this preprint awaits peer review and results may change. The modest predictive variance indicates immune markers are just one piece of the recovery puzzle. While promising for developing precision medicine approaches to surgical outcomes, larger validation studies across diverse populations will be essential before clinical implementation.