Total Knee Replacement Rehabilitation Guide
A comprehensive 12-week rehabilitation protocol following total knee arthroplasty. From immediate post-op care to return to daily activities.
Understanding Your Knee Replacement
Total knee replacement (TKR) is one of modern medicine's most successful procedures. The damaged knee joint is replaced with metal and plastic components, creating a new articulation that should last 15-25 years. But surgery is just the beginning—rehabilitation determines your final outcome.
Think of your new knee as a fresh start, but one that requires careful breaking in. The tissues need time to heal, the muscles need retraining, and the brain needs to learn trust in the joint again. The rehabilitation process follows a carefully timed sequence that balances healing with loading.
The 'Motion is Lotion' Philosophy
Successful TKR recovery is guided by one principle: early protected movement prevents stiffness while protecting the healing surgical site. Too little motion causes permanent stiffness. Too much motion can damage healing tissues. This protocol finds the sweet spot—progressive loading that promotes healing without compromising the surgical repair.
Recovery Timeline Overview
Understanding what to expect at each stage helps you stay on track:
Understanding Your Results (weeks)
Wound healing, pain control, achieve 0-90° flexion, walker-assisted ambulation
Progress to 110° flexion, wean from walker to cane, normalize gait pattern
Achieve 115° flexion, walk unassisted, return to light recreational activities
Full functional ROM, return to recreational activities, maintain surgical outcomes
Week 0-2: Protection Phase
The goals are simple but critical: wound healing, pain control, and early motion.
Daily Milestones
Week 0-2 Priorities and Actions
| Factor | Effect | What to Do |
|---|
Always tell your doctor about medications, supplements, and recent health events before testing.
Essential Exercises (Weeks 0-2)
Quadriceps Sets:
- Lie or sit with surgical leg extended
- Push knee down into surface, tightening thigh muscle
- Hold 5-10 seconds, relax
- 3 sets of 10-15 reps, 3x daily
Straight Leg Raises:
- Lie on back, tighten quad, lift leg 12 inches
- Keep knee straight throughout
- Hold 3-5 seconds, lower slowly
- 3 sets of 10 reps, 3x daily
Heel Slides:
- Lie on back, slide heel toward buttock
- Bend knee as far as comfortable
- Return to full extension
- Use plastic bag under heel for easier sliding
- 3 sets of 10-15 reps, 3x daily
Week 2-6: Mobility Phase
This is where most people see dramatic improvement. Focus shifts from protection to progression.
Mobility Progression
Key Exercises (Weeks 2-6)
Wall Slides for flexion:
- Lie on back near wall with feet on wall, knees bent
- Let gravity help knees bend toward floor
- Slide feet down wall to increase stretch
- Hold at maximum stretch for 30 seconds
- 2 sets of 10-15 reps, 2x daily
Mini Squats for function:
- Stand holding counter for support
- Squat slightly, bending knees 20-30 degrees
- Keep weight evenly on both feet
- Avoid going past 90 degrees
- 2 sets of 10 reps, 2x daily
Step Ups for confidence:
- Use step with handrail
- Step up with surgical leg, bring non-surgical up
- Step down with non-surgical first, then surgical
- Start with 4-inch step, progress to standard step height
- 2 sets of 10 reps, 2x daily
Week 6-12: Strengthening Phase
Now that mobility is established, focus shifts to strength and endurance.
Strengthening Progression
| Factor | Effect | What to Do |
|---|
Always tell your doctor about medications, supplements, and recent health events before testing.
Warning Signs: When to Seek Help
Red Flags That Require Medical Attention
Seek immediate care (ER) for:
- Calf pain or swelling: Possible DVT (blood clot)—life-threatening if it travels to lungs
- Shortness of breath or chest pain: Possible pulmonary embolus—call 911
- Increasing redness, warmth, or drainage: Possible infection—contact surgeon within 24 hours
- Fever above 101°F (38.3°C): Possible infection—contact surgeon
Seek urgent care (surgeon's office) for:
- Sudden increase in pain: May indicate mechanical problem
- Pain not improving: Or worsening after initial improvement
- Stiffness plateau: ROM not improving for 2+ weeks—may need manipulation
- New swelling: After period of minimal swelling
Pain and Swelling Management
Managing post-op symptoms effectively makes rehabilitation more comfortable and productive:
The R.I.C.E. Protocol:
- Rest: Balance activity with elevation periods, but avoid bed rest
- Ice: 15-20 minutes, 3-4 times daily, especially after exercise
- Compression: TED stockings as prescribed (usually 6-12 weeks)
- Elevation: Elevate leg above heart level when resting
Medication Management
Take prescribed medications as directed:
- Blood thinners: Continue as directed (aspirin, rivaroxaban, etc.)—typically for 2-6 weeks minimum to prevent DVT
- Pain medication: Transition off opioids as quickly as possible
- Anti-inflammatories: May be prescribed after initial healing
- Stool softeners: Use while taking opioids to prevent constipation
Never stop blood thinners without medical clearance—DVT risk is real and dangerous.
Nutrition for Optimal Healing
Your body needs the right building blocks to repair tissues:
Nutritional Support for Recovery
| Factor | Effect | What to Do |
|---|
Always tell your doctor about medications, supplements, and recent health events before testing.
Driving and Return to Work
Driving:
- Right knee surgery: 4-6 weeks before driving
- Left knee surgery: 2-3 weeks (automatic transmission)
- Requirements: Off narcotic medications, adequate reaction time, sufficient braking strength
Return to work:
- Desk job: 4-6 weeks
- Light duty: 6-8 weeks
- Heavy labor: 3-4 months
Discuss timing with your surgeon—individual factors matter.
Expected Outcomes
By 3 months, most people achieve:
- Knee flexion: 115-120°
- Full extension: 0°
- Walking 1/4 mile without assistance
- Stairs: Reciprocal pattern (one foot per step)
- Minimal pain with normal activities
Full recovery continues for up to 12 months as strength and endurance continue to improve.
Setting Realistic Expectations
Your new knee will feel different than your native knee. Some mild clicking or warmth is normal and may persist for months. Complete pain relief is not guaranteed—some people have mild aching with weather changes or overactivity. However, most people report significant improvement in pain and function compared to pre-surgery. Satisfaction rates are 85-90% at 10 years.
Long-Term Protection
Your new knee will last longer with some precautions:
- Avoid high-impact activities: Running, jumping sports, high-impact aerobics
- Recommended activities: Walking, swimming, cycling, golf, dancing, hiking
- Maintain healthy weight: Each extra pound adds 4-6 lbs of pressure across the knee
- Continue exercises: Maintenance program 2-3 times weekly
- Report infections: Any dental or surgical procedures requires antibiotics to prevent joint infection
Common Questions
References
References
- [1]American Academy of Orthopaedic Surgeons (AAOS). Surgical Management of Osteoarthritis of the Knee. 2023. https://www.aaos.org/
- [2]British Orthopaedic Association. Knee Replacement: Guidelines for Recovery. 2022. https://www.boa.ac.uk/
- [3]National Institute for Health and Care Excellence (NICE). Total Knee Replacement Post-operative Care. NG157. https://www.nice.org.uk/guidance/ng157
- [4]American Physical Therapy Association. Clinical Practice Guidelines for TKR Rehabilitation. 2022. https://www.apta.org/
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Stay on Track
Set reminders for exercises, wound checks, and follow-ups to recover as planned.