Physical Therapy After Knee Replacement

If you have had a total knee replacement, also known as TKR, you will need physical therapy after surgery. This will help you regain mobility.

A post-operative protocol is a guideline that your surgeon and physical therapist (PT) may follow. It ensures you are making progress after your knee surgery. The TKR protocol gives you and your PT a framework for building your rehabilitation program.

This article will show you the physical therapy protocols from right after surgery, while you're still in the hospital, through to advanced exercises.

senior man with care worker at home touching the senior's leg - stock photo

Sturti / Getty Images

Physical Therapy in the Hospital

When you wake up after your TKR surgery, your knee may be in a continuous passive motion (CPM) machine. This device helps gently and slowly bend and straighten your knee.

Settings on the CPM adjust the amount of motion at your knee joint. Your healthcare provider and PT can work with you to ensure the CPM machine is set properly.

A physical therapist may visit you in the hospital on the first day after your surgery. This person is called an acute care physical therapist. In that visit, your acute care PT may help you:

  • Sit up in bed
  • Get out of bed
  • Start to walk

A standard walker or wheeled walker is often used after surgery. This device will give you extra support while you are walking.

Your acute care PT will also have you do knee exercises in the hospital. These exercises help improve your knee's range of motion and strength. They also help keep your ankles and hips moving. This will make walking easier.

Simple exercises can help stop blood from pooling in your body. Examples include:

  • Pumping your ankles
  • Squeezing your buttocks

These exercises help prevent a serious condition called deep vein thrombosis (DVT). This is when a blood clot blocks a large vein. You are particularly at risk if you are immobile for an extended period, such as after surgery.

After TKR, your main goal is to become independent with functional mobility. This includes:

  • Moving while in bed
  • Getting out of bed
  • Walking

If you have stairs in your home, you must be able to navigate them. Your acute care PT can also help prepare you for this. Once you can do these things, you will be ready to leave the hospital.

Physical Therapy After Leaving the Hospital

You should have improved functional mobility after two to three days in the hospital. At this point, you will be discharged to your home or to a sub-acute rehabilitation facility.

Sub-Acute Rehabilitation

If you still need nursing care or more intense rehabilitation, you may be moved to a sub-acute rehabilitation facility.

This is an inpatient center that will help you get to the point where you will be able to go home. Here, you will focus on improving knee range of motion and strength.

Sub-acute rehabilitation lasts about one to two weeks. A typical day involves two sessions of physical therapy.

Your PT will help you improve your knee strength and range of motion. You may continue with the CPM machine if your healthcare provider feels it will help.

Home and Outpatient Physical Therapy

If you are sent home, you may choose to have a home care PT visit you. This option is usually for people who can't travel to an outpatient physical therapy center.

Your goal for home physical therapy is to make sure you can move safely in your home. You will keep working on knee range of motion and strength. Walking and stair climbing may also be a part of your home physical therapy.

Scar tissue will form as your incision heals. Your PT may use gentle scar tissue massage and mobilization to help improve the mobility of your incision. This can help the skin and other tissues around your knee move more freely.

You may begin outpatient physical therapy if you can travel to a physical therapy center. There, you will keep improving your knee range of motion. You should be able to bend your knee to a 90-degree angle by the end of week two.

How Long Will Healing Take?

Recovery comes in stages. You’ll be discharged from the hospital within four days. You may be able to resume normal activities within three to six weeks. You may continue to have swelling for months after surgery. You will need to work with a physical therapist to regain mobility.

Early Exercises After Knee Replacement

You should work in an outpatient physical therapy center by the third week.

Your therapy will include more range of motion exercises. These should continue to help you improve your knee motion. By the end of week six, your knee motion should be about 100 to 105 degrees.

You may benefit from riding a stationary bicycle after TKR surgery. Your PT will help you find the right seat height.

Don't be surprised if you can't pedal all the way around when you first start. Keep working the pedals forward and backward. As your range of motion improves, you should be able to pedal the bike fully.

You will keep doing exercises that build strength in your knee. Your PT will also teach you exercises to improve the strength of other muscles, including your:

Simple straight leg-raising exercises will help you build these muscles. You may add cuff weights to your lower leg or ankle as your strength improves.

Your PT may also use neuromuscular electrical stimulation (NMES). This will help your quadriceps contract and improve your ability to use these muscles on your own.

During the three- to six-week post-op period, your PT will help you improve your ability to walk. You’ll gradually increase your distance and time. For the first six weeks, you’ll likely need some support when walking, like a cane, walker, or single crutch. Your physical therapist may recommend you work up to 30 minutes of walking two or three times a day during recovery.

During this time, you may still use ice to help control pain and swelling around your knee joint. Sometimes swelling persists for many weeks after TKR surgery.

Advanced Exercises After Knee Replacement

During the final two weeks of your rehabilitation, you should work with your PT to maximize your functional mobility. Exercises will focus on gaining strength in the muscles around your knee and leg.

You may do more advanced balance exercises. You may also use a BAPS board. This is a device that can help you improve your balance. It can also help you improve your proprioception, which is your ability to sense your body's position in space.

During this time, you should move on to walking without an assistive device. Your pain should be under control.

As you get close to the end of your rehabilitation, ask your PT about how to keep up your exercise program. A fitness center with stationary bicycles and weight training equipment can help you maintain mobility and strength after TKR surgery.

Summary

Physical therapy after total knee replacement can help you regain your mobility. In the first day or two after surgery, an acute physical therapist will help you leave your hospital bed. You will start to walk using an assistive device.

After you leave the hospital, you will continue therapy at home or in a physical therapy center. You should be able to bend your knee 90 degrees at the end of the second week.

Physical therapy will continue to focus on improving strength and mobility. You should move from a walker to a cane during weeks three through six. Your pain should be under control by the end of the eighth week. You should be able to walk without an assistive device.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Academy of Orthopaedic Surgeons. Total knee replacement.

  2. American Academy of Orthopaedic Surgeons. Total knee replacement exercise guide.

  3. American Academy of Orthopaedic Surgeons. Deep vein thrombosis.

  4. American Academy of Orthopaedic Surgeons. Total knee replacement.

  5. Mutsuzaki H, Takeuchi R, Mataki Y, Wadano Y. Target range of motion for rehabilitation after total knee arthroplastyJ Rural Med. 2017;12(1):33–37. doi:10.2185/jrm.2923

  6. Peng L, Wang K, Zeng Y, Wu Y, Si H, Shen B. Effect of neuromuscular electrical stimulation after total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Front Med (Lausanne). 2021;8:779019. doi:10.3389/fmed.2021.779019

  7. Yau LK, Henry F, Man Hong C, et al. Swelling assessment after total knee arthroplasty. J Orthop Surg (Hong Kong). 2022;30(3):102255362211276. doi:10.1177/10225536221127668

Brett Sears, PT

By Brett Sears, PT
Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.