Congratulations! You’ve decided to finally go through with it and have a total knee replacement surgery. The joint replacement surgery itself is the easy part. You get to go to sleep and wake up with a brand new knee joint thanks to your orthopedic surgeon. Now, however, the acute postoperative phase begins.
You get to go to sleep and wake up with a brand new knee joint thanks to your orthopedic surgeon.
Knee pain, leg swelling, and joint stiffness will dominate during this acute postoperative phase. This phase will require a large amount of dedication, commitment, and hard work on your part. Unfortunately, surgeons sometimes do a poor job of accurately portraying the true amount of hard work that patients will need to put forth to obtain an optimal functional outcome postoperatively. As a physical therapist, helping my patients through this difficult phase is an immensely gratifying experience and one that I am excited to help guide you through as well. Physical therapy exercises after a total knee replacement surgery have been found to speed up and improve physical function.
- Convenient Access: Print or Use On-the-Go on Any Mobile Device
- Customized Healing Plans: Easy-to-Follow, Tailored Exercise Guides
- Holistic Recovery: Reduce Pain, Improve Mobility, & Increase Strength
- Comprehensive Progression: All-in-One Rehab Worksheets Include a Progressive Exercise Sequence for Optimal Results
- Expertly Designed by Dr. Tim Schuckers, PT, DPT, OCS
Convenient Access: Print or Use On-the-Go on Any Mobile Device
Customized Healing Plans: Easy-to-Follow, Tailored Exercise Guides
Holistic Recovery: Reduce Pain, Improve Mobility, & Increase Strength
Comprehensive Progression: All-in-One Rehab Worksheets Include a Progressive Exercise Sequence for Optimal Results
Expertly Designed by Dr. Tim Schuckers, PT, DPT, OCS
Table of Contents
Total knee replacement surgery, formally known as total knee arthroplasty (TKA), is considered the gold-standard treatment for end-stage knee osteoarthritis. Most patients report significant improvements in functional status after successful completion of a postoperative rehabilitation program. However, long-term outcomes are variable depending on a few different factors. These factors include:
- Period of Time (Duration) That the Knee Pain Has Been Worsening Prior to Surgery
- Severity of the Joint Arthritis Prior to Surgery
- Ability to Bend the Knee Through Full Range of Motion Prior to Surgery
- Your Dedication to Performing Knee Strengthening and Stretching Exercises Postoperatively
If you haven’t yet had a total knee replacement surgery, you’ll want to read my article on the 8 Must-Do Knee Replacement Exercises Before Surgery!
Postoperative Pain Management
Just before the surgery begins, the anesthesiologist and surgical team will provide a nerve block injection with a local anesthetic (pain relief medication). The nerve that is most often targeted for the nerve block is the Femoral Nerve, which is located in the front of the thigh, as it controls the pain sensations in most of the areas around the knee. The nerve block helps relieve postoperative pain in the knee and leg for approximately 24-48 hours.
The key here is to begin taking the prescribed oral opioid medications (i.e. hydrocodone, oxycodone, etc.) BEFORE the nerve block wears off. Opioids take time to build up in the bloodstream. They are not fast-acting. You do not want to get “behind on your pain,” so plan ahead to ensure a proper transition while the nerve block wears off. As always, be sure to follow the recommendations of your doctor or pharmacist in regards to the pain medication schedule.
Leg Swelling Management
Compression stockings (socks) should be strongly considered if you are suffering from significant swelling in the lower legs (below the knee to the foot). In order to get the proper size for the leg stockings, you’ll need to closely measure the calf circumference with a tape measure per the directions specific to each brand of stocking. Most doctors recommend stockings with graduated compression of 15-20 mmHg, though some prefer 20-30 mmHg (moderate compression), so you should ask your surgeon for his/her preference before you buy them.
- MULTIPLE COLORS AVAILABLE
- STRENGTH GRADUATED COMPRESSION
- IMPROVES CIRCULATION FOR EXTENDED SITTING, STANDING, OR TRAVEL
- HELPS REDUCE SWELLING, VARICOSE VEINS, SPIDER VEINS, DVT BLOOD CLOTS
Do I Need to Go to an Outpatient Physical Therapy Clinic for Treatment?
Yes, I would highly recommend that you seek in-person rehabilitation postoperatively in an outpatient physical therapy clinic. The primary reason for this is that most people are unable to stretch their own knee past the initial point of pain. It’s an instinctive protective mechanism that most people simply cannot push themselves through this type of pain. A physical therapist will help you regain full knee mobility and he/she will guide you through the next 2-3 months of rehab. You should expect to begin outpatient physical therapy approximately 7 days post-op after a total knee replacement surgery.
“Most people are unable to stretch their own knee past the initial point of pain.”
To achieve an optimal functional outcome after a TKA, it is critical to gain more than 125° of knee flexion (ability to bend the knee). I always tell my patients that if they achieve 135° knee flexion, they will receive a ⭐! I say this because the average person requires a minimum of 125° knee flexion in order to be able to put on shoes and socks and squat down to pick items up from the floor. However, achieving at least 135° knee flexion will allow someone to kneel down on the ground and never be limited by their total knee prosthesis regardless of the activity.
When Can I Start Exercising After My Total Knee Replacement Surgery?
Generally, one can start basic exercises at home 3-4 days after a total knee replacement surgery.
To be honest, the first 1-2 days post-op will be tough. During this time, the focus should be placed on recovering from the anesthesia and the initial soreness from the surgery. Ankle pump exercises and quad sets isometrics (find these exercises below) should be performed as part of the home exercise program several times throughout the day to prevent blood clots from forming in the lower legs.
Leg exercises will help to improve nerve and muscle motor control, prevent joint stiffness, improve mobility, and improve tolerance to weight-bearing activities such as walking and standing.
How Long Will it Take to Recover After a Knee Replacement?
You can expect it to take 2-3 months to regain full function to the point where you won’t be limited when performing most daily activities. However, episodic knee swelling and joint stiffness (especially morning stiffness) will continue for 4-6 months post-op. Most individuals will need to continue to periodically strengthen and stretch the knee up until an entire year after surgery.
I usually educate my patients that it will take about 1-year before it gets to the point that they don’t think about their knee every day.
“It will take about 1-year [after a TKA procedure] before it gets to the point that they don’t think about their knee every day.”
Exercises to Avoid After a Knee Replacement Surgery
While there are many types of exercise and sports that are generally considered safe to perform after a total knee replacement, there are some forms of higher-intensity exercise that post-op patients are discouraged from participating in by most surgeons. Exercises and sports that involve sudden impact and twisting of the knee joint should be avoided.
Therefore, sports such as skiing, baseball, basketball, skiing, lacrosse, soccer, football, running, rock climbing, hang gliding, gymnastics, bungy jumping, and high-impact aerobics should generally be avoided after a total knee replacement surgery.
Ultimately though, it just depends on how determined you are in wanting to get back to participating in these exercises and/or sports. There are no long-term studies that have shown that definitively shown that these high-impact activities actually cause loosening of the knee joint replacement hardware. The recommendations of activities to avoid after a joint replacement are more of a general medical consensus that we would expect repetitive impacts to increase the risk of hardware loosening, so medical professionals usually recommend against it.
“There are no long-term studies that have definitively shown that high-impact acticvities actually cause loosening of the knee joint replacement hardware.”
Now, have I ever rehabilitated a patient who has had a total knee joint replacement to get him/her back to skiing? Yes, I absolutely have, multiple times. But, in these cases, the individuals were highly motivated, fit and healthy, and were generally participating in these activities right up until the time of surgery.
Ultimately, it’s your knee and your choice as to the risk that you are willing to accept at having to undergo a total knee joint revision in the future if the hardware loosens. At least you will be able to make educated choices on the potential risks vs. benefits. Either way, performing the proper exercises after a total knee replacement surgery will propel you in the right direction!
How Often Should I Ice My Knee After Surgery?
Using a cryotherapy cooling machine is highly beneficial after a total knee replacement surgery to help reduce knee swelling. Icing should be performed several times per day (4-5x/day) for up to 30 minutes each time, especially during the first week after surgery. Gradually over the next 1-3 weeks, the frequency can be reduced as joint swelling decreases.
- EFFECTIVE, SOOTHING AND LOCALIZED TREATMENT
- OFFERS POST-OPERATIVE PAIN AND SWELLING RELIEF
- STAY COOLER, LONGER!
- STRONG, SILENT AND LIGHTWEIGHT
- INCLUDES A KNEE PAD
- 6-MONTH MANUFACTURER WARRANTY
I highly recommend that the leg is elevated when icing. In this way, it will combine the beneficial effects of gravity helping to draw the swelling down out of the lower leg plus the additional benefits of cryotherapy to reduce swelling. Use a wedge pillow for proper elevation and support during this time.
- MEASUREMENTS: 18″ Width, 11 3/4″ Height, 23″ Length
- PERFECT FOR REDUCING VENOUS ISSUES, LEG DISCOMFORT, LEG SWELLING AND BACK PAIN
- PROPER ELEVATION ANGLE
- DURABLE FABRIC PERFORMANCE COVER TO REPEL STAINS AND MOISTURE
The 11 BEST Exercises After Total Knee Replacement Surgery!
- Convenient Access: Print or Use On-the-Go on Any Mobile Device
- Customized Healing Plans: Easy-to-Follow, Tailored Exercise Guides
- Holistic Recovery: Reduce Pain, Improve Mobility, & Increase Strength
- Comprehensive Progression: All-in-One Rehab Worksheets Include a Progressive Exercise Sequence for Optimal Results
- Expertly Designed by Dr. Tim Schuckers, PT, DPT, OCS
Convenient Access: Print or Use On-the-Go on Any Mobile Device
Customized Healing Plans: Easy-to-Follow, Tailored Exercise Guides
Holistic Recovery: Reduce Pain, Improve Mobility, & Increase Strength
Comprehensive Progression: All-in-One Rehab Worksheets Include a Progressive Exercise Sequence for Optimal Results
Expertly Designed by Dr. Tim Schuckers, PT, DPT, OCS
Ankle Pumps
- Ankle pumps are CRITICAL to help prevent blood clots (Deep Vein Thrombosis) in your lower leg after surgery.
- Press your toes down away from you, pause, then pull your toes up towards you, pause, then repeat.
- This causes a muscle pump action in the calf muscles, which helps promote blood flow and prevents blood pooling in the lower leg.
- Perform: 30 reps (several times per day)
Quad Set Isometrics
- Start this exercise by sitting on the floor with your injured leg straight out in front of you and your toes pointing towards the ceiling.
- Slowly engage your quadriceps muscles (thigh muscles) by actively pressing both knees down into the floor essentially straightening out both legs. In order to perform this movement, you should notice that your quadriceps muscles contract.
- Perform: 10 sec holds x 10 reps (3-4x/day)
Heel Slides with Strap
- Use this: OPTP Stretch-Out Strap
- Slowly begin to actively bend your injured knee by sliding your heel towards you.
- Pause at the point of pain, stiffness, or tightness in the knee, then return to the starting position.
- Try to increase the amount of bend gradually with each successive repetition.
- Perform: 10-15 reps (2-3x/day)
Short Arc Quads
- Use these: BalanceFrom Ankle Weights (2-10 lbs) & OPTP Pro-Roller Foam Roll
- While keeping the knee on top of the foam roll, lift your foot up towards the ceiling. This will straighten the knee while engaging the quads.
- Pause at the top of the motion, then lower your foot back to the surface. Repeat.
- Add ankle weights when ready to advance.
- Perform: 3 sets x 10 reps (1x/day)
Long Arc Quads
- Use these: BalanceFrom Ankle Weights (2-10 lbs)
- Slowly extend the knee by kicking the leg straight out in front of you.
- Pause at the top with the knee fully straight and the toes pointing towards the ceiling, then slowly lower back to the starting position.
- Add ankle weights when ready to advance.
- Perform: 3 sets x 10 reps (1x/day)
Side-Lying Hip Abduction
- Squeeze your upper buttock muscle while lifting your top leg (knee straight) directly upwards
- You should feel this exercise activating and isolating your glute complex
- Perform: 2-3 sets x 10 reps (1x/day)
Straight Leg Raise
- Engage your core by contracting your abdominal muscles.
- Lift the injured leg towards the ceiling while striving to keep the knee completely straight. Pause. Then lower.
- Perform: 2-3 sets x 10 reps (1x/day)
Glute Isometric Squeeze
- Lie on your back with both knees bent evenly and both feet shoulder-width apart.
- Squeeze your buttock muscles together as if you were going to lift your hips up from the surface (isometric muscle squeeze).
- Hold the squeeze, then relax and repeat.
- Perform: 10 sec holds x 10 reps (1-2x/day)
"Tail Hook" Seated Knee Flexion/Extension
- While seated actively bend the surgical knee by sliding that foot underneath your chair until a stretch is felt.
- You can provide some overpressure into the stretch by taking the opposite foot and “hooking” it around the ankle of the surgical leg.
- Hold, then straighten the leg and repeat.
- Perform: 1 set x 10 reps (1-2x/day)
Seated Knee Extension "Heel Prop" Stretch
- While seated in a chair, place your foot up onto another chair or a coffee table in front of you.
- Ensure that the knee and toes are pointing straight upwards (do not allow the leg to roll out to the side).
- Relax into this stretch for 5-10 minutes to promote full knee extension range of motion.
- This is a long-duration relaxation stretch.
- Perform: 5-10 minutes (1x/day)
Recumbent Exercise Bike
- Begin rocking back and forth on a recumbent bike to improve knee joint range of motion.
- Perform a slight pause with the knee bent into a stretch at both ends of motion.
- Eventually, you will be able to perform a full revolution on the bike once you are able to flex the knee to at least 110 degrees.
- Perform: 5-10 mins (1-2x/day)
