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Rehab Following a Knee Replacement: What does it take?

Tired of knee pain and hoping a total knee replacement is the answer?  According to the American Academy of Orthopedic Surgeons, many Americans think new is better:  over 600,000 total knee replacement surgeries are performed in the United States each year.  This number is sure to increase with the “Baby Boomer” generation wanting to stay active and live with less pain.  Patients are often surprised by the amount of work and pain involved with getting a new knee up and running, or at the very least, up and walking.  Physical therapy is the key to ensuring how well your new knee performs, so here’s a breakdown of what to expect following total knee replacement surgery.

Post Knee Replacement Rehab

The rehabilitation program following a total knee replacement surgery is a crucial process which commonly lasts up to 6 months before returning back to normal participation in daily activities. Diligent and active participation in your post-replacement rehabilitation is what will ensure improved function and pain reduction. It won’t be easy, but the results you will gain with daily commitment to your exercises and activity will show in the final success and health of your new knee.

Your rehabilitation process will begin within 24 hours after surgery with emphasis on ensuring your ability to stand and initiate walking on your new joint. The physical therapist at the hospital will provide you with exercises to focus on:

  • swelling control
  • range of motion
  • and strengthening.

With the assistance of a walker, you will be up on your feet quickly, learning to safely maneuver to and from the bathroom, short walks up and down the hall, and learning to trust your new knee.

During these early stages of recovery the physical therapist will focus on obtaining range of motion goals, before the stiffness from scarring and swelling can take over. Physical therapy will become a part of your daily routine.  By the time you leave the hospital, the expectation is to be able to have the physical therapist obtain full knee extension (straight) and 90 degrees of flexion (bending). These two goals are very important to allow normal walking without undue stress on your knee, hip, and back. Before discharge you should be able to walk with either your walker or crutches with minimal assistance, get up and down from a chair independently, ascend/descend stairs as needed, and keep your pain under control with oral medication.

Depending on the amount of assistance you have at home, your therapist may decide to have you transferred to a rehabilitation center where you can continue therapy (typically about 4-6 hours per day) in order to be safe when you return home independently.

Upon returning home after discharge, your individual dedication to rehabilitation from your total knee replacement will continue under the direction from either a Home Health therapist or a therapist at an Outpatient Physical Therapy clinic. Over the next three weeks, the goal is to reduce the need for an assistive device, and transition to a cane or single crutch when you are able to maintain full extension of your knee joint on your own. The progression of this range of motion is very dependent on each individual, and is based upon the amount of range of motion you had prior to the knee replacement surgery, ability to control post-surgical swelling, how quickly you set down scar tissue, and most importantly, how dedicated you are to your home range of motion and strengthening exercises.  Expect 2-3 visits per week with your physical therapist during the first couple of months following surgery.

This is not a pain-free process!!

Be prepared for hard work, some pain, and try your best to keep a positive attitude. Listen to your therapist’s instruction to learn how hard to push yourself during healing. You can expect to make big gains in your function, pain control, and activity tolerance during these early weeks although pain and swelling will continue to fluctuate. Dedication to your exercise routine and learning to pace your activity level is very important.

Ideally, by the 2-4 month mark following your total knee replacement you will be integrating back to work activities, driving, shopping, and have improved tolerance to household activities. Your dedication to therapy during this time is critical for your long-term success and return to maximum level of function.  Weekly physical therapy visits are generally required during this time.

Knee range of motion at this stage should be at its maximum, fully straight (0 degrees) to 115-120 degrees of bending (flexion). Your rehabilitation program will continue to focus on progressive strengthening, balance, endurance activities, and, as needed, range of motion exercises. Light recreational activities will be integrated at this time including walking, pool exercises, and a light gym program. Some individuals may continue to have to focus on range of motion exercises to obtain end-range motion with flexion and sometimes even extension. Swelling and pain will continue to fluctuate depending on activity level. Discharge from formal physical therapy services is typically towards the end of this time period, as soon as range of motion, daily function, a home exercise program is finalized, and general strength goals have been met.

There will be gradual and progressive improvement in the knee pain, strength, and range of motion for up to a year after the total knee replacement. There are varying paths that every knee replacement can follow, every person is different and every recovery time line will be different.

Statistics range when addressing time line for full recovery, ranging from 3 months to 1 year.

Success of the total knee replacement requires a commitment of time and energy, and ironically, a willingness to endure yet more pain.  From this physical therapist’s perspective, patients should ask themselves if they’ve explored all other possible avenues to restore function and reduce pain before opting for this surgery.  A thorough physical therapy evaluation can help you explore your options and determine the best treatment course for solving your knee problems.


Guest Blog by: Marie Long, MSPT, CMPT

New Heights Physical Therapy, Plus

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