Total knee joint replacement

Post-op recovery	First 2 weeks	Date
Goals	Protect the knee and surgical incision Recover from swelling and inflammation Control of post-surgical pain
Precautions	Walk short distances only Use crutches for support
Recommendations	Weight bear as tolerated using crutches for support Rest and elevate as required Ice the knee as desired – particularly in the first week Range of motion exercises of ankle Range of motion exercises of hip Gentle movement of the knee from full extension to maximum flexion as pain and swelling allows
Suggested exercises	Static quads contraction Supine straight leg raise Ankle pumps Supine bed supported knee bend Sitting supported knee bend Sitting knee extension stretch – foot on floor Supine knee extension – foot elevated/supported Standing knee extension

Phase 1	Week 2 to week 6
Goals	Begin training to walk normally Fully weight bear with crutches for support as required Increase range of motion Begin strengthening
Precautions	Avoid long walks, cycles or exercise sessions that inflame the knee – shorter sessions – three times a day – is better. Allow the knee to settle and rest between sessions.
Recommendation	When standing with your weight on the leg, push the both knees back into full extension – hold for 20 seconds (do this often) When flexing your knee as far as you can – hold for 20 seconds If able to – begin using an exercycle – short and gentle to begin with Hip and gluteal muscle strengthening Ankle range of motion and strengthening When stable and safe – use one crutch (opposite to operated knee) When stable and safe and gait improving, discard the use of crutches (better to walk well with crutches than lurch and limp without)
Suggested exercises	Supine straight leg raise Sitting supported knee bend Supine knee extension – foot elevated/supported Standing knee extension Sitting knee extension stretch – foot on floor Wall slide mini squat Single leg stance – knee straight, knee flexed Step ups Double calf raises Side leg raise – knee straight, knee flexed

Phase 2	Week 7 to week 12
Goals	Walk asnormally as possible Continue to increase range of motion Strengthen knee, hip and ankle
Precautions	Avoid long walks, cycles or exercise sessions that inflame the knee – shorter sessions – three times a day – is better. Allow the knee to settle and rest between sessions
Recommendations	Use an exercycle. Increase session length slowly When standing with your weight on the leg, push the knee back into full extension – hold for 20 seconds (do this often) When flexing your knee as far as you can – hold for 20 seconds Passive stretching to achieve full extension and flexion Hip and gluteal muscle strengthening Ankle range of motion and strengthening
Suggested exercises	Wall slide mini squat Double leg squats (0-60) Sitting unsupported knee extension and flexion Single leg stance – knee straight, knee flexed Straight leg raise Step ups Double calf raises Side leg raise – knee straight, knee flexed Gluteal band exercises Bridging with gluteal contraction Exercycle – increasing resistance and training time

Phase 3	3 Months – 6 months
Goals	Gain full function and strength
Precautions	None
Recommendations	Passive stretching to achieve full extension and flexion Squats Concentrated full rehab program that includes strengthening of core, hip flexors, gluteal muscles, external rotators of the hip, quadriceps, hamstrings and calves. Neuromuscular control and co-ordination of leg