Total knee joint replacement

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Click here to see a video produced by St Mary’s Joint Replacement Institute where a physiotherapist guides you through recommended exercises after a knee joint replacement. You can use this video at home, in addition to your physiotherapy appointments.

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

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