Overview

Knee replacement (total knee arthroplasty) rehabilitation is a months-long process that starts in the hospital and continues at home. The first weeks are about restoring extension and controlling swelling; the following months are about strength, stairs and stamina.

This guide is general education. Your surgeon's and physiotherapist's protocol — including any movement restrictions, weight-bearing rules and exercise doses — always takes priority.

Who This Guide Is For

This is for anyone recovering from total knee replacement surgery, usually after advanced knee osteoarthritis. If you have not had surgery, this is not the guide for you — see the knee osteoarthritis guide instead.

The Two Jobs of Early Rehab

The first weeks have two priorities:

Full knee extension — being able to straighten the knee completely. This is the strongest predictor of a good long-term result.
Swelling control — elevation, ice and gentle movement keep swelling down so the knee can move and the muscles can work.

Everything else builds on these two.

Phase 1: The First Days (Day 0–3)

Goals: protect the new joint, start moving, control swelling.

Ankle pumps: 10 every hour while awake
Quadriceps sets: tighten the front thigh, hold 5–10 seconds, repeat 10 times, several times a day
Knee extension: press the back of the knee down into the bed, hold 5–10 seconds
Walk with a walker as directed — weight bearing is usually allowed early
Elevate and ice the knee regularly

Phase 2: Early Recovery (Weeks 1–6)

Goals: normal walking with an aid, improved bending, muscle activation.

Terminal knee extension: straighten the knee against light resistance — 2 sets of 10–15
Heel slides: bend the knee while lying or sitting, sliding the heel toward you — 2 sets of 10
Straight leg raises once the knee can lock straight — 2 sets of 8–10
Sitting-supported knee bends: let the knee bend over the edge of a chair — 2 sets of 10
Walk several times a day, using a walker, then a cane as strength improves

Phase 3: Rebuilding Strength (Months 2–3)

Goals: walk without aids, climb stairs, rebuild quadriceps and calf strength.

Sit-to-stand: rise from a chair with both legs, then progress to the operated leg — 2 sets of 8–10
Step-downs: step down slowly and controlled from a low step — 2 sets of 8
Calf raises: rise onto the toes, holding support — 2 sets of 10–15
Single-leg balance: near a support — 3 holds of 20–30 seconds
Stationary cycling once the knee bends enough for a full revolution

Phase 4: Stamina and Return to Activity (Months 3–6+)

Goals: return to daily life, low-impact exercise and confident stairs.

Progress walking distance and pace
Continue cycling, swimming or water exercise
Add progressive resistance to leg exercises
Return to physically demanding work and recreation with clearance, guided by strength and swelling response

Precautions

Follow your surgeon's restrictions on bending, twisting and weight bearing
Avoid pivoting and twisting on the knee
Do not push through sharp pain — some discomfort is expected, but sharp pain is a signal to reduce load
Keep the knee moving — long periods of stillness make recovery harder

What Exercise Should Feel Like

Expect discomfort around the knee and thigh, especially in the first weeks. Mild soreness that settles within a day is normal. Sharp pain, catching or swelling that climbs with every repetition is a signal to back off.

Common Mistakes

Skipping extension work because it feels tight
Doing too much too soon and driving up swelling
Avoiding movement because of discomfort
Comparing your timeline to someone else's — every knee is different

When to See Someone Urgently

Contact your care team for a red or leaking wound, fever, severe calf pain or swelling, sudden shortness of breath, or a knee that suddenly becomes very painful, hot or unstable. Contact your physiotherapist if you cannot restore extension or if swelling keeps climbing.

Questions to Ask Your Clinician

What movement and weight-bearing restrictions apply to me?
How much swelling is normal, and when should I be concerned?
Which exercises should I prioritize in the first two weeks?
When can I drive, climb stairs normally and return to work?

References

AAOS OrthoInfo. "Total Knee Replacement Exercise Guide." https://www.orthoinfo.org/recovery/total-knee-replacement-exercise-guide/
AAOS OrthoInfo. "Total Knee Replacement." https://orthoinfo.aaos.org/en/treatment/total-knee-replacement/

This information is for education only and is not a medical diagnosis. InjuryAtlas does not replace an assessment by a qualified health professional. If you have severe pain, visible deformity, numbness, loss of function, or symptoms that are getting worse, seek medical care promptly. Always follow your surgeon's specific protocol after surgery.

Knee Replacement Rehabilitation Guide