Click here for a comprehensive patient guide to knee replacement surgery.


General considerations:

•    All times are to be considered approximate, with actual progression based upon
     clinical presentation.
•    Patients are full weight bearing with the use of crutches, a walker or a cane to assist
     walking until they are able to demonstrate good walking mechanics.
•    Early emphasis is on achieving full extension equal to the opposite leg as soon as
     able.
•    No passive or active flexion range of motion greater than 90 degrees for the first two
     weeks.
•    No two-legged biking or flexion exercises for at least two weeks. Well-leg biking is
     fine.
•    Regular manual treatment should be conducted to the patella and all incisions so
     they remain mobile.
•    Early exercises should focus on recruitment of the vastus medialis obliquus (VMO).
•    No resisted leg extension machines (isotonic or isokinetic) at any point in the rehab
     process.


Week 1:

•    Goal is to allow the medial arthrotomy to heal and decrease swelling.
•    M.D. visit after hospital discharge to change dressing and review home exercise
     program.
•    Icing, elevation, and aggressive edema control (i.e. circumferential massage,
     compressive wraps).
•    Straight leg raise exercises (standing and seated), passive and active ROM
     exercises.
•    OK to gently bend knee < 90 degrees 1-2x per day.
•    Initiate quadricep/adduction/gluteal sets, gait training, balance/proprioception
     exercises.
•    Well leg cycling and upper body conditioning.
•    Soft tissue treatments and gentle mobilization to the posterior musculature, patella,
     and incisions to avoid flexion or patella contracture.


Week 2-4:

•    M.D. visit at 14 days for suture removal and check-up.
•    Continue with home program, progress flexion range of motion, gait training, soft
     tissue treatments, and balance/proprioception exercises.
•    Incorporate functional exercises as able (i.e. seated/standing marching, , hamstring
     carpet drags, hip/gluteal exercises, and core stabilization exercises).
•    Aerobic exercise as tolerated (i.e. bilateral stationary cycling as able, UBE, pool
     workouts once incisions are healed.)


Week 4-6:

•    M.D. visit at 4 weeks post-op.
•    Increase the intensity of functional exercises (i.e. progress to walking outside,
     introducing weight machines as able).
•    Continue balance/proprioception exercises (i.e. heel-to-toe walking, assisted single
     leg balance). Slow to normal walking without a limp.


Week 6-8:

•    Add lateral training exercises (i.e. lateral steps, lateral step-ups, step overs) as able.
•    Incorporate single leg exercises as able (eccentric focus early on).
•    Patients should be walking without a limp and range of motion should be < 10
     degrees extension and > 110 degrees flexion.


Week 8-12:

•    Begin to incorporate activity specific training (i.e. household chores, gardening,
     sporting activities).
•    Low impact activities until after week 12.
•    Patients should be weaned into a home/gym program with emphasis on their
     particular activity/sport