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Knee Replacement Rehabilitation

Welcome to our Knee Replacement Rehab video series.  The goal of these videos is to help maximize your recovery following knee replacement surgery. These videos should not be used as a substitute for regular physical therapy visits and guidance from your physician.

Click here to download a pdf version of the Knee Replacement Rehabilitation Guide

PHASE I – Protect Healing and Early Motion (0-2 weeks post-op) / Knee Replacement Rehab

GOALS:  Protect the knee during early healing, regain motion and prevent muscle de-conditioning.

KEY POINTS:

  • Icing is very important following surgery to help prevent swelling, stiffness, and pain. Apply ice pads or cooling pads for 15 minutes 3-4 times daily during this phase, especially after therapy sessions.
  • If the knee is swollen elevate it on pillows above the level of your heart while sedentary. Do NOT place pillow only under the knee so that it is slightly bent, as this will encourage it to heal slightly bent.
  • It is critical to regain full extension [straightening] of the knee ASAP after surgery. Work on heel props [Exercise #1 in video] whenever sedentary or at least 3-4 times per day for 30 minutes during this phase.  If your knee heals without full extension you will walk with a limp after surgery.
  • Exercises should be conducted three times daily with 1-2 sets of 12-15 repetitions each set. Start light and progress as strength and motion improve and pain decreases.
  • Try to progressively bend the knee during this phase, with the goal of reaching a 90 degree bend.
  • Start long arc quads [Exercise #8 in video] when you are able to bend the knee to 90 degrees.
  • Do weight shifts [Exercise #9 & 10 in video] to help regain balance.

PHASE 2 – Motion and Early Strengthening (2-6 weeks post-op) / Knee Replacement Exercises

GOALS: Progress to full motion of the knee; start to regain strength.

KEY POINTS:

  • Continue all Phase 1 exercises.
  • It is important to perform all exercises on both legs as this will help prevent imbalance between the rehab and non-rehab knee.
  • If the affected joint is stiff, try using moist heat for 10 minutes prior to exercise to help loosen things up.
  • Continue to ice after exercise for 10 minutes to help prevent irritation and swelling.
  • If too weak for standing squats [Exercise #2 in video}, start by doing squat to chair [Exercise #3 in video].
  • Start short arcs on stationary bike [moving legs through lower half of pedal cycle only] until there is enough motion in the knee to bend through the upper part of the pedal rotation.
  • Bike for 10-15 minutes on low resistance, and increase duration as tolerated.
  • Exercises should be conducted three times daily with 1-2 sets of 12-15 repetitions.

PHASE 3 – STRETCHING AND STRENGTHENING (6-12 weeks post-op) / Total Knee Replacement Exercises

GOALS:  Address any motion deficits; improve functional strength.

Key points:

  • Continue Phase 2 exercises.
  • For lunges bend the back knee down and closer to floor as strength increases.
  • Use a walker or cane if unsteady during exercises to prevent falls or hold on to wall.

PHASE 4 – ADVANCED STRENGTHENING & FUNCTIONAL ACTIVITY (> 12 weeks post op) / Knee Replacement Physical Therapy

GOALS:   Return to full activity.

Key points:

  • Stretching exercises [Exercises #1-3 in video] should be held for 10 seconds each; do one set of 5 repetitions each stretch.
  • Conduct 1-2 sets of strengthening exercises [Exercises #7-12 in video] for 12-15 repetitions.
  • Begin regular cardiovascular exercise; start with 15-20 minutes and progress as tolerated.
    • It is important to cross-train for cardio exercise; rotate bike, elliptical, or walking to prevent irritation and pain from the same repetitive exercise.
  • Start functional exercises (e.g., golf, tennis swings).
    • Return to light golf or doubles tennis activity at 12-14 weeks per physician’s approval.
  • Continue exercises for up to 12 months for maximum recovery.
  • Return to full activity per individual physician’s recommendation.

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