Essential Guide to Knee Replacement Rehabilitation: Prehab, Recovery Phases, and Long-Term Success
Introduction
Knee replacement surgery—whether total or partial—is one of the most successful procedures for restoring mobility and reducing pain in people with advanced arthritis or joint damage. But surgery is only half the journey. The real success depends on structured rehabilitation.
In this guide, we’ll cover everything you need to know:
• How to prepare before surgery (prehabilitation)
• Recovery phases and exercises for total and partial knee replacements
• Red flags to watch out for
• Long-term strategies to protect your new joint
Understanding Total vs Partial Knee Replacement
Before diving into rehabilitation, it helps to understand the procedure you’ve had:
• Total Knee Replacement (TKR): The entire knee joint surface is replaced with artificial implants. Rehabilitation typically takes longer and requires more progressive strengthening.
• Partial Knee Replacement (PKR): Only one part of the knee joint (medial, lateral, or kneecap surface) is replaced. Rehab can often be faster, with quicker return to daily activities.
👉 Both require consistent, structured rehabilitation, but recovery times may differ. Partial knee replacements sometimes allow patients to return to walking without aids a little earlier than total replacements.
Phase 0: Pre-Surgery Preparation (Prehabilitation)
Your journey starts before surgery. Stronger muscles, better flexibility, and good preparation can speed up recovery and reduce complications.
Goals:
• Strengthen quadriceps, hamstrings, and glutes
• Improve knee mobility
• Build upper body strength for crutch use
• Optimise general health (weight, nutrition, blood sugar, blood pressure)
Exercises: (if pain allows)
• Box Squats
• Reverse lunges with turn over front leg - depth as pain allows
• Glute bridges Or Romanian deadlifts
• Step ups - Alternate or single leg Left then Right.
• Wall push-ups or seated rows
Lifestyle prep:
• Organise home (remove trip hazards, add grab bars)
• Maintain a protein-rich diet (plus calcium & vitamin D)
• Stop smoking and reduce alcohol
• Prepare mobility aids (walker, cane, supportive footwear)
💡 Think of this as training for your recovery. The better prepared you are, the smoother the rehab journey will be.
Phase 1: Immediate Post-Op (0–2 Weeks)
Goals:
• Manage pain and swelling
• Protect the new joint
• Regain knee extension
• Begin walking safely
Exercises:
Ankle pumps – 10–20 reps, hourly throughout the day
Quad sets – 5–10 second hold, 10 reps, 3–4x/day
Heel slides – 2–3 sets of 10 reps
Short walks – every 2–3 hours, 1–5 minutes at a time
Phase 2: Early Recovery (2–6 Weeks)
Goals:
• Flexion target: 0–90°
• Strengthen quads and glutes
• Progress walking
Exercises:
Straight leg raises – 2–3 sets of 10–12 reps
Step-ups (low step) – 2 sets of 8–10 reps per leg
Stationary cycling – start 5 mins, progress to 15–20 mins daily
Gait practice – 5–10 mins, 2–3x/day
Phase 3: Functional Recovery (6–12 Weeks)
Goals:
• Walk without aids
• Build functional strength
• Achieve 110–120° flexion
• Improve balance
Exercises:
Sit-to-stands (from a chair) – 2–3 sets of 8–12 reps
Resistance band hamstring curls – 2–3 sets of 12–15 reps
Supported balance drills – hold 20–30 sec, repeat 3x per side
Walking – aim for 20–30 mins, 4–5x/week
Phase 4: Advanced Conditioning (3–6 Months)
Goals:
• Return to normal daily activities
• Build endurance and strength
• Resume light recreational exercise
Exercises:
Leg press (light weight) – 2–3 sets of 10–12 reps
Hamstring curls (machine or band) – 2–3 sets of 10–12 reps
Step-ups / Step-downs – 2–3 sets of 8–10 reps each leg
Swimming / cycling – 20–30 mins, 2–3x/week
Functional drills (floor transfers, carrying items)
Phase 5: Long-Term Maintenance (6+ Months)
Goals:
• Maintain joint health
• Protect the implant for 15–20 years
• Support overall strength and balance
Ongoing Strategy:
Strength training – 2–3x per week (8–12 reps, 2–3 sets per exercise)
Walking / low-impact cardio – 30 mins, 4–5x/week
Balance / mobility drills – 5–10 mins as part of warm-up or cool-down
Flexibility work
Avoid running and jumping
Key Principles for Successful Recovery
• ✅ Consistency > intensity
• ✅ Prioritise extension before flexion
• ✅ Train hips, core, and ankles too
• ✅ Mild discomfort is normal; sharp pain is not
Red Flags – When to Seek Help
• Increasing pain/swelling
• Redness or warmth at incision
• Sudden calf pain (possible clot)
• Knee instability or giving way
The Long Game: Setting Realistic Expectations
• Partial replacements: Many patients resume daily life within 3–4 months
• Total replacements: Full recovery may take 12–18 months
• Long-term success depends on ongoing exercise, strength, and weight management
💡 Rehab is not just about healing the knee—it’s about building resilience for your whole body.
Conclusion
Whether you’ve had a total or partial knee replacement, structured rehabilitation is the key to success. By preparing before surgery, progressing through each recovery phase, and maintaining long-term strength, you’ll not only protect your new joint but also enjoy a more active, pain-free life..
