Total Knee Replacement

Knee replacements are a very common orthopedic surgery happening today. Most days of the week patients are having this surgery done. Compared to Hip and shoulder replacements, I see this one more often.

On average a person is usually finished with PT after about 12 weeks following knee replacement surgery. I have seen this as low as 8 weeks but as high as 6 months. 

The biggest factor of a person’s length of rehabilitation is usually how well they tolerate discomfort and how much they commit to their recovery. 

A typical knee replacement, as seen in the image above, is when metal pieces are placed on the areas of bone (femur and tibia) that were covered in Osteoarthritis. Afterwards, the patient is no longer “bone on bone”. To learn more about the techniques used for the surgery, check out this article here.

I have a previous blog post on osteoarthritis and how exercise can help improve it without surgery. Check that out here.

Week 1 of Physical Therapy

Most of the time, a patient will come into Physical Therapy about 3-4 days following surgery. (Sometimes they will go to inpatient rehabilitation or have a PT come to their house, but these are special circumstances.) 

Exercises will consist of ROM (range of motion) and muscle activation activities. Including: 

  • Quad sets
  • Heel slides
  • Mini squats
  • Heel raises

Manual Therapy at this time will consist of PROM (passive range of motion) into flexion and extension. As well as Soft tissue mobilizations to improve swelling. 

Week 2-6 of Physical Therapy

During this time, the main focus is going to be to improve ROM to normal and improving functional strength with activities including:

  • Knee extension on bolster
  • SLR, LAQ
  • Sit to stands 
  • Step ups
  • Side stepping
  • Bicycle 

Pain is going to be a limiting factor during this time but come the end of the 6 weeks, most of the pain is gone. I like to call this first 6 weeks “the period of regret” because the pain can be substantial but you will get through it!

Manual therapy will be the same as the first week but will be more aggressive to improve ROM.

Week 6-12 of Physical Therapy

During this time, activities will focus on getting strength back to as close to normal as possible. And pain should be mostly gone, some soreness with certain activities can remain.

Exercises will  include:

  • Squatting
  • Leg extensions
  • Hamstring curls
  • Deadlifts 

Manual will probably include PROM if it has not completely returned yet, others might be manual resistance exercises where the PT will resist your knee motions themselves. 

These exercises are just a blueprint and PT session will include more and be more tailored to the specific patient’s needs.

Because knee replacements are a very common orthopedic surgery happening today, be sure to not compare yourself to others’ progress. Work only towards your goals and at your pace.