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Recovery Timeline for TKR: Rehabilitation Stages and Physical Therapy

Overview

When you have total knee replacement (TKR) surgery, the recovery and rehabilitation process plays a crucial role in helping you get back on your feet and resume an active lifestyle. It can help you heal from surgery faster and greatly improve your chances for long-term success.

It’s important that you commit to a plan and push yourself to do as much as possible each day. Read on to learn what you can expect during the critical 12 weeks of recovery and rehab, and how to set goals for your healing.

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Day 1

Day 1

Rehabilitation begins almost immediately after you wake up from surgery. Within the first 24 hours, you’ll begin standing and walking using an assistive device with the help of a physical therapist (PT). In fact, it’s critical to get up and use your artificial knee as soon as possible.

Expect the PT to provide exercises that will help strengthen your muscles and guide you through them every day.

Your PT will also demonstrate how to get in and out of your bed and move around with the aid of an assistive device, such as a walker, crutches, or a cane. They may ask you to sit at the side of the bed, walk a few steps, and transfer yourself to a bedside commode.

A nurse or occupational therapist will help you with tasks such as changing the bandage, dressing, bathing, and using the toilet.

The PT will also discuss your home environment and help you get set up with a continuous passive motion (CPM) machine for use in the hospital room and possibly at home. Some people leave the operating room with their leg already in a CPM machine. The machine keeps your knee in motion to help prevent buildup of scar tissue and stiffness from immobility.

Learn more: How to prepare for recovery after knee replacement surgery »

Day 2

Day 2

Your PT may ask you to walk for brief periods using an assistive device. They may also request that you use a regular toilet rather than a bedpan and ask you to try to climb a few steps at a time. You may be asked to continue using the CPM machine. As you recover from surgery, your activity level should increase.

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Discharge

Discharge

By now your knee should be getting stronger and you should be able to increase your exercise and activity level.

Your doctor will be shifting you from prescription-strength painkillers to lower-dose pain medication.

Your PT may ask you to go on longer walks outside your hospital room, climb up and down a flight of stairs, move onto a chair or a toilet without assistance, and reduce the use of a walker, crutches, or a cane.

At discharge, you should be able to do the following:

  • Bend your knee well, preferably to a minimum of a 90-degree angle.
  • Dress and bathe on your own.
  • Minimally rely on an assistive device.

Goals by discharge:

  • Get in and out of bed and perform transfers with the least amount of help possible using appropriate assistive devices.
  • Walk at least 25 feet and go up and down stairs using a walker or crutches.
  • Achieve a 90-degree range of motion with your knee so you can perform sit-to-stand transfers.
  • Display an understanding of suggested exercise and activity.
Timeline Activity Treatment
Post-op day 1 (day of surgery) Rest. Ask for help getting out of bed. Walk a short distance with the help of a PT. Work on bending (flexing) and straightening (extending) your knee, using a CPM machine, if prescribed.
Post-op day 2 Stand up, sit, and change locations with assistance. Walk an increased distance using a walker. Climb a few steps at a time with the help of a PT. Work on achieving full extension. Increase knee flexion by at least 10 degrees.
Post-op day 3 to discharge Stand up and sit with little to no assistance. Walk at least 25 feet using a walker or crutches. Go up and down stairs using walker or crutches. Achieve at least 70–90 degrees of flexion, with or without CPM.
 

By week 3

Discharge through week 3

You should be able to move around more freely while experiencing reduced pain by the time you’re back home or in a rehab facility. You’re likely to rely less and less on an assistive device. For example, if you needed a walker at the hospital, you’ll probably be able to get by on crutches or a cane now.

You should be engaged in a daily regimen of exercise as prescribed by your PT. Bathing and dressing should be easier, and you may be able to go outside for longer walks. You will require fewer and less powerful pain medications. Your doctor may ask you to keep using a CPM machine during this period.

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Weeks 4–6

Weeks 4 through 6

If you’ve stayed on your exercise and rehab schedule, you should notice a dramatic improvement in your knee. It should display improved flexion (bending) and strength.

Your PT may ask you to go on longer walks and wean yourself off of an assistive device. Toward the end of this period, you may be able to go for a half mile or farther on your walks. Ideally, you’ll feel as though you’re regaining your independence. Activities such as cooking, cleaning, and other household chores should be much easier to perform.

You should consult with your PT and surgeon to determine when you’ll be able to return to work and regular activities. Some TKR recipients resume driving within four to six weeks of surgery — but don’t just go for it. Make sure your surgeon says you’re fit to drive first.

Goals by week 6:

  • Increase the strength of your knee by continuing your exercise regimen and walking.
  • Experience decreased swelling and inflammation.
  • Return to everyday activities.
  • Achieve improved range of motion, preferably at least the 90 degrees of flexion required for normal walking and climbing stairs.

Read more: Following up with your orthopedic surgeon after total knee replacement »

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Weeks 7–11

Weeks 7 through 11

At this point, you should be well on the road to recovery. You may be able to walk a couple of blocks without any type of assistive device and engage in other basic activities that require physical exertion, including driving, housekeeping, and shopping.

Your PT will be monitoring your exercises and perhaps modifying them as your knee improves and you’re able to move it more freely. These might include:

  • toe and heel raises, which involve alternating between rising up on your toes and heels while in a standing position
  • partial knee bends, which require you to bend your knees and move upward and downward while standing
  • hip abductions, which require you to move your leg to one side while standing
  • leg balances, which involve standing on one foot at a time for as long as possible
  • step-ups, which involve stepping up and down on a single step, alternating which foot you start with each time
  • bicycling on a stationary bike

This period is crucial for long-term success. Your commitment to an exercise and rehab plan will play a key role in determining how quickly you return to a normal lifestyle and how well your knee works in the future.

Goals by week 11:

  • Improve your range of motion, possibly to 115 degrees.
  • Rapidly improve mobility and have dramatically less stiffness and pain.
  • Increase strength in your knee and the surrounding area.
  • Return to most everyday activities, including recreational walking, swimming, and bicycling.
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Week 12

Week 12

If you’ve been diligent and committed to rehab, it’s likely that you are up and about and beginning to enjoy activities such as walking, swimming, golf, dancing, and bicycling. It’s important to continue with the exercises prescribed by your PT and avoid the temptation to engage in high-impact activities that could damage your implant or cause damage to surrounding tissue. These include:

  • running
  • aerobics
  • skiing
  • basketball
  • football
  • high-intensity cycling

At this point, you should be experiencing a dramatic decrease in pain. It’s critical to stay in touch with your medical team throughout this period and begin activities only after receiving clearance from them.

Goals by week 12:

  • Experience less pain or no pain at all during normal activities and recreational exercise.
  • Have no loss of flexion or range of motion.
  • Continue ongoing exercise regimen such as walking, swimming, golf, cycling, and dancing.
  • Maintain ongoing contact with your medical team.
Timeline Activity Treatment
Week 1–3 Walk and take stairs for longer distances without an assistive device. Complete at-home exercises to increase strength and range of motion. Continue regular rehab sessions to monitor and improve mobility and range of motion. Use ice and a CPM machine at home, if prescribed.
Week 4–6 Walk and take stairs for extended distances on your own. Continue home exercises and resume household chores and activities. Return to work and begin driving with a recommendation from your PT or surgeon. Continue regular rehab sessions to monitor and increase strength and flexibility.
Week 712 Walk for longer periods, use a stationary bike, and continue prescribed exercises at home. Return to low-impact activities. Continue rehab for strength and endurance training and work to achieve a range of motion of 0–115 degrees.
 

Outlook

Week 13 and beyond

You should notice gradual and continuing improvement in your knee during this period. As time goes on, pain should subside. Typically, you should feel at or near 100 percent after a year.

However, it’s important to stay in touch with your medical team and have periodic checkups to ensure that your knee is continuing to work properly. Don’t wait to check with your surgeon if at any point you feel pain, swelling, stiffness, or unusual movement in your knee.

Of course, every person is different and recovery periods can vary, depending on a number of factors. A typical full recovery from a TKR is 3 to 12 months. However, know that the harder you work rehabbing, the more likely you are to enjoy a faster and fuller recovery.

Goals by week 13:

  • Achieve 115 degrees of flexion so that it’s possible to engage in a wide range of everyday activities.
  • Be almost entirely pain-free.

Read more: Do’s and don’ts for knee replacement success »

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