General post-surgical guidelines

Icing & elevation:

  • Ice and elevate above the level of the heart regularly throughout the day and night
    • Can use the ice machine or other icing agents 15 - 20 minutes every other hour, with a pillow case or other thin barrier between skin and ice pack to avoid skin irritation
  • Immediately post-op with gauze dressing still on: OK to leave ice machine on constantly as the dressing will provide a strong buffer against the cold

Weight bearing:

  • Progress to weight bearing as tolerated. Use the crutches to assist your walking and wean off after one week or as soon as you can walk without a limp
  • Use crutches (or crutch) for 1 week post-op to control swelling and inflammation no matter how well you are walking

Activity level:

  • Minimize walking and standing for the first week to minimize swelling and inflammation. Swelling will lead to pain, stiffness, muscle shutdown, and increased scar tissue formation. Spend more time icing and elevating
  • Take it easy; you just had surgery
  • Avoid impact and twisting of the knee for 4 weeks

Stretching and strengthening exercises:

  • Refer to the illustrated exercise handout from your Physical Therapist
  • Should have full knee extension equal to opposite side by Day 3 post-op
  • Make sure you are following the prescribed pain medication schedule in order to better tolerate the exercises
  • Can perform upper extremity training and abdominal/back/trunk training immediately as tolerated
  • Can start well-leg stationary biking immediately as tolerated.• If you continue to improve each day and have no problems with swelling, you can ride a stationary bike with both legs beginning 1 week after surgery. Start easy with light or no resistance for 10 minutes max and gradually progress day-by-day if your knee does not swell much and does not have increased pain by the next morning

 Clinic visits:

  • Day 14 nurse check-up and suture removal
  • Month 1: Check-up with Dr. Stone
  • Physical Therapy appointments should be initiated within 3 days post-op

Exercise post-surgical guidelines

All exercises are to be performed without increasing pain or swelling

Week 1:

  • Open-chain exercises including leg raises.
  • Well-leg biking.
  • Upper body and trunk training.
  • Gait training to normalize patterns.
  • Standing calf raises.
  • Weight shift in mutiple planes.
  • Seated or standing trunk mobility exercises (trunk rotation, side-bending)
  • Single-leg balancing
  • Bridging

 Weeks 2 - 3:

  • Mini and split squats
  • Wide-based walks with Theraband looped around ankle (Monster Walks)
  • Light 2-legged stationary biking with light or no resistance
  • Mini step-ups with perfect knee biomechanics
  • Single-leg balancing with perturbation
  • Deep water work-outs. Flutter kicks
  • Elliptical cardio machine (light resistance, no more than 20 minutes)

 Week 4:

  • Low-impact lateral agility work
  • Functional squatting and lunging
  • Outdoor road biking--avoid steep hills
  • Moderate step-ups
  • Train for components of sport-specific activities such as lateral lunges for skiers
  • Progress intensity of exercises per patient and symptom tolerance
  • VersaClimber cardio machine

 Week 6 and beyond:

  • Progressive return to sports activities
  • Avoid cutting and pivoting until Week 8


NOTE: All progressions are approximations and should be used as a guideline only. Progression will be based on individual patient presentation, which is assessed throughout the treatment process.

Total Knee Replacement Protocols 6 Weeks and Beyond