Recovery Timeline for TKR: Rehabilitation Stages and Physical Therapy

Overview

When you have total knee replacement (TKR) surgery, recovery and rehabilitation is a crucial stage. In this stage, you’ll get back on your feet and return to an active lifestyle.

The 12 weeks following surgery are very important for recovery and rehab. Committing to a plan and pushing yourself to do as much as possible each day will help you heal faster from surgery and improve your chances for long-term success.

Read on to learn what to expect during the 12 weeks after surgery and how to set goals for your healing.

Day 1

Rehabilitation begins right after you wake up from surgery.

Within the first 24 hours, your physical therapist (PT) will help you to stand up and walk using an assistive device. Assistive devices include walkers, crutches, and canes.

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

Your PT will show you how to get in and out of bed and how to move around using an assistive device. They may ask you to sit at the side of the bed, walk a few steps, and transfer yourself to a bedside commode.

They will also help you use a continuous passive motion (CPM) machine, which is a device that moves the joint slowly and gently after surgery. It helps prevent a buildup of scar tissue and joint stiffness.

You’ll probably use the CPM in the hospital and possibly at home, too. Some people leave the operating room with their leg already in the device.

Some pain, swelling, and bruising are normal after TKR surgery. Try to use your knee as soon as possible, but avoid pushing yourself too far too soon. Your healthcare team will help you set realistic goals.

What can you do at this stage?

Get plenty of rest. Your PT will help you get out of bed and walk a short distance. Work on bending and straightening your knee and use a CPM machine if you need one.

Day 2

On the second day, you might walk for brief periods using an assistive device. As you recover from surgery, your activity level will increase gradually.

If the surgeon used waterproof dressings, you can shower the day after surgery. If they used normal dressing, you’ll have to wait for 5–7 days before showering, and avoid soaking for 3–4 weeks to let the incision heal fully.

Learn more

Your PT might ask you to use a regular toilet rather than a bedpan. They might ask you to try to climb a few steps at a time. You might still need to use the CPM machine.

Work on achieving full knee extension at this stage. Increase knee flexion (bending) by at least 10 degrees if possible.

What can you do at this stage?

On day two you can stand up, sit, change locations, and use a toilet instead of a bedpan. You can walk a little further and climb a few steps with help from your PT. If you have waterproof dressings, you can shower the day after surgery.

Discharge day

You will likely stay in the hospital for 1 to 3 days after surgery, but this can be a lot longer.

When you can leave the hospital depends heavily on the physical therapy you need, how quickly you are able to progress, your health before surgery, your age, and any medical issues.

By now your knee should be getting stronger and you’ll be able to increase your exercise and other activities. You’ll be working toward bending your knee further with or without a CPM machine.

Your doctor will be shifting you from prescription-strength to lower-dose pain medication. Learn more about the different types of pain medications.

What can you do at this stage?

At discharge, you may be able to:

• stand with little or no help
• go on longer walks outside your hospital room and rely on assistive devices less
• dress, bathe, and use the toilet on your own
• climb up and down a flight of stairs with help

By week 3

By the time you’re back home or in a rehab facility, you should be able to move around more freely while experiencing reduced pain. You’ll require fewer and less powerful pain medications.

Your daily routine will include exercise your PT has given you. These will improve your mobility and range of motion.

You might need to keep using a CPM machine during this time.

What can you do at this stage?

You can probably walk and stand for more than 10 minutes, and bathing and dressing should be easier.

Within a week, your knee will technically be able to bend 90 degrees, though it may be difficult due to pain and swelling. After 7–10 days, you should be able to fully extend your knee out straight.

Your knee may be strong enough that you’re not carrying weight on your walker or crutches anymore. Most people are using a cane or nothing at all by 2–3 weeks.

Hold the cane in the hand opposite to your new knee, and avoid leaning away from your new knee.

Weeks 4 to 6

If you’ve stayed on your exercise and rehab schedule, you should notice a dramatic improvement in your knee, including bending and strength. The swelling and inflammation should also have gone down.

The goal at this stage is to increase your knee strength and range of motion using physical therapy. Your PT may ask you to go on longer walks and wean yourself off of an assistive device.

What can you do at this stage?

Ideally, at this stage, you’ll feel as though you’re regaining your independence. Talk to your PT and surgeon about when you can return to work and daily activities.

Weeks 7 to 11

You’ll keep working on physical therapy for up to 12 weeks. Your goals will include rapidly improving your mobility and range of motion — possibly to 115 degrees — and increasing strength in your knee and the surrounding muscles.

Your PT will modify your exercises as your knee improves. Exercises might include:

• Toe and heel raises: While standing, rise up on your toes and then your heels.
• Partial knee bends: While standing, bend your knees and move upward and downward.
• Hip abductions: While lying on your side, raise your leg in the air.
• Leg balances: Stand on one foot at a time for as long as possible.
• Step-ups: Step up and down on a single step, alternating which foot you start with each time.
• Bicycling on a stationary bike.

This is a very important time in your recovery. Committing to rehab will determine how quickly you can return to a normal, active lifestyle, and how well your knee works in the future.

What can you do at this stage?

At this point, you should be well on the road to recovery. You should have significantly less stiffness and pain.

You may be able to walk a couple of blocks without any type of assistive device. You can do more physical activities, including recreational walking, swimming, and bicycling.

Week 12

At week 12, keep doing your exercises and avoid high-impact activities that could damage your knee or the surrounding tissues, including:

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

At this point, you should have much less pain. Keep talking to your healthcare team and avoid starting any new activities before checking with them first.

What can you do at this stage?

At this stage, many people are up and about and beginning to enjoy activities like golf, dancing, and bicycling. The more committed you are to rehab, the sooner this can happen.

At week 12, you will likely have less pain or no pain during normal activities and recreational exercise, and a full range of motion in your knee.

Read more on: replacement