Knee replacement: rehabilitation guide
Last reviewed 5 August 2026 · Reviewed by Dr Matthew Broadhead, FRACS (Orth) · 22 minute read
This guide walks you through recovery after a total knee replacement, week by week, what to do, what to expect, and when to call us. Keep it somewhere handy; most patients come back to it many times in the first three months.
One sentence matters more than any other in this guide: a knee replacement is a rehabilitation operation, not just an operation. The surgery creates the opportunity; the result is earned in the first twelve weeks. The work described here is not optional extra credit. It is the treatment.
Every timeframe in this guide is typical, not a rule. Your knee, your health and your operation are your own, and Dr Broadhead’s instructions for you always override the general figures here.
The knee is a hinge between the thigh bone (femur) and the shin bone (tibia). In a total knee replacement, the worn surfaces at the end of the thigh bone and the top of the shin bone are removed and resurfaced with shaped metal components, with a smooth plastic (polyethylene) bearing between them. Often a plastic button is fitted to the back of the kneecap as well.
The ligaments around the knee are balanced during surgery so the new joint is stable through its whole range of movement. The metal and plastic are fixed and stable immediately, which is why you can stand on the new knee straight away.
The surgery creates the opportunity; the result is earned in the first twelve weeks. Patients who do the daily work get better knees. This is the single most important idea in this guide.
A knee that will not fully straighten limps and aches. Prioritise full extension (a completely straight knee) every single day from day one: heel props, prone hangs, and never a pillow behind the knee.
Swelling and bending are inversely related: the more swollen the knee, the less it bends. Control the swelling with elevation, ice and pacing, and the range of movement follows.
Most of the improvement happens in the first 3 months, and useful gains continue to about 12 months. Scores generally plateau after the first year, significant improvement between 12 and 24 months is not the average experience, though some people, particularly those who started stiffer, do keep gaining. Warmth, tightness, clicking, occasional sharp twinges and a numb patch beside the scar are all normal along the way.
Australian registry data show about 80% of patients are satisfied or very satisfied, and about 82% say the knee is "much better" at 6 months. Roughly 1 in 10 are clearly dissatisfied and a further 1 in 10 are neutral, so about 1 in 5 are not fully satisfied. The strongest known predictor of dissatisfaction is not the implant or the surgeon: it is unmet expectations, a nearly 11-fold effect. That finding is the reason this guide exists, knowing what is normal is half the battle.
Weight bearing
Full weight bearing as tolerated from day one
You will stand and walk on the new knee, taking as much weight as comfort allows, on the day of surgery or the day after. Walking early is safe and gets you home sooner.
Early mobilisation is recommended by the major enhanced-recovery and physiotherapy guidelines, and is part of preventing blood clots. Getting moving early shortens hospital stay by about 1.8 days with no increase in problems.
In Australia, most patients stay two to four nights; rapid-recovery pathways in the private sector routinely achieve one to two nights in suitable patients.
| Stage | Typical timing | Move on when |
|---|---|---|
| Wheeled frame or two crutches | Day 0 to about 1 week | Safe balance; walking without a lurch |
| Two crutches | To about 2 weeks | Confident on level ground; managing stairs with help |
| One crutch or a stick (opposite hand) | About 2–4 weeks | Level walking without a limp |
| No aid | About 4–6 weeks | No limp; confident indoors and outdoors; able to manage a kerb |
| Milestone | Earliest (weeks) | Typical | Latest |
|---|---|---|---|
| Walking with frame or crutches | 0 | 0 | 1 |
| First review (wound check) | 2 | 2 | 3 |
| Bend past 90° | 1 | 2 | 6 |
| Walking without any aid | 3 | 5 | 8 |
| Desk work | 4 | 5 | 6 |
| Driving (right knee: criteria met, discussed with us) | 4 | 5 | 8 |
| Clinical review with X-ray | 6 | 7 | 8 |
| Bend past 105° | 4 | 6 | 10 |
| Physical work | 10 | 13 | 16 |
| Three-month review (only if progress is slower than expected) | 12 | 13 | 14 |
| Kneeling practice (padded surface) | 12 | 13 | 20 |
| Most sports and activities open | 24 | 26 | 32 |
| Six-month review with X-ray | 24 | 26 | 28 |
| Twelve-month review with X-ray | 50 | 52 | 56 |
You move to the next phase by meeting its exit criteria, not by the calendar. The week numbers are typical, nothing more.
Get the knee straight, keep the swelling down, wake the quadriceps up, and walk little and often.
Ready for the next phase when…
Build the bend towards 105 degrees and beyond, walk normally, and wean off the aids.
Ready for the next phase when…
Turn a healing knee into a working one: strength, balance, endurance and stairs without thinking.
Ready for the next phase when…
Back to the activities that matter, at the right pace, with realistic expectations of the finish line.
Ready for the next phase when…
Little and often beats one heroic session. Each exercise lists what you should feel, sharp pain that lingers afterwards means ease off and, if it persists, call.
Keep blood moving in the calf: your main clot-prevention exercise.
10 firm pumps, every waking hour, for the first 2 weeks
Feel: You should feel the calf muscles working. Move through the full range each time.
Switch the thigh muscle back on: swelling turns it off, and everything else depends on it.
10 holds of 5 seconds, 3–4 times daily
Feel: You should feel this in the front of the thigh. The heel may lift slightly off the bed as the knee flattens: good.
Harder: Add a rolled towel under the ankle so the knee presses down through a fuller range.
Restore the bend, gently and often.
10 slow slides, 3–4 times daily
Feel: A firm stretching feeling at the front of the knee is right; sharp lingering pain means ease off. A towel or plastic bag under the heel makes it slide easier.
Easier: Loop a towel around the ankle and assist the slide with your arms.
Quadriceps strength with the knee locked straight. The milestone is lifting without a sag.
10 lifts, hold 3 seconds, 3 times daily
Feel: If the knee sags as you lift (a “lag”), keep working the static quads. The lag going is the sign of progress.
Full straightening: the highest-priority exercise in this entire guide.
5–10 minutes, 2–3 times daily
Feel: A firm stretch behind the knee is exactly right. Never put a pillow under the knee to “rest” it afterwards.
Keep the kneecap gliding freely so the bend and the scar do not tether.
1–2 minutes in each direction, twice daily, once the dressing allows
Feel: It should feel odd, not painful.
Progress the bend using gravity and the other leg.
10 bends, hold 5–10 seconds, 3 times daily
Feel: Work to a firm stretch; back off from sharp pain.
Real-world leg strength: the movement you will do more than any other.
2–3 sets of 8–10, once or twice daily
Feel: Share the load evenly between the legs, no swinging or flopping.
Harder: Lower the chair height, then progress to no hands.
Calf strength for a normal push-off when walking.
2–3 sets of 10, once or twice daily
Feel: Even weight through both feet.
Harder: More weight onto the operated side over time.
Thigh and hip strength through a small, safe range.
2–3 sets of 10 to about 45 degrees, once or twice daily
Feel: You should feel the thighs working, not the knee pinching.
Single-leg strength for stairs and slopes.
2–3 sets of 8 each leg, once daily
Feel: Push through the whole foot; keep the knee tracking over the toes, not diving inward.
Harder: Raise the step height, then reduce hand support.
Range, circulation and endurance with almost no joint load.
10–20 minutes, most days, once the bend allows a full revolution
Feel: Mild stretch at the top of the pedal stroke is useful; lower the saddle gradually as the bend improves.
Soften and desensitise the scar once fully healed.
2–3 minutes, twice daily, from about 3 weeks once healed and dry
Feel: Firm enough to blanch the skin slightly; it should not be painful.
The strength that controls stairs going down: the last thing to feel normal.
2–3 sets of 8 each leg, alternate days
Feel: Slow and controlled beats deep; keep the pelvis level.
Steadiness and confidence: protects you from trips and falls.
Build to 3 holds of 30 seconds each leg, daily
Feel: Quiet foot, tall posture.
Active bend strength through range.
2–3 sets of 10, once daily
Feel: Keep the knees level with each other; move only below the knee.
Sleep in whatever position is comfortable, on your back or either side. There are no positional restrictions after a knee replacement.
Never sleep with a pillow under the knee. If you want support, place a pillow under the whole lower leg from the calf to the heel, so the knee stays straight.
Disturbed sleep is very common for the first several weeks and improves as the swelling settles. Ice before bed, timing pain relief for the night, and a pillow between the knees when side-lying all help.
Expect real pain for the first two to three weeks, needing regular pain relief: a knee replacement hurts more early on than a hip replacement, and knowing that in advance helps.
Take pain medication as prescribed and ahead of exercise sessions rather than chasing pain afterwards. Wean the strongest medications first as things settle.
You will usually be on a blood thinner for some weeks: take it exactly as directed.
Aches, warmth, tightness, clicking and the occasional sharp twinge continue for months and are normal. Pain that is increasing week on week is not, call the rooms.
How far the knee could bend before surgery is the single strongest predictor of how far it will bend afterwards, so progress is always measured against your own starting point, not somebody else’s.
You may drive when all of the following are true:
What the research actually measures is braking reaction time on a simulator. Those studies show braking performance returns to its pre-operative level at about 2 weeks after a right hip replacement and about 4 weeks after a right knee replacement, with movement time back to normal by 6 weeks. After knee arthroscopy the simulator evidence is more conservative than common practice: in the one study that measured it directly, braking was still slower one week after surgery than before it, and had recovered by four weeks, and a 2021 review of eight studies put the average return at about six weeks. Most people having a simple arthroscopy are driving well before that, which is why the criteria above matter more than the date. But these are averages, in one study, about one in three right-hip patients still could not meet an emergency-stop benchmark at six weeks. Treat the timeframes in this guide as targets for discussion with us, not as permissions.
No published study has compared automatic and manual cars. The logical point is simply that a manual needs the left leg for the clutch, so left-sided surgery is the relevant caution in a manual. Advice about driving earlier with a left-leg operation in an automatic is clinical judgement, not trial evidence.
In Australia, your treating doctor’s advice governs: under the Austroads "Assessing Fitness to Drive" standards, temporary post-operative impairment is a matter of clinical judgement, and commercial drivers are held to a higher standard. Driving while impaired may invalidate your insurance, check your insurer’s position. Do not drive for at least 24 hours after any general anaesthetic or sedation.
| Activity | Typical | When it’s right | Notes |
|---|---|---|---|
| Walking for exercise | From the outset | Comfort and steadiness | Build distance gradually; it is the core of the programme |
| Swimming and aqua fitness | 2–3 weeks | Wound fully healed and reviewed | No baths, spas or pools before the wound is checked |
| Stationary cycling | From the outset | Enough bend to turn the pedals | Saddle high at first |
| Driving | 4–6 weeks (right knee) | All the driving criteria below, discussed with us | Often sooner for a left knee in an automatic: clinical judgement, not trial evidence |
| Desk work | 4–6 weeks | Comfortable sitting; travel sorted | Elevate the leg under the desk where possible |
| Cycling on level ground; yoga | 6–12 weeks | Confident balance; bend allows | Per European surgeon consensus (expert opinion, not trial data) |
| Physical work | Around 3 months | Strength and endurance for the actual duties | Modified duties in between where available |
| Kneeling | Practise from about 3 months | Padded surface, down on the non-operated knee first | Kneeling does not damage the implant, about a third kneel comfortably by one year, about half by three; with structured practice, most regain it |
| Golf, doubles tennis, gym weights, hiking, aerobics | From about 6 months | Strength and confidence built in Phase 3–4 | 21 of 47 activities are recommended from 6 months in the European consensus, squash was the only sport ruled out entirely |
| Running, jumping sports, contact sport, singles tennis on hard courts | Not recommended | — | Running was not among the activities recommended at 6 months; the advice against it is about implant wear and longevity, not a proven risk of sudden failure. About 70% of patients return to sport overall, mostly shifting to low-impact activity |
You will often hear "no flying for six weeks" after joint replacement. Be aware that this is a convention, not a proven rule: a 2025 review found limited data and no demonstrated difference in clot risk between people who did and did not fly after hip or knee replacement: mostly within the first week.
The six-week convention reflects practical realities rather than trial evidence: managing airports and cramped seating, being past the highest-risk clot window while still on prevention, the higher baseline clot risk of long-haul flights over four hours, and individual airline and travel-insurance rules, check both, as some airlines impose their own restrictions.
If you need to travel long-haul in the first six weeks, talk to the rooms first so clot prevention, an aisle seat, stockings and on-board movement can be planned.
None of these should be watched overnight to see how they go. Early treatment of a problem is simple; late treatment is not.
EMERGENCY: 000Emergency department / call 000
GP TODAYSee your GP today
CALL THE ROOMSCall the rooms: same day
For joint replacement patients, a wound problem is never something to "wait and see". Early treatment of an infected joint replacement is vastly more successful than late treatment, call the rooms the same day.
Typically a frame or crutches for 1–3 weeks, a single stick to about 4–6 weeks, and nothing after that. You progress when you can walk without a limp, not on a set date. Many people keep a stick for crowds and uneven ground a little longer. That is sensible, not slow.
Yes: full weight from day one. The implant is fixed and stable from the moment of surgery, so you will stand and walk on it the same day or the day after, using a frame or crutches for balance. Walking early is safe and gets you home sooner.
Typically 4–6 weeks for a right knee, and often sooner for a left knee in an automatic, but the date matters less than the criteria: off strong painkillers, able to emergency-stop at full force without hesitation, and practised in a stationary car. Braking studies show performance returns around 4 weeks on average after a right knee replacement; confirm your own timing with us.
We aim for a fully straight knee and a bend past 90 degrees in the first couple of weeks, but these are targets we work towards, not a pass mark. In one Australian study only 25% of patients had even 80 degrees at hospital discharge. How far your knee bent before surgery is the strongest predictor of the final bend. Straight matters more than bent.
No. The Cochrane review of 24 trials found CPM (continuous passive motion) machines add about 2 degrees of bend and make no meaningful difference to pain or function, and physiotherapy guidelines specifically advise against routine use. Active exercise, ice, elevation and walking are what work. Please don’t hire one.
Yes: kneeling does not damage the implant. About a third of patients kneel comfortably by one year and about half by three years; the barrier is skin and soft-tissue discomfort at the front of the knee, not the metal. In one study, everyone who completed a structured kneeling practice programme regained the ability. Practise from about 3 months on a padded surface, going down on the non-operated knee first.
15–20 minutes at a time, 4–6 times a day for the first two weeks, then after exercise as needed: always with a cloth between ice and skin. Honestly: the trial evidence shows only small, short-lived benefits, so ice because it is comfortable and harmless, not because it changes the end result. An expensive cold-compression machine has never been shown to beat a bag of ice.
Some swelling, warmth and tightness at three months is completely normal, measurable swelling is still present at 7 weeks in most patients, and the knee can puff up after a big day for months. A knee that is bigger the morning after activity means you did too much yesterday. Swelling that is increasing week on week, or comes with fever or spreading redness, is different, call the rooms.
Desk work typically at 4–6 weeks, once you are comfortable sitting and have transport sorted. Physical work takes around 3 months, sometimes with modified duties in between. Your own job’s demands set the real date, raise it at the two-week review so a plan is in place early.
Real, medication-needing pain usually lasts two to three weeks and then steadily fades. Aches, warmth, tightness and the odd sharp twinge continue for months and are normal. Most improvement comes in the first three months, with useful gains to a year. Pain that is increasing rather than settling after the first week is a reason to call, not wait.
Usually not. An Australian randomised trial (HIHO) showed a structured, monitored home programme matches inpatient rehabilitation for uncomplicated knee replacement, home-based does not mean doing nothing, it means supervised physiotherapy based at home. Patients who live alone, lack support, or have other medical or mobility problems do benefit from supervised inpatient care, and we arrange it where it is needed.
A numb patch beside the scar (usually on the outer side) is expected: one small study found it in around 70% of patients. The small nerve supplying that skin crosses the incision line and cannot be avoided. It does not affect how the knee works, it did not affect satisfaction in that study, and the patch usually shrinks with time.
| Claim | Source |
|---|---|
| CPM adds ~2° flexion with no meaningful benefit, not justified routinely | Harvey, Brosseau & Herbert, Cochrane Database Syst Rev 2014;2(2):CD004260 (PMID 24500904) |
| Physiotherapists should not use CPM after uncomplicated primary TKA | Jette et al., Phys Ther 2020: APTA clinical practice guideline (PMID 32542403) |
| Pre-operative flexion is the strongest predictor of post-operative flexion (4,727 knees) | Ritter et al., J Bone Joint Surg Am 2003 (PMID 12851353) |
| Best results at 128–132° of flexion; function substantially compromised below 118°; flexion contracture worsens pain, walking and stairs | Ritter et al., J Bone Joint Surg Am 2008 (PMID 18381316) |
| Only 25% achieved ≥80° flexion at discharge; discharge extension predicts one-year extension | Naylor et al., J Eval Clin Pract 2012, Parts 1 and 2 (PMID 21414107, 21414108) |
| Flexion contracture associated with worse Oxford Knee Score and satisfaction | Goudie et al., Orthopedics 2011 (PMID 22146201); Su, J Bone Joint Surg Br 2012 (PMID 23118396) |
| Manipulation within 12 weeks gains 36.5° vs 17° late; poor results beyond 26 weeks | Issa et al., J Bone Joint Surg Am 2014 (PMID 25143495) |
| Best manipulation outcomes within 12 weeks (22 studies) | Gu et al., J Arthroplasty 2018 (PMID 29290334) |
| Stiffness defined as range <90° beyond 12 weeks; about 4% of patients | Tibbo et al., J Bone Joint Surg Am 2019 (PMID 31318813) |
| Monitored home programme non-inferior to inpatient rehabilitation at 26 weeks (Australian RCT) | Buhagiar et al., JAMA 2017: HIHO trial (PMID 28291891) |
| Home-based rehabilitation an appropriate first line with adequate social supports | Buhagiar et al., JAMA Netw Open 2019 (PMID 31026026) |
| Supervised physiotherapist management recommended; setting individualised | Jette et al., Phys Ther 2020 (PMID 32542403) |
| Self-directed rehabilitation as usual care; inpatient rehabilitation for the at-risk minority (Australian) | Sattler, Hing & Vertullo, Aust J Gen Pract 2020 (PMID 32864678) |
| Kneeling: 36.8% at 1 year, 47.6% at 3 years | Nadeem, Mundi & Chaudhry, Knee Surg Relat Res 2021 (PMID 34600595) |
| 68% could kneel at 18–24 months; structured practice restores it | Wallace & Berger, J Arthroplasty 2019 (PMID 30773356) |
| Braking returns to baseline about 4 weeks after right TKA | van der Velden et al., Bone Joint J 2017 (PMID 28455464) |
| Movement time normalises by 6 weeks | Giannoudis et al., Knee 2021 (PMID 33945981) |
| Satisfaction: 80.8% satisfied, 10.5% dissatisfied, 81.6% "much better" at 6 months (AOANJRR) | Heath et al., Bone Jt Open 2021 (PMID 34182793) |
| Unmet expectations: 10.7× risk of dissatisfaction | Bourne et al., Clin Orthop Relat Res 2010 (PMID 19844772) |
| Cryotherapy: small benefits that may be too small to justify routine use | Aggarwal, Adie, Harris & Naylor, Cochrane Database Syst Rev 2025;10(10):CD007911 (PMID 41165130) |
| Function plateaus after the first year (no significant gain from 1 to 2 years) | Ekhtiari et al., Int Orthop 2024 (PMID 39007939) |
| No patient-reported-outcome trajectory shows decline or stagnation (reassuring) | Omran et al., JAAOS Glob Res Rev 2025 (PMID 40505133) |
| Swelling peaks days 6–8; still measurable at 7 weeks | Loyd et al., Disabil Rehabil 2020 (PMID 30668214) |
| 21 of 47 activities recommended at 6 months; squash the only outright exclusion | Thaler et al., Knee Surg Sports Traumatol Arthrosc 2021: EKA consensus (PMID 33404817) |
| About 70% return to sport, shifting to low-impact activity | Hanreich et al., J Arthroplasty 2020 (PMID 32389409) |
| Prehabilitation: large effect pre-operatively and early, not significant at 6–12 months | Gränicher et al., J Orthop Sports Phys Ther 2022 (PMID 36125444) |
| Infrapatellar branch sensory change in 70% (n=20); no effect on satisfaction | Mistry & O’Meeghan, ANZ J Surg 2005 (PMID 16174002) |
| Early mobilisation recommended for clot prevention | Mont et al., J Am Acad Orthop Surg 2011: AAOS (PMID 22134209) |
| Early mobilisation reduces stay by 1.8 days with no increase in adverse events | Guerra, Singh & Taylor, Clin Rehabil 2015 (PMID 25452634) |
| ERAS pathway consensus for hip and knee replacement | Wainwright et al., Acta Orthop 2020 (PMID 31663402) |
| Driving criteria and pooled recommendations individualised by side and transmission | Patel et al., Hip Int 2023 (PMID 33736494) |
| Australian hospital-stay context (short-stay pathways) | Qurashi et al., ANZ J Surg 2022 (PMID 36221212); Lloyd et al., BMC Health Serv Res 2024 (PMID 39633364) |
This guide is general information for patients of Dr Matthew Broadhead (Harbour Orthopaedics & Sports Medicine) and is not a substitute for the specific advice given to you by Dr Broadhead, your physiotherapist or your hospital team.
Surgical findings vary, and your protocol may differ from what is written here: your operation record and your surgeon’s instructions always take precedence.
If in doubt, call the rooms on (02) 9052 1883. In an emergency, call 000.
Last reviewed: 2026-08-05 by Dr Matthew Broadhead, FRACS (Orth).
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