Rehabilitation exercises after knee replacement
Home exercise program to complement rehabilitation after total knee replacement surgery. These exercises are prescribed by our physiotherapists at discharge and should be maintained for at least 6 months to achieve maximum range of motion and strength. The goal is to reach 120 degrees of knee flexion and full extension.
Warning signs — consult your physiotherapist if you experience:
- •Excessive swelling that does not improve with ice and elevation
- •Intense redness or excessive warmth in the operated knee
- •Fever above 38°C (100.4°F)
- •Severe pain that does not respond to prescribed medication
- •Joint locking (unable to bend or straighten the knee)
Phase 1 — Immediate post-operative
Goal: control inflammation, achieve full extension, and begin flexion. These exercises start in the hospital and continue at home.
Ankle pumps
20 repetitions every hour while awakeLying down or seated, move your foot up and down (as if pressing a gas pedal) briskly. This activates circulation and helps prevent blood clots.
Start on the same day as surgery. This is the most important exercise for circulation.
Knee extension with towel
3x5 minutesLying down, place a rolled towel under your heel (NOT under the knee). Let the weight of the leg straighten the knee by gravity. The knee should become fully straight.
NEVER place a pillow under the knee — it prevents full extension.
Heel slide (flexion)
3x15 repetitionsLying face up, slide your heel toward your buttock, bending the knee as much as possible. You can use a towel looped around the ankle to help pull. Hold for 10 seconds at the maximum point.
Goal: gain a little more each day. Do not force through sharp pain.
Quadriceps contraction
3x15 repetitionsLying with your leg straight, tighten your thigh by pressing the back of the knee into the floor (or bed). Hold for 5 seconds and relax.
You should see the thigh muscle become firm. If you cannot feel it, place your hand on top to check.
Phase 2 — Mobility and strength recovery
Goal: achieve 90 degrees of flexion and full extension. Begin walking without a cane at home. Go up and down stairs.
Seated knee flexion
3x15 repetitions, 3 times a daySeated in a tall chair, slide your foot backward (under the chair) until you feel a pull. You can use your other foot to gently push. Hold for 15 seconds at the maximum point.
Target: 90 degrees at 4 weeks, 110 degrees at 8 weeks.
Straight leg raise
3x15 repetitionsLying down, tighten the quadriceps (knee completely straight) and lift the straight leg 30-40 cm off the floor. Hold for 5 seconds and lower slowly.
If the knee bends while lifting, work more on the quadriceps contraction first.
Wall squat
3x10 repetitionsWith your back against the wall, slide down by bending your knees to 45 degrees (no more than 90 degrees in this phase). Hold for 10 seconds and slide back up.
Stationary bike
10-15 minutes per dayIf you have a stationary bike, start with the seat high (less flexion) and gradually lower it. No resistance for the first few weeks.
If you cannot complete a full pedal revolution, do half turns forward and backward.
Phase 3 — Strengthening and functionality
Goal: regain strength for daily activities without limitation. Walk long distances. Go up stairs normally.
Free squat
3x12 repetitionsStanding, feet shoulder-width apart. Lower to 90 degrees of knee flexion (or as far as you can) as if sitting in a chair. Rise by squeezing your glutes and quadriceps.
You may hold onto a chair at first for safety.
Step-up
3x10 each legFacing a step (15-20 cm), step up with the operated leg placing the entire foot on the step. Straighten fully at the top and lower in a controlled manner with the other leg.
Single-leg bridge
3x10 each legLying down, one foot flat on the floor and the other leg extended. Lift your hips until aligned with your shoulders using only the supporting leg. Hold for 3 seconds.
Progressive walking
Daily, progressiveGoal: walk 45-60 minutes without discomfort. Progress gradually: week 9 = 20 min, week 12 = 30 min, week 16 = 45 min.
You may use a cane outside the house if you feel unsteady. No rush to stop using it.
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