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REHAB PROTOCOL · KNEE

Total Knee Replacement Rehab Protocol

By Dr. Shayne Kelly, DO — Fellowship-Trained Sports Medicine Surgeon · Tri-City Orthopedics, Kennewick, WA

The written protocol Dr. Kelly provides to his patients and their physical therapists in the Tri-Cities. Time frames are guidelines — progression is criteria-based, and your own post-op instructions always govern.

⬇  Printable protocol (PDF)Request an appointment →
Educational information, not medical advice. This is not a substitute for the specific instructions Dr. Kelly and your physical therapist give you. Your timeline depends on your surgery, your body, and your progress. Follow your own care team's directions. In an emergency, call 911.
Acute Phase (0–2 Weeks) Goals
Sub-Acute Phase (Weeks 2–6)
Weeks 2–4
Weeks 4–6

Acute Phase (0–2 Weeks) Goals

  • •Active quadriceps muscle contraction; sufficient quadriceps control to allow safe independent ambulation.
  • •Passive knee extension to 0°; knee flexion to 90° or greater; control of swelling.
DAY 1 UNTIL HOSPITAL DISCHARGE
  • •Weight bearing as tolerated with walker / crutches; elevation for edema control.
  • •Ice 20 minutes of every hour for edema and pain control.
  • •Gait training: continue safe ambulation for 50 feet, instruct in transfers and stairs prior to discharge.
HOME EXERCISES TO INCLUDE
  • •Ankle pumps with leg elevation; quad sets; knee extension with patient generated overpressure.
  • •Gentle knee flexion stretches (i.e. heel slides); outpatient physical therapy should be scheduled prior to surgery.
DAYS 3 TO 14
  • •Begin outpatient physical therapy at approximately 2 days post-op.
  • •Change bandage at 1 week post-op unless excessive drainage is evident then change sooner. Staple removal at 14 days post-op by PT or in office at which time shower normally without a bandage covering the incision. No submersion.
  • •Gait training with appropriate assistive device; continue elevation and ice for edema and pain control.
  • •Tubigrip stocking for edema control; perform home exercise program (HEP) as issued by P.T.
  • •Instruct in all appropriate transfers for independence in home.
EXERCISES TO INCLUDE
  • •Ankle pumps with leg elevation; quad sets; knee extension with patient generated overpressure.
  • •Stretch hamstrings, gastroc-soleus.
  • •Active assistive range of motion knee flexion: i.e wall slides, seated knee flexion.
  • •Active terminal knee extension with bolster; straight leg raises (flexion, extension, abduction).
  • •AROM knee extension exercises, long and short arc quads; AROM knee flexion exercises.
  • •Terminal knee extension (biodex, theraband, seated); mini squats to ¼ depth; gait and balance.

Sub-Acute Phase (Weeks 2–6)

GOALS
  • •Full range of motion 0–120°; enhance muscular strength/endurance; minimize swelling / inflammation.
  • •Return to functional activities.

Weeks 2–4

  • •Continue ice, compression, and elevation for edema and pain control.
  • •Continue gait training. Wean from assistive device as able to safely without limp.
EXERCISES TO INCLUDE
  • •Continue all exercises listed previously; knee RROM extension exercises 90–0° (long arc quads); resisted hamstring curls.
  • •Bicycle for range of motion, may progress to a program per tolerance; step ups forward and lateral.
  • •Wall squats 45° knee flexion, progress to tolerance; seated leg press machine; progress balance and proprioception .

Weeks 4–6

  • •Continue all exercises listed previously with appropriate progressions.
  • •Progress to Nautilus type equipment for resisted knee extension and hamstring curls.
  • •Initiate progressive return to ADL’s and walking. Final Phase (Weeks 7–12) Goals:
  • •Progression of range of motion, 0–120° and greater; maximize strength, proprioception, and endurance.
  • •Cardiovascular fitness; functional activity performance.
EXERCISES TO INCLUDE
  • •Continue all exercises listed previously; continue to progress walking program; continue pool program participation.
  • •Return to all gym programing.
  • •Progress all recreation and sporting activity to pre-surgical levels per MD clearance.
  • •Running and high impact activity are not allowed.
  • •When ROM, strength, gait, balance, and endurance are acceptable, patient may be placed on HEP.

Discharge Criteria

  • •Independent ambulation without assistive device, including stairs
  • •Functional ROM for ADLs; independent home program
  • •Low-impact recreation per Dr. Kelly

Time frames are guidelines — progress when phase goals are met, per Dr. Kelly and the treating therapist.

When to call

Increasing pain, numbness, redness, drainage from the wound, or fever/chills — call (509) 460-5588. After hours, the answering service can reach Dr. Kelly. If your issue feels emergent, call 911 or go to the nearest emergency department.

Physical therapists

Treating one of Dr. Kelly's patients? Download the printable protocol for your clinic, and call (509) 460-5588 with questions about an individual patient's progression.

⬇  Protocol PDF

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