Total Knee Replacement Rehab Protocol

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Phase 1 (0-2 weeks)

  • Goals: Control swelling, quadriceps activation, restore neuromuscular communication loops, prevent kinesiophobia.
  • Modalities: Compressive cyrotherapy, e-stimulation.

* Do not elevate beneath the knee with a pillow in a bent posture. This may encourage a knee flexion contracture.

  • Weightbearing: Immediate weight bearing as tolerated. Use crutches for support.
    • Educate patient to recognize maladaptive limp and use assistive devices until gait is normalized.
  • Brace: None
  • ROM: Encouraged immediately.
    • Focus on early terminal knee extension: heel elevations, bridges, prone hangs, quad isometrics.
  • Exercises: Heel slides, quadriceps/hamstring sets, SLR, planks, bridges, abs, gluteal strengthening, step-ups and stationary bike as tolerated.

Phase 2 (2-4 weeks)

  • Weightbearing: Full
  • Brace: None
  • ROM: Once terminal extension is captured, progress to knee flexion exercises with a goal of 90° within 4 weeks.
    • Controlled knee lowering into flexion with the contralateral limb.
    • Cross-legged, passive assisted deep knee bending from a high chair, stool or tall mattress.
  • Exercises: Progress Phase 1 exercises. Begin to add sport-specific exercises as tolerated. Cycling, elliptical, jogging; then progressing to running as tolerated.

Phase 3 (4-12 weeks)

  • Frequency: Begin to wean appointments based on patient’s progress and use home exercises rigorously.
  • Weightbearing: Full
  • Brace: None
  • ROM: Full
  • Exercises: Educate a home program. Advance sport-specific exercises as tolerated. Maintenance core, gluteal, hip and balance program.