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Knee Replacement Exercise Guide

Importance of Knee Replacement Exercises 

Exercising the muscles that surround and support the knee help restore range of motion and joint strength after knee replacement surgery. To ensure a positive surgical outcome after knee replacement, you are recommended to perform physical therapy exercises 2-3 times a day and walk for 30 minutes every day. You will be provided with a specific exercise routine by your doctor. The following exercises are generally recommended: 

Knee Replacement Exercises for the Early Post-Surgical Recovery Phase

These exercises can be performed while in the recovery room soon after the surgery. You are encouraged to do them as soon as possible as they improve blood circulation in your feet and legs and prevent the formation of blood clots in addition to strengthening your muscles.

  • Quadriceps Set Exercise: Lie on your back on your bed with your leg fully extended. Contract the thigh muscle (quadriceps) and hold the contraction for about 10 seconds and then relax. Do about 3-4 sets of 10 repetitions 2-3 times a day.
  • Ankle Pump Exercise: Lie on your back with your leg extended and rhythmically contract your calf and shin muscles to perform a back and forth pumping movement with your feet. Do this exercise continuously for 2 minutes every hour while in the recovery room.  
  • Knee Straightening Exercise: Lie on your back with your leg fully extended. Place a rolled-up towel under your heel. Tighten your thigh muscles and try to press the back of your knee into the bed. Hold the position for 10 seconds and then relax.  Do about 3-4 sets of 10 repetitions 2-3 times a day.
  • Straight Leg Lift Exercise: Lie on your back on your bed with your leg fully extended. Raise you heel a few inches off the bed while keeping your leg as straight as possible. Hold this position for about 10 seconds and then slowly lower your heel. Do about 3-4 sets of 10 repetitions 2-3 times a day.
  • Heel Slides: Lie on your back on your bed with legs extended. Slowly slide your heel towards your buttocks while bending your knee and then slide your heel back to extend your leg. Do about 3-4 sets of 10 repetitions 2-3 times a day.
  • Seated Knee Bend Exercise: While sitting at the end of a chair or bed, place the foot of the unoperated leg behind the heel of the operated leg. Slowly bend the operated knee sliding the heel across the floor towards the chair or bed and hold the position for 10 seconds and then extend your knee again. Do about 3-4 sets of 10 repetitions 2-3 times a day.

Resumption of Activities after Knee Replacement

You will be encouraged to start walking while in the recovery room. Early resumption of weight-bearing and walking helps you speed up your recovery and return to routine activities of daily living.

  • Walking: Initially, you may have to use a walker or a pair of crutches to walk so you can control the amount of weight placed on the knee. From a standing position, with your weight evenly balanced, advance the walker or crutches a small distance and move the operated leg forward by lifting the toes of the ground first and bending the knee and hip joint to lift the foot. When placing the operated leg on the ground, touch your heel first, then flatten the foot. As your muscles become stronger, you can use a walking cane in your opposite hand to assist with walking, and finally, walk without using any aids.
  • Stair Climbing: Initially, use the handrail for balance and support when going up and down the stairs. Lead with the unoperated knee when going up the stairs and with a cane and the operated knee when going down the stairs. The stairs should be no higher than 7 inches (standard height) when you start stair climbing after knee replacement. This is an excellent activity to improve endurance and strength.

Advanced Knee Replacement Exercises

Full recovery after knee replacement may take a few months. The following exercises help maximize knee function and mobility:

  • Standing Knee Bend Exercise: Stand erect with the support of a walker or crutches and lift your operated leg up while bending at the knee as much as possible. Hold the position for 10 seconds and put the leg down again. Do about 3-4 sets of 10 repetitions of this exercise 2-3 times a day.
  • Resistance Exercises for the Knee: About 4-6 weeks after the surgery, you may be strong enough to use wrap-around ankle weights weighing no more than 1-2 pounds and perform any of the above exercises. You can gradually increase the weight as you make strength and endurance gains. 
  • Stationary Bike: This is an excellent low-impact activity to improve knee function. Adjust the seat height so that your foot just touches the pedal with the knee fully extended. Pedal backward initially, and once you have achieved a comfortable backward cycling motion, start pedaling forwards. Build up your endurance to 20 minutes 3 times a week.

You may have temporary discomfort and swelling after exercise, but this should improve with foot elevation and the application of ice wrapped in a towel to the knee. Contact your doctor or physical therapist for persistent or worsening symptoms. 

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