Getting back to exercise after a total knee replacement

The good news is that moving early is one of the most important things you can do after a total knee replacement (TKR). Your surgical team will aim to get you up and moving on the day of your surgery, or at the latest by day 1 afterwards. This is not just about getting you home sooner — early movement reduces your risk of serious complications like blood clots, helps your knee recover strength, and sets you up for a better long-term result.

Most people do not need to go to an inpatient rehabilitation facility after a knee replacement. For most patients, going home — with support from outpatient physiotherapy [a physiotherapist who you visit in a clinic] or a home exercise program — leads to equally good outcomes with fewer complications. Your care team will make this decision with you based on your individual situation.

In the first one to two weeks, your main goals are to manage pain, reduce swelling, and start building movement and strength in your knee.

You will start walking with a walking frame or crutches from day 1, under the guidance of your physiotherapist or hospital team. Before you leave hospital, you will need to show that you can transfer safely [move from sitting to standing and back], walk at least 70 metres with your walking aid, get dressed independently, and manage stairs if needed at home.

A structured exercise program — including gentle strengthening exercises for your thigh muscles [quadriceps], hip muscles, and calf muscles — should begin in this first phase. Exercises like sitting down and standing up from a chair, gentle knee bends, and ankle pumps are common early exercises. Aim to exercise at least twice a day.

You may feel some pain during or after exercise. This is normal and does not mean you are damaging your knee. Your care team will explain the difference between expected exercise soreness and pain that needs attention. Take your pain relief as prescribed — good pain management helps you move more and recover faster.

Your pain relief is likely to include paracetamol and anti-inflammatory medicines [such as ibuprofen or naproxen, if these are safe for you]. Strong opioid pain medicines [such as codeine or oxycodone] should be used as little as possible, as they can slow your recovery.

As your wound heals and your pain settles, your exercise program should gradually become more challenging. This is called progressive exercise — you slowly increase the difficulty as your body adapts.

During weeks 2 to 6, your physiotherapist will progress your strengthening exercises to include movements like step-ups, mini squats, and resistance work for your thigh and hip muscles. Balance and coordination exercises [neuromuscular training] are also important at this stage to help your knee feel stable and controlled.

Walking is one of the best things you can do during this phase. Gradually increase how far and how long you walk each day. You will likely transition from crutches or a frame to walking independently during this period.

You should also be working on bending and straightening your knee as fully as possible. A key goal is to reach at least 90 degrees of bend [flexion] in your knee by 6 weeks after surgery. If you are struggling to achieve this, let your physiotherapist or surgeon know early.

Swimming and aquatic exercise in a pool are not recommended until your wound is fully healed and your surgeon has given you the all-clear — this is usually from around 6 to 8 weeks after surgery.

From around 6 weeks, most people are ready to significantly increase their activity levels, with the goal of returning to the activities and hobbies they enjoy.

Low-impact activities such as recreational walking, riding a stationary or road bike, swimming, and golf are well supported after a knee replacement. Most people return to these kinds of activities by around 12 to 13 weeks after surgery. Having done these activities before your operation is the strongest predictor of getting back to them.

Moderate-impact activities — such as doubles tennis, hiking on uneven ground, or skiing — may be possible for some people, but this depends on your individual recovery, your strength and balance, how stable your knee feels, and advice from your surgeon. These activities should not be started until your physiotherapist and surgeon are satisfied with your progress, and generally not before 3 to 6 months after surgery.

High-impact activities such as running, contact sports, singles tennis, or impact team sports are not currently recommended after a total knee replacement. There is not yet enough evidence about how these activities affect the long-term life of your knee implant. Your care team can talk with you about what the research currently shows.

Recovery takes time, and everyone's journey is different. The most important thing is to keep moving, keep progressing, and make exercise a long-term part of your life — not just something you do for a few weeks after surgery.

Pelvic floor exercises are not a specific focus of total knee replacement recovery. However, staying active and doing gentle lower limb exercises in the early post-operative period can support your general circulation and overall wellbeing. If you have any concerns about bladder or bowel control — which can sometimes be affected by anaesthesia or reduced mobility — speak with your physiotherapist or GP [general practitioner].

There are no specific lifting restrictions that apply to all total knee replacement patients in the way there are after some other surgeries. However, in the first few weeks, you should avoid any activity that places sudden, heavy load through your operated leg or causes you to lose your balance. This includes lifting heavy objects while standing unsupported, as this increases the risk of a fall.

As your strength and stability improve, you can gradually return to everyday lifting tasks. If you do physical work or have specific lifting demands at home or at work, speak with your physiotherapist about when and how to return to these activities safely.

Most discomfort during exercise after a knee replacement is normal and expected. However, there are some warning signs that mean you should stop exercising and get medical help straight away. These are listed below in the red flags section.