If you have a knee replacement booked, or have recently come out of surgery, the next question is usually the same: what does the rehabilitation actually look like? Physiotherapy is the part of recovery that happens after the operating theatre, and for most people it is the part that shapes how well the new knee works in everyday life. This guide walks you through it.
01 · Where it fits
Where knee replacement physiotherapy fits in the picture
A total knee replacement (also called a total knee arthroplasty) is usually offered when osteoarthritis has reached the point where pain, stiffness and loss of function no longer respond to first-line measures. The Royal Australian College of General Practitioners guideline for knee and hip osteoarthritis places exercise, weight management and education as the first-line treatments, with medication and surgery kept for situations where those are no longer enough.
Knee replacement is one of the most commonly performed orthopaedic operations in Australia. The Australian Orthopaedic Association National Joint Replacement Registry publishes annual data on procedure volumes, prosthesis performance and revision rates, and is the canonical source for Australian knee replacement figures (AOA NJRR).
Physiotherapy sits on both sides of the operation. Pre-operative physiotherapy (sometimes called prehabilitation) prepares the leg and the person for surgery. Post-operative physiotherapy rebuilds the knee through a structured program over the following weeks and months. Most people meet a Physiotherapist on the day of surgery and continue out-patient rehabilitation for the next six to twelve weeks.
02 · The first weeks
What the first weeks after surgery usually look like
The first phase of rehabilitation begins in hospital. A Physiotherapist will usually get you up and moving on the day of surgery or the day after, often with a frame or crutches, and will start gentle range-of-motion exercises and quadriceps activation drills.
Once you are home, the focus shifts to a structured out-patient program. The early weeks are about three things at once:
- Range of motion. Gradually regaining knee flexion (bending) and full extension (straightening). Many programs aim for around 90 degrees of flexion in the first two weeks and keep improving from there.
- Strength. Quadriceps, hamstring and hip muscles all weaken around surgery. Targeted exercises rebuild them so the new knee is supported during walking and stairs.
- Walking and balance. Re-learning a smooth walking pattern, easing off the frame or crutches as strength returns, and rebuilding confidence on uneven ground and stairs.
Progress is reviewed at each visit. The exact dose and intensity of each exercise are set by your Physiotherapist based on swelling, pain, range and strength on the day.
03 · What rehab includes
What a knee replacement physiotherapy program actually includes
A knee replacement physiotherapy program is more than a list of exercises. Five core elements usually run alongside each other for the first six to twelve weeks, and continue in a lower-dose form for longer.
1. Range of motion work. Heel slides, gentle stretches, and assisted flexion drills. The aim is full extension early, then steady gains in bending. Knee range is measured with a goniometer at each visit so progress is tracked.
2. Progressive strengthening. Quad sets, straight-leg raises, mini-squats, step-ups, and over time, fuller lower-limb resistance work. Progressive resistance training is a well-established, core part of rehabilitation after knee replacement.
3. Walking re-education. Gait retraining on level ground, then stairs, then uneven surfaces. The Physiotherapist watches for limp, knee thrust, hip drop and toe-out patterns that can linger after surgery if they are not addressed.
4. Balance and falls prevention. Single-leg stands, tandem stance, and graded balance drills. Lowering fall risk matters for everyone after lower-limb surgery, and especially for older adults.
5. Pain and swelling management. Ice, elevation, compression where appropriate, gentle soft-tissue work, and education on pacing your activity. Pain that does not settle, or that gets worse rather than better over time, is worth flagging to your Physiotherapist and surgeon.
The mix of these five changes week by week. Early on, range and pain management lead. By week four to six, strengthening and walking re-education take more of the session. By week eight to twelve, the program shifts toward higher-load strength, return-to-activity work and stair confidence.
The new knee gives you the chance to move better. The physiotherapy program is how you get there.
04 · Clinic, home or telehealth
Clinic, home or telehealth, and what the evidence says
A common question is whether rehabilitation has to be done face-to-face in a clinic. The evidence here is encouraging.
A 2019 systematic review and meta-analysis compared clinic-based or inpatient rehabilitation with home-based rehabilitation after a total knee replacement. It found no clinically important difference in pain, function or walking distance between the settings, and concluded that home-based rehabilitation is an appropriate first-line option after uncomplicated surgery for people with enough support at home.
A 2020 randomised trial compared a supervised virtual rehabilitation program at home with usual care after a total knee replacement. The virtual program reached similar knee function at twelve weeks, with a Physiotherapist providing oversight throughout.
The practical reading: clinic, home and supervised tele-rehabilitation programs can all work, provided the program is structured, the dose is right, and a Physiotherapist is reviewing progress. The right setting for you depends on access, mobility, confidence and the surgeon’s post-operative protocol. Your Physiotherapist can help you pick the mix.
05 · When to seek help
When to talk to your Physiotherapist or surgeon
Most people recover steadily after a knee replacement, but a small number of issues need quick attention rather than waiting until the next scheduled visit.
- A sudden increase in pain or swelling, especially if it is out of proportion to recent activity.
- Calf pain, redness or warmth, which can be a sign of deep vein thrombosis and needs same-day medical review.
- Fever, chills or wound drainage that appears after the early healing phase. This may need a surgical review.
- A knee that will not bend past 90 degrees by around six weeks, or that cannot fully straighten. Both are addressable with the right program, and tend to be easier to shift earlier.
- A persistent limp, or a feeling that the knee is giving way under load.
If any of these appear, contact your Physiotherapist, surgeon or general practitioner. Healthdirect Australia publishes general consumer information on knee replacement surgery and recovery, and is a useful starting point for further reading (Healthdirect knee replacement page).
The first twelve weeks set the trajectory, but the work continues beyond that. Strength, balance and walking pattern can keep improving for six to twelve months after surgery, and a maintained exercise habit is part of looking after the new knee for the longer term.
Further reading
If you want to understand related parts of knee and lower-limb rehabilitation, these guides may help:
- Correct technique is important. Why form matters in any strengthening program.
- Balance, falls and Physiotherapy. How Physiotherapy lowers fall risk after surgery and in older adults.
- Exercise and bone health. The role of resistance exercise across the lifespan.
