Phase I: Early Recovery and Motion (0–6 Weeks)

Immobilisation:

• No brace routinely required

• Walking aids (crutches or frame) as needed

Precautions:

• Avoid prolonged sitting with knee flexed

• Avoid placing pillows directly under the knee (encourage full extension)

• Monitor wound healing and signs of infection

• Gradual progression of activity based on pain and swelling

Therapy:

• Early mobilisation (day of surgery or day 1 postoperatively)

• Range of motion exercises with emphasis on full extension and progressive flexion

• Encourage full extension when in bed by placing pillow under the heel

• Quadriceps activation (quads sets, straight leg raises)

• Gait retraining with walking aids

• Patellar mobilisation

• Swelling management (ice, compression, elevation)

• Sit-to-stand and basic functional exercises

Criteria to Progress:

• Knee flexion typically ≥90–110°

• Full or near full extension

• Independent ambulation with or without aids

• Acceptable pain and swelling levels

Phase II: Progressive Strengthening and Function (6–12 Weeks)

Precautions:

• Avoid high-impact activities

• Avoid excessive loading if swelling increases

Therapy:

• Progress range of motion towards functional range

• Strengthening exercises (quadriceps, hamstrings, gluteals)

• Closed chain exercises (sit-to-stand, step-ups, leg press)

• Balance and proprioceptive training

• Stationary cycling, hydrotherapy if available

• Progress gait to normal pattern without aids

Criteria to Progress:

• Functional range of motion (typically ≥110–120°)

• Minimal swelling

• Independent ambulation without aids

• Improved strength and control

Phase III: Advanced Strengthening (12–16 Weeks)

Precautions:

• Avoid high-impact or pivoting activities

Therapy:

• Progressive strengthening including single-leg exercises

• Lunges, step-downs, and leg press progression

• Advanced balance and proprioception

• Endurance training (cycling, walking programs)

Criteria to Progress:

• Good functional strength

• No significant pain or swelling with activity

• Confidence with functional tasks

Phase IV: Return to Function and Endurance (4–6 Months)

Precautions:

• Avoid high-impact sports (e.g. running, jumping)

• Avoid activities with high risk of falls or excessive joint loading

Therapy:

• Continued strengthening and endurance training

• Low-impact recreational activities (cycling, swimming, golf)

• Functional and activity-specific training

• Criteria for Return to Activity

• Functional range of motion

• Good strength and balance

• No significant pain or swelling

General Recommendations

Work:

• Desk-based work may resume after 2–4 weeks.

• Manual labour is typically deferred until 3–4 months depending on job demands and recovery progression.

Driving:

• It is important that you are medically fit to return to driving and you feel safe to control the vehicle and take evasive action if needed.

• In general, for left knee surgeries in vehicles with automatic transmission, return to driving may be sooner.

Sports and Leisure:

• Low-impact activities may resume from 6–12 weeks.

• Activities such as cycling, swimming, and golf are encouraged.

• High-impact activities (running, jumping, contact sports) are generally discouraged following total knee replacement.

Thromboprophylaxis

All patients undergoing a knee replacement require postoperative thromboprophylaxis in accordance with current guidelines. The choice of agent and duration of treatment will be determined by A/Prof Ernstbrunner and his medical team based on the individual patient’s risk factors and comorbidities.

Disclaimer: This protocol is intended as a general rehabilitation guide only. Rehabilitation progression should always be individualised and may be modified by A/Prof Ernstbrunner and the treating rehabilitation team based on the patient’s clinical progress, surgical findings, and individual circumstances.