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

Immobilisation:

• No brace routinely required

• Walking aids as required (crutches or frame), typically weaned early

Precautions:

• Avoid prolonged sitting with knee flexed

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

• Gradual progression of activity based on pain and swelling

• Monitor wound healing

Therapy:

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

• Range of motion exercises aiming for 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 early normalisation of walking pattern

• Patellar mobilisation

• Swelling management (ice, compression, elevation)

• Functional exercises (sit-to-stand, step practice)

Criteria to Progress:

• Knee flexion typically ≥100–120°

• Full or near full extension

• Independent ambulation, often without aids

• Minimal swelling

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

Precautions:

• Avoid high-impact activities

• Avoid excessive loading if swelling increases

Therapy:

• Progress to full functional range of motion

• Strengthening exercises (quadriceps, hamstrings, gluteals)

• Closed chain strengthening (leg press, step-ups, squats within comfort)

• Balance and proprioceptive training

• Stationary cycling and low-impact cardiovascular exercise

• Normalisation of gait and functional activities

Criteria to Progress:

• Functional range of motion

• Minimal swelling

• Good strength and neuromuscular control

• Independent ambulation

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 functional strengthening

• Advanced balance and proprioception

• Endurance training (cycling, walking programs)

Criteria to Progress:

• Good functional strength

• No significant pain or swelling

• Confidence with higher-level activities

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

Precautions:

• Gradual return to higher-level activities

• Avoid excessive impact loading if symptomatic

Therapy:

• Continued strengthening and endurance training

• Return to low-impact and selected moderate-impact recreational activities

• Functional and sport-specific training as appropriate

• Criteria for Return to Activity

• Full range of motion

• Good strength and balance

• No pain or swelling

General Recommendations

Work:

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

• Manual labour is typically deferred until 2–3 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 4–8 weeks.

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

• Running and higher-impact activities may be considered selectively depending on patient factors and surgeon guidance.

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.