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Total Knee Replacement

The orthopedic procedure of knee joint replacement is called a total knee arthroplasty (TKA). This surgery involves replacing the existing knee joint with a prosthetic joint . Orthopedic surgeons replace knee joints in order to end pain, stiffness, and loss of function most commonly from arthritis. Proper physical therapy and exercise will help restore strength and mobility to the knee and a gradual return to everyday activities after a total knee replacement.

Reasons for a Total Knee Replacement

Both chronic osteoarthritis and rheumatoid arthritis commonly cause people to lose knee function and damage the joint to the degree that they need a total knee joint replacement (total knee arthroplasty or TKA). But knee damage may also stem from injury or infection. Sometimes, people with severe rheumatoid arthritis of the knee can require a TKA at an early age.



The damaged knee joint is removed and manufactured components (prosthesis) are then placed in the knee. The prosthesis can have both metal and plastic parts. Some newer prostheses now are made of metal on metal, ceramic on ceramic, or ceramic on plastic.

The surgery for total knee replacement lasts about two hours and involves an incision over the knee. The femur and tibia will be cut to prepare them for the new prosthesis. The patella will be moved at the beginning of the procedure, and later a bone cement will be utilized to fasten the prosthesis to it. This is the traditional way the procedure has been performed. Several modifications to the procedure can be made and partial knee replacements are options for certain patients as well.

During the procedure, you will either have general anesthesia (when you are fully asleep) or a regional block (spinal or epidural with more localized anesthesia) that numbs your legs combined with an intravenous medication that will sedate you during the procedure. Your surgeon and anesthesiologist will discuss the advantages and disadvantages of both techniques.

You will usually leave the hospital within one day of the procedure and start physical therapy.  


What is the best physical therapy for knee replacements ?

Physical therapy after a knee replacement should focus on strength, range of motion, and functional exercises.

Regular exercise to restore strength and mobility to your knee and a gradual return to everyday activities are important for your full recovery after knee replacement. Your orthopedic surgeon and physical therapist may recommend that you exercise for 20 to 30 minutes, 2 or 3 times a day and walk for 30 minutes, 2 or 3 times a day during your early recovery.

This guide can help you better understand your exercise and activity program, supervised by your physical therapist and orthopedic surgeon. To ensure your safe recovery, be sure to check with your therapist or surgeon before performing any of the exercises shown.

Early Postoperative Exercises

Postoperative exercises will help increase circulation to your legs and feet which is important for preventing blood clots. They will also help strengthen your muscles and increase your range of motion. 


Start the exercises as soon as you are able. You can begin them in the recovery room shortly after surgery. You may feel uncomfortable at first, but these exercises will help speed your recovery and actually diminish your postoperative pain.


Early Activity

Soon after your surgery, you will begin to walk short distances in your hospital room and perform everyday activities. This early activity aids your recovery and helps your knee regain its strength and movement.



Proper walking is the best way to help your knee recover. At first, you will walk with a walker or crutches. Your surgeon or therapist will tell you how much weight to put on your leg, it's usually weight bearing as tolerated or as much weight as you can put on your leg and tolerate the pain while walking.

Walk as rhythmically and smoothly as you can. Don't hurry. Adjust the length of your step and speed as necessary to walk with an even pattern. As your muscle strength and endurance improve, you may spend more time walking. You will gradually put more weight on your leg. You may use a cane in the hand opposite your surgery and eventually walk without an aid.

When you can walk and stand for more than 10 minutes and your knee is strong enough so that you are not carrying any weight on your walker or crutches (often about 2 to 3 weeks after your surgery), you can begin using a single crutch or cane. Hold the aid in the hand opposite the side of your surgery. You should not limp or lean away from your operated knee.


Stair Climbing and Descending

The ability to go up and down stairs requires both strength and flexibility. At first, you will need a handrail for support and will be able to go only one step at a time. Always lead up the stairs with your good knee and down the stairs with your post surgical knee. Remember, "up with the good" and "down with the bad." You may want to have someone help you until you have regained most of your strength and mobility.

Stair climbing is an excellent strengthening and endurance activity. Do not try to climb steps higher than the standard height (7 inches) and always use a handrail for balance. As you become stronger and more mobile, you can begin to climb stairs foot over foot.

How long is physical therapy for a total knee replacement?

Total knee replacements are an effective way to treat severe arthritis of the knee.  90 percent of patients who have a knee replacement have a significant decrease in pain.  Full range of motion and strength of the entire surgical limb along with a normal gait or walking pattern is the goal of rehabilitation after surgery.  Functional activities of the patient should be incorporated into physical therapy as the patient progress.  Average time for recovery after a total knee replacement is about six weeks.

If you need post-operative therapy after Total Knee Replacement Surgery, please visit Excel Rehabilitation Services on Burnside Ave. in Gonzales, Louisiana. You will receive personal care from a professional physical therapist!


Online Sources:



Firestein, Gary, et al. Kelley & Firestein's Textbook of Rheumatology, 10th Ed. China: Elsevier, 2016

Note:  Sources updated 7-2022  Older links and materials no longer available were deleted. 

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