Total Knee Replacement Exercise Protocol

Preoperative (1-2 weeks prior to surgery)

The preoperative protocol includes the following:

Education on the surgical process and outcomes Instruction on a postoperative exercise program Assessment of the home environment

Postoperative (day 1)
The first-day postoperative protocol includes the following:

Bedside exercises - For example, ankle pumps, quadriceps sets, and gluteal sets Review of weight-bearing status Bed mobility and transfer training - Bed to/from chair

Postoperative (day 2)
The second-day postoperative protocol includes the following:

Exercises for active ROM, active-assistive ROM (AAROM), and terminal knee extension Strengthening exercises - For instance, ankle pumps, quadriceps sets, gluteal sets, heel slides, straight leg raises, and isometric hip adduction Gait training with an assistive device and functional transfer training - Such as sit to/from stand, toilet transfers, bed mobility)

Postoperative (days 3-5 or on discharge to the rehabilitation unit)

The protocol during this period includes the following:

Progression of ROM and strengthening exercises to the patient's tolerance Progression of ambulation on level surfaces and stairs (if applicable) with the least restrictive device[14] Progression of ADL training

Postoperative (day 5 to 4 weeks)

The protocol includes the following:

Strengthening exercises - Including seated leg extensions, standing hip abduction and extension, knee bends, and short arc quads Stretching of quadriceps and hamstring muscles Progression of ambulation distance

Progression of independence with ADL