Physical Therapy After Knee Replacement: What to Expect
Physical therapy after knee replacement usually starts within 24 hours of surgery and continues for about 2 to 3 months. The core of it is strength training, walking and balance training, and getting the knee to bend and straighten. Most of the improvement in pain and function happens in the first 3 months, and recovery keeps going for up to a year.
This post explains what physical therapy after knee replacement looks like for people in Burbank and across Los Angeles County. It covers what the 2026 national guideline recommends, what each stage of recovery feels like, the exercises a physical therapist (PT) often starts with, how many visits to expect, and the warning signs that mean you should call your surgeon.
Quad Therapy Inc. is a California therapy company founded by a licensed physical therapist. We provide in-home therapy so patients can get care without clinic wait lines, and we place qualified therapists with clinics, schools, and facilities that need staff.
Key facts
More than 680,000 knee replacements were done in the United States in 2014, and that number is projected to keep rising.
191 studies with 59,667 patients: average pain fell from 64 to 24 out of 100 by 3 months after surgery, and to 17 by 12 months.
Function scores rose from 47 to 73 out of 100 by 3 months, and to 78 by 12 months.
About 2 degrees: the extra knee bend a continuous passive motion (CPM) machine gave at 6 weeks in 24 trials. That is too small to matter.
26 visits over 11 weeks: the outpatient program in a 162-person trial, where patients matched their pre-surgery stair climbing by about 2 months.
When should physical therapy start after knee replacement?
Physical therapy usually starts within 24 hours of surgery, often on the same day. The 2026 clinical practice guideline from the American Physical Therapy Association supports starting therapy and walking within the first day when it is safe.
The first sessions focus on getting in and out of bed, standing up from a chair, and walking with a walker. You also start simple exercises like tightening the thigh muscle and pumping the ankles. Many people now go home the same day or after 1 to 3 days, according to the American Academy of Orthopaedic Surgeons (AAOS), so a lot of the early work happens at home.
What does the 2026 guideline recommend after knee replacement?
The 2026 guideline, published in Physical Therapy in July 2026 by Bove and colleagues, gives strong support to strength training and to balance and walking training. It replaces the 2020 guideline by Jette and colleagues. The main points:
Exercise before surgery. A PT-designed program for strength, flexibility, and endurance before surgery can help both before and after the operation.
Progressive strength training. Start early after surgery and add load over time while watching pain, swelling, and knee motion. This is a strong recommendation.
Balance and movement training. Practice sit-to-stand, stairs, walking, and balance. This is also a strong recommendation.
Electrical stimulation of the thigh muscle. Neuromuscular electrical stimulation (NMES) uses small electrical pulses to help the quadriceps contract. The guideline suggests using it at least daily, starting early.
Ice and elevation. Use ice for early pain, and raise the leg with the knee slightly bent to reduce swelling.
No CPM machine. The guideline strongly recommends against CPM for a routine knee replacement. It also advises against routine bracing or splinting to gain motion.
Daily activity. Build up walking and activity over time, using tools such as step counts and goal setting.
The guideline found no setting that is clearly better. It suggests outpatient therapy when it is possible and safe, and it supports other options based on your safety, mobility, and home situation. Our post In-Home Physical Therapy vs Clinic compares the two.
What does recovery look like after knee replacement?
Recovery has stages, and the biggest changes happen in the first 3 months. A 2021 review by Sayah and colleagues of 191 studies described recovery as large and fast but not complete. Your surgeon's instructions come first, and timing differs from person to person.
Days 1 to 3. Walking with a walker, getting in and out of bed, ankle pumps, thigh tightening, ice, and elevation.
Weeks 1 to 6. Working on knee bending and straightening, controlling swelling, moving from a walker to a cane, practicing stairs, and building strength.
Weeks 6 to 12. Harder strength and balance work, longer walks, and often a stationary bike.
Driving. There is no set week. AAOS says driving usually returns once you are off opioid pain medicine, your strength and reflexes are back, and your surgeon agrees.
Months 3 to 12. Slower but steady gains. AAOS notes that mild to moderate swelling can last 3 to 6 months, and recommends keeping up your PT exercises for at least 2 months after surgery.
What exercises does a physical therapist give after knee replacement?
Early exercises focus on waking up the thigh muscle and getting the knee moving. Your PT chooses and adjusts them for you, so do not start any of these without guidance. Common examples:
Quad sets. Tighten the front of the thigh to press the back of the knee down.
Ankle pumps. Move the foot up and down to help blood flow.
Heel slides. Slide the heel toward you to bend the knee.
Straight leg raises. Lift the straight leg a short distance while lying down.
Sit-to-stand. Stand up from a sturdy chair, using your arms less over time.
Step-ups and balance work. Added later as strength and control improve.
Balance matters after surgery because a weak leg raises the chance of a fall. Our post Balance Exercises for Seniors: 7 Safe Moves for Home shows the kind of balance work a PT may add once you are ready.
How many physical therapy visits will I need after knee replacement?
A common plan is 2 to 3 visits a week for about 2 to 3 months. For example, in a 2017 trial by Bade and colleagues, 162 patients had 26 outpatient sessions over 11 weeks. The exact number depends on your progress, your goals, and your insurance.
Under Original Medicare, outpatient PT is covered under Part B, and Medicare home health can cover visits at no cost if you are homebound. Our guide Does Medicare Cover In-Home Physical Therapy? explains both paths. After surgery you will usually have a referral from your surgeon, and your insurance may require one.
Is harder physical therapy better after knee replacement?
Not always. In the Bade trial, a high-intensity program with progressive weights, balance, and agility work was safe, but it did not lead to better results than a gentler program. Both groups were back to their pre-surgery stair climbing by about 2 months, and both kept improving at 12 months.
The 2026 guideline still supports progressive strength training. The point is steady progress you can keep up, not pushing through severe pain. Some soreness after exercise is normal. Pain or swelling that gets worse day after day is a reason to tell your PT.
When should I call my surgeon after knee replacement?
Call your surgeon right away if you notice signs of infection or a blood clot. AAOS lists these warning signs:
A fever over 100 degrees that does not go away, or shaking chills.
More redness, tenderness, or swelling around the wound, or drainage from it.
Pain in the calf or leg that is not from the incision.
Swelling in the calf, ankle, or foot that keeps getting worse.
Call 911 for shortness of breath or sudden chest pain. These can be signs of a blood clot in the lungs.
Can I do physical therapy at home after knee replacement?
Yes, for many people. A 2019 meta-analysis by Buhagiar and colleagues of 5 trials and 752 people found that clinic-based rehab was not better than home-based rehab for walking or for pain and function scores. In-home PT fits best when you cannot drive yet, have trouble with stairs or getting in and out of the house, or need to practice in your own bathroom and bedroom.
Frequently asked questions
How long does physical therapy last after knee replacement?
Most people have formal PT for about 2 to 3 months. Many keep doing a home exercise program after that, because function keeps improving for up to a year.
Is it normal for my knee to be swollen months after surgery?
Yes, some swelling is normal. AAOS says mild to moderate swelling can last 3 to 6 months. Swelling that suddenly gets worse, or comes with redness, fever, or calf pain, needs a call to your surgeon.
Do I need a CPM machine after knee replacement?
Usually not. A Cochrane review of 24 trials found CPM added only about 2 degrees of bend at 6 weeks, and the 2026 guideline strongly recommends against routine use.
Can I skip physical therapy after knee replacement?
It is not a good idea. Strength and balance training are strong recommendations in the 2026 guideline, and the exercises help you walk, use stairs, and stand up safely. Talk with your surgeon and PT if cost or travel makes therapy hard.
Can I get in-home physical therapy after knee replacement in Burbank?
Yes. Quad Therapy Inc. is based in Burbank and provides in-home physical therapy. Call (855) 313-3201 to ask whether we serve your neighborhood in Los Angeles County.
About Quad Therapy
Quad Therapy Inc. is a therapy company in Burbank, California, founded by a licensed physical therapist. We go to the patient. Our licensed therapists provide [SERVICES] in the home, and we staff clinics, schools, and facilities with qualified therapists. Every service is provided by a clinician licensed by the matching California board and stays within that board's scope of practice. To schedule a visit or ask about staffing, call (855) 313-3201 or visit quadtherapy.com. Our office is at 455 N Moss St, Suite 102, Burbank, CA 91502.
Next step: if your surgery is scheduled, ask your surgeon about starting PT before the operation, and set up your first post-surgery visit before you leave the hospital. To ask about in-home physical therapy after knee replacement in Burbank or Los Angeles County, call (855) 313-3201.
This article is for education. It is not medical advice. Talk with a licensed clinician about your situation.
Sources
Bove AM, Carroll LA, Cone S, et al. Clinical practice guideline for physical therapist management of total knee arthroplasty: revision 2026. Physical Therapy. 2026;106(7):pzag058. doi.org
Jette DU, Hunter SJ, Burkett L, et al. Physical therapist management of total knee arthroplasty. Physical Therapy. 2020;100(9):1603-1631. doi.org
Sayah SM, Karunaratne S, Beckenkamp PR, et al. Clinical course of pain and function following total knee arthroplasty: a systematic review and meta-regression. Journal of Arthroplasty. 2021;36(12):3993-4002.e37. doi.org
Harvey LA, Brosseau L, Herbert RD. Continuous passive motion following total knee arthroplasty in people with arthritis. Cochrane Database of Systematic Reviews. 2014;CD004260. cochrane.org
Bade MJ, Struessel T, Dayton M, et al. Early high-intensity versus low-intensity rehabilitation after total knee arthroplasty: a randomized controlled trial. Arthritis Care and Research. 2017;69(9):1360-1368. doi.org
Buhagiar MA, Naylor JM, Harris IA, Xuan W, Adie S, Lewin A. Assessment of outcomes of inpatient or clinic-based vs home-based rehabilitation after total knee arthroplasty: a systematic review and meta-analysis. JAMA Network Open. 2019;2(4):e192810. doi.org
Singh JA, Yu S, Chen L, Cleveland JD. Rates of total joint replacement in the United States: future projections to 2020-2040 using the National Inpatient Sample. Journal of Rheumatology. 2019;46(9):1134-1140. jrheum.org
American Academy of Orthopaedic Surgeons. Activities after knee replacement. OrthoInfo. orthoinfo.org