TKA Rehab Protocol
  • Sports Medicine

  • Knee Surgery

  • Shoulder Surgery

  • Elbow Surgery

  • Hip Surgery

  • Ankle Surgery

  • Arthroscopic Surgery

TKA Rehab Protocol

Phase I (Day 0 to Day 2‐3) Rehab:


  • Control swelling, inflammation, and pain
  • Initiate Therapeutic Exercise program(both involved and non‐involved leg)
  • o Include Quad Sets, Hamstring Sets, Glut Sets
  • o Heel slides, Ankle Pumps
  • Safe ambulation with walker or crutches
  • Safe and independent bed mobility and transfers
  • ROM to 90 degrees flexion, 0 degree extension

To be carried out in the hospital

  • Patient education
  • Analgesia (cold compress)
  • CPM per hospital or physician protocol
  • Initiate Quad sets, hamstring sets, glut sets, ankle pumps, heel slides(Bilaterally)
  • Standing and ambulation with Physical Therapist using a walker
  • Stair climbing if relevant
  • Bed mobility, transfer training (bed to stand/ to chair/ to toilet)
  • Occupational Therapy to see patient for independence in ADL’s such as dressing and personal hygiene
  • Discharge to home when patient meets discharge criteria.
  • Discharge planning to arrange for any assistive devices/cpm/home health
  • Discharge to Post‐op week 2:


  • Safe functionally within the home
  • control of pain and inflammation
  • Progression of HEP
  • Increase ROM to 0‐100 degrees.
  • Initiate Out Patient PT (Patient must be discharged from Home Health

PT/OT and nursing care for more than 72 hours prior to initiating outpatient PT)


  • Muscle re‐education: Initiate quad contractions, SLRs, Short Arc Quads and Long Arc Quads, Bridging.
  • Soft tissue mobilization for scar management
  • PROM/assisted stretch/Grade 1‐2 joint mobilization
  • AAROM using ‘dangle and drop’, Sliderboard, etc. include proning and propping to increase extension.
  • Stationary Bike on low resistance, ‘Rocking’ if unable to perform


  • Modalities for controlling pain and inflammation.
  • Exercise for non‐involved limbs to maintain functional strength
  • Gently increasing weight bearing tolerance in gait
  • continue gait training to include steps/stairs and varied surfaces
  • Consider Pool therapeutic exercise if incision is healed and Surgeon
  • Approves and pool is available.

Phase II Rehab (Week 3 to Week 6):


  • Regaining endurance
  • Increased co‐ordination and proprioception
  • Further strengthening of knee muscles and kinetic chain (P.R.E.)
  • Improvement of ROM to 100‐110 degrees
  • Restore normalized gait
  • Control pain and inflammation
  • Maintain strength and endurance in non‐involved limbs and trunk
  • Progress HEP


  • Bike with resistance as tolerated
  • WBAT: wean off walker in 1‐2 weeks to a cane, wean off all assistive devices by 4 weeks. Functional stair climbing with normal use of both legs
  • Strengthening exercises in OKC (SLRs, TKE, hamstring curls) and CKC (minisquats, heel and toe raises, small step ups, TKE, sports cord, leg press, Total Gym, reformer)
  • Joint mobilization and assisted ROM
  • Proprioceptive exercises using wobble boards, trampolines, pneumatic disks
  • Modalities to control pain and inflammation
  • Continue ther ex for non‐involved regions to maintain needed functional Strength
  • Progress HEP

Phase III Rehab (weeks 7‐12):


  • Returning the patient to their premorbid status (ADLs, walking for exercise)
  • Further improvement of ROM past 110 degrees
  • Gain eccentric‐concentric control of limb
  • Walk independently without assistive devices without community barriers
  • Greater emphasis on patient responsibility of their own exercise regimen (owning the HEP)
  • Discharge planning


  • Directed to residual restrictions in ROM, Strength, or function
  • Progress HEP and determine independence in preparation for discharge
  • Modalities for any pain or inflammation control