Physical Therapy After Total Knee Replacement: What the Latest Guidelines Mean for You
Jette DU, Hunter SJ, Burkett L, et al. Physical therapist management of total knee arthroplasty. Phys Ther. 2020;100(9):1603-1631. doi:10.1093/ptj/pzaa099
Background
A total knee arthroplasty (TKA), or knee replacement, is one of the most common and successful surgeries for people with severe knee arthritis. As medical knowledge evolves, clinicians rely on Clinical Practice Guidelines (CPGs) to determine what care is backed by the strongest evidence. This guide was developed by a team of physical therapists, physicians, nurses, and patient advocates to summarize what works, and what doesn’t, for optimizing recovery after a knee replacement.
What question is the study trying to answer?
What is the most effective way for physical therapists to help people before and after knee replacement surgery recover function, reduce pain, and return to daily activities safely and successfully?
What are the experimental groups and differences in the trial?
This wasn’t a single clinical trial but rather a large review of studies from 1995 to 2018. The expert panel reviewed hundreds of studies and rated different interventions based on how strong the evidence was. They made recommendations across the entire recovery process, from before surgery to the final follow-up visit.
What did the study find?
Here are the key takeaways that affect you as a patient:
Preoperative Exercise: Stronger, more flexible patients recover faster. If you're able, do strengthening and flexibility exercises before surgery with guidance from a PT.
Preoperative Education: Knowing what to expect makes a difference. Education about surgery, rehab, assistive devices, and discharge planning can improve outcomes and reduce complications.
Cryotherapy: Using cold packs or cooling devices after surgery can help manage pain with minimal risk.
Motor Function Training: Balance and walking-focused exercises significantly improve mobility, especially when supervised.
Avoid CPM Machines: Continuous Passive Motion machines were shown to offer no real benefit in uncomplicated surgeries and may delay mobility.
High-Intensity Strength Training: When safe and appropriate, early strengthening helps improve walking, balance, and functional independence.
Neuromuscular Electrical Stimulation (NMES): NMES can help restore muscle strength, especially when started early and used consistently.
Postoperative Physical Therapy Timing: Starting PT within 24 hours of surgery is ideal.
Outcome Tracking: Clinicians should measure your progress using standardized tools like the KOOS-JR and TUG test.
Discharge Planning: A physical therapist should be part of the decision about when and where you're discharged to—home is often safe if support is in place.
Potential limitations to the study
This guideline is built on the best available evidence but not every recommendation had the same level of support. Some areas (like the use of group therapy or exact exercise dosages) still need more research. Most studies also focus on uncomplicated surgeries, so if you have complex health conditions, your care plan may differ.
What does this mean for you as a patient?
With the right guidance and support, most people can make a strong recovery after a knee replacement. However, you play a big role in your outcome. Showing up for therapy, doing your home exercises, staying active, and asking questions are all powerful steps and the responsibility of the patient. The evidence shows that education and consistent physical activity really matter. Patients who understand their recovery process and follow structured plans tend to do better.
You should also feel empowered to discuss these topics with your care team. If your surgeon or PT doesn't mention some of the items above (like early strength training), it’s worth asking about them.
Final thoughts
This guideline reflects a shift in how knee replacement recovery is viewed: you are not just recovering passively—you are an active participant in your success. When paired with expert support, education, and appropriate exercise, the likelihood of returning to an active, pain-free lifestyle is very high.
⚡Want to know what recovery looks like after knee replacement? Read our full article on the first month after total knee replacement.
Written by Christian Hill, PT, DPT, CDNT – Licensed Physical Therapist with over 10 years in orthopedic rehab.
