Total Knee Replacement Protocol

Name: Total Knee Replacement Protocol
Creator: HEP Drop

Post-op TKA rehab by week and by day for the first two weeks: phases, weight bearing, restrictions and milestones, with cited sources and a free printable PDF.

By HEP Drop staff · Reviewed by a licensed physical therapist, Oct 2026 · Version 2026.10 · 19 sources · How we write protocols

At a glance (Primary TKA): PT within 24 h · WBAT with a walker from day 0 · cane typically from wk 2 · no device typically wk 3–6 · 0–90° by wk 2 · 0–120° by wk 10 · low-impact activity from about 3 mo with surgeon clearance. Criteria-based.

Timeline

Currently showing: Primary TKA · Version 2026.10

Timeline, weeks 0–10 after surgery. Select any bar for details. Key dates are also in the key milestones table. The first two weeks are also shown by day. After the protocol: Kneeling practice can start · wk 12.

Phase

Weight bearing

Motion

Strength

Restrictions

Milestones

First 14 days ↓

First 14 days

Days 0–14 after surgery, by day: the hospital days and the first days at home. Select any bar for details.

First days

Weight bearing

Motion

Milestones

Phase 1 · Early motion

wk 0–2

CPM is not used after primary, uncomplicated TKA^{[1, 8]}, and neither is routine bracing or splinting to gain motion early^[1].

Goals

Walking with a walker, weight bearing as tolerated unless the surgeon restricts it^{[2, 3]}
Knee motion toward 0–90° by wk 2^{[2, 4]}
Quadriceps activation^[5]; pain and swelling control^[1]
Safe transfers and a home program before hospital discharge^[2]

Allowed

PT, including getting up, within 24 hours of surgery^[1]
Gait training with the walker, then a cane once the step-down criteria are met^[6]
Passive, active-assisted and active knee ROM^[1]
Sustained end-range flexion and extension in short bouts, about 30 min a day in total, until 0–120° is reached^[6]
Progressive walking, guided by pain and swelling (no step cap)^{[1, 6]}
Cryotherapy for early pain; plain cold packs work as well as cold-flow devices^{[1, 7]}

Avoid

Driving, until getting in and out of the car and moving from gas to brake are comfortable, and off opioids (until wk 4)

Advance to Phase 2 when

2 × 8 repetitions without fatigue^[5] (yes/no check)
Resting pain < 5/10 (NPRS)^[5]
Active knee ROM better than 15–80°^[5] (yes/no check)

Exercises

Ankle Pumps2 × 10, 2–3×/day (sets/reps: our default)See it in HEP Drop →

Quad Set2 × 10, 2–3×/day (sets/reps: our default)See it in HEP Drop →

Glute Set2 × 10, 2–3×/day (sets/reps: our default)See it in HEP Drop →

Supine Heel Slide with Strap2 × 10, 2–3×/day (sets/reps: our default)See it in HEP Drop →

Short Arc Quad2 × 10, 2–3×/day (sets/reps: our default)See it in HEP Drop →

Active Straight Leg Raise with Quad Set, start

Active Straight Leg Raise with Quad Set, finish

Active Straight Leg Raise with Quad Set2 × 10, 2–3×/day (sets/reps: our default)See it in HEP Drop →

Seated Knee Extension Stretch (Heel Prop), start

Seated Knee Extension Stretch (Heel Prop), finish

Seated Knee Extension Stretch (Heel Prop)short bouts, about 30 min a day in total with the flexion stretch, until 0–120°See it in HEP Drop →

Seated Knee Flexion Stretchshort bouts, about 30 min a day in total with the heel prop, until 0–120°See it in HEP Drop →

How protocols differ: The only phased plan in the cited evidence moves on by criteria, not by date, and its phases overlap^[5]; the compared protocols end their first stage at wk 3, at wk 1, or at hospital discharge^{[17, 18, 19]}.

Create HEP for Phase 1 →Match the surgeon's protocol →Opens HEP Drop · Free during early access

Key milestones by week

How this protocol compares with published total knee protocols and the cited evidence, on a shared week scale (low-impact activity on a 12-month scale). Criteria-based: advance only when each phase's criteria are met.

Want the patient's dates here? (or weeks post-op).

This protocol vs published protocols · Primary TKA
Milestone	This protocol	0410 wk Range in published protocols	Published range
Off the walker or cane	wk 3		wk 3–8^{[17, 18, 19]}all three compared protocols include wk 6
Driving again	wk 4		wk 2–8^[10]most often about wk 4
Discharge from outpatient PT	wk 10		wk 8–15^[13]typical recovery about wk 10
Low-impact activity	from 3 mo	months scale: 0–12 mo	wk 9 to 6 mo^{[16, 17, 18, 19]}mean about 13 wk

Range in published protocolsMost commonThis protocol

All phases

⬇ Download PDFDownload PDF / Print protocol: your clinician copy, no email needed. Create HEP: a patient handout in HEP Drop with that phase's exercises prefilled. Opens HEP Drop · Free during early access.

Phase 1 · Early motion

wk 0–2Create HEP for Phase 1 →

Allowed

PT, including getting up, within 24 hours of surgery^[1]
Gait training with the walker, then a cane once the step-down criteria are met^[6]
Passive, active-assisted and active knee ROM^[1]
Sustained end-range flexion and extension in short bouts, about 30 min a day in total, until 0–120° is reached^[6]
Progressive walking, guided by pain and swelling (no step cap)^{[1, 6]}
Cryotherapy for early pain; plain cold packs work as well as cold-flow devices^{[1, 7]}

Avoid

Driving, until getting in and out of the car and moving from gas to brake are comfortable, and off opioids (until wk 4)

Exercises

Ankle Pumps2 × 10, 2–3×/day (sets/reps: our default)

Quad Set2 × 10, 2–3×/day (sets/reps: our default)

Glute Set2 × 10, 2–3×/day (sets/reps: our default)

Supine Heel Slide with Strap2 × 10, 2–3×/day (sets/reps: our default)

Short Arc Quad2 × 10, 2–3×/day (sets/reps: our default)

Active Straight Leg Raise with Quad Set2 × 10, 2–3×/day (sets/reps: our default)

Seated Knee Extension Stretch (Heel Prop)short bouts, about 30 min a day in total with the flexion stretch, until 0–120°

Seated Knee Flexion Stretchshort bouts, about 30 min a day in total with the heel prop, until 0–120°

Advance to Phase 2 when

2 × 8 repetitions without fatigue^[5] (yes/no check)
Resting pain < 5/10 (NPRS)^[5]
Active knee ROM better than 15–80°^[5] (yes/no check)

Phase 2 · Motion and strength

wk 2–6Create HEP for Phase 2 →

Allowed

Progressive resistance, 2 × 8 at an 8-repetition maximum^[6]
Stationary bike for motion^{[1, 5]}
Balance and gait training^[1]
Quadriceps, hamstring and calf stretches, 3 × 1 min daily, from wk 5^[6]
Walking program, building toward 30 min, 5 days a week^[6]
NMES to the quadriceps, daily, if used (optional)^[1]

Avoid

Driving, until getting in and out of the car and moving from gas to brake are comfortable, and off opioids (until wk 4)

Exercises

Active Straight Leg Raise with Quad Set2 × 10, 2–3×/day (sets/reps: our default)

Hip Abduction (Side-Lying)2 × 8 at an 8-repetition maximum

Clamshell2 × 8 at an 8-repetition maximum

Seated Long Arc Quad2 × 8 at an 8-repetition maximum

Standing Knee Flexion AROM with Chair Support2 × 8 at an 8-repetition maximum

Sit to Stand2 × 8 at an 8-repetition maximum

Standing Mini Squat2 × 8 at an 8-repetition maximum

Standing Calf Raise2 × 8 at an 8-repetition maximum

Standing Hip Flexion (Marching)2 × 10 (sets/reps: our default)

Single Leg Balance3 × 30 s (sets/reps: our default)

Seated Knee Extension Stretch (Heel Prop)short bouts, about 30 min a day in total with the flexion stretch, until 0–120°

Seated Knee Flexion Stretchshort bouts, about 30 min a day in total with the heel prop, until 0–120°

Stationary Bikefor motion, as tolerated (sets/reps: our default)

Walking Programbuild to 30 min, 5 days a week

Prone Quad Stretch3 × 1 min, daily · from wk 5

Supine Hamstring Stretch3 × 1 min, daily · from wk 5

Standing Calf Stretch (Gastrocnemius)3 × 1 min, daily · from wk 5

Advance to Phase 3 when

2 × 8 repetitions without fatigue^[5] (yes/no check)
Resting pain < 5/10 (NPRS)^[5]
Active knee ROM better than 15–90°^[5] (yes/no check)

Phase 3 · Strengthen and return

wk 6–10Create HEP for Phase 3 →

Allowed

Progressive resistance, 2 × 8 at an 8-repetition maximum, including leg press and step work^{[6, 5]}
Balance and agility work: foam stance, side steps, backward walking^[5]
Walking program, then other cardio^[6]

Avoid

No time-based limits in this phase.

Exercises

Leg Press2 × 8 at an 8-repetition maximum

Step Up2 × 8 at an 8-repetition maximum

Lateral Step Up2 × 8 at an 8-repetition maximum

Step Down (Forward)2 × 8 at an 8-repetition maximum

Forward Lunge2 × 8 at an 8-repetition maximum

Wall Squat (Wall Sit)2 × 8, holding 5–10 s at the bottom

Standing Terminal Knee Extension with Resistance2 × 8 at an 8-repetition maximum

Bridge (Bilateral)2 × 8 at an 8-repetition maximum

Banded Side Step2 × 10 steps each way (sets/reps: our default)

Bosu / Foam Balance Stance3 × 30 s (sets/reps: our default)

Retro Walking (Backward Ambulation)2 × 10 steps (sets/reps: our default)

Stationary Bikefor motion, as tolerated (sets/reps: our default)

Walking Programbuild to 30 min, 5 days a week

Prone Quad Stretch3 × 1 min, daily

Supine Hamstring Stretch3 × 1 min, daily

Discharge from PT when

2 × 8 repetitions without fatigue^[5] (yes/no check)
Resting pain < 3/10 (NPRS)^[5]
Knee ROM 0–120°^[6] (yes/no check)
Normal gait without a device (yes/no check)
Reciprocal stairs (yes/no check)
Quadriceps strength ≥ 80% of the other leg

Return to low-impact activity when

About 3 months since surgery (mean return to low-impact sport about 13 wk)^[16]
Cleared by the surgeon (yes/no check)

Phase

Allowed

Avoid

Exercises

Advance / discharge when

Phase 1 · Early motion
wk 0–2

PT, including getting up, within 24 hours of surgery^[1]
Gait training with the walker, then a cane once the step-down criteria are met^[6]
Passive, active-assisted and active knee ROM^[1]
Sustained end-range flexion and extension in short bouts, about 30 min a day in total, until 0–120° is reached^[6]
Progressive walking, guided by pain and swelling (no step cap)^{[1, 6]}
Cryotherapy for early pain; plain cold packs work as well as cold-flow devices^{[1, 7]}

Driving, until getting in and out of the car and moving from gas to brake are comfortable, and off opioids (until wk 4)

Ankle Pumps 2 × 10, 2–3×/day (sets/reps: our default)
Quad Set 2 × 10, 2–3×/day (sets/reps: our default)
Glute Set 2 × 10, 2–3×/day (sets/reps: our default)
Supine Heel Slide with Strap 2 × 10, 2–3×/day (sets/reps: our default)
Short Arc Quad 2 × 10, 2–3×/day (sets/reps: our default)
Active Straight Leg Raise with Quad Set 2 × 10, 2–3×/day (sets/reps: our default)
Seated Knee Extension Stretch (Heel Prop) short bouts, about 30 min a day in total with the flexion stretch, until 0–120°
Seated Knee Flexion Stretch short bouts, about 30 min a day in total with the heel prop, until 0–120°

2 × 8 repetitions without fatigue^[5] (yes/no check)
Resting pain < 5/10 (NPRS)^[5]
Active knee ROM better than 15–80°^[5] (yes/no check)

Phase 2 · Motion and strength
wk 2–6

Progressive resistance, 2 × 8 at an 8-repetition maximum^[6]
Stationary bike for motion^{[1, 5]}
Balance and gait training^[1]
Quadriceps, hamstring and calf stretches, 3 × 1 min daily, from wk 5^[6]
Walking program, building toward 30 min, 5 days a week^[6]
NMES to the quadriceps, daily, if used (optional)^[1]

Driving, until getting in and out of the car and moving from gas to brake are comfortable, and off opioids (until wk 4)

Active Straight Leg Raise with Quad Set 2 × 10, 2–3×/day (sets/reps: our default)
Hip Abduction (Side-Lying) 2 × 8 at an 8-repetition maximum
Clamshell 2 × 8 at an 8-repetition maximum
Seated Long Arc Quad 2 × 8 at an 8-repetition maximum
Standing Knee Flexion AROM with Chair Support 2 × 8 at an 8-repetition maximum
Sit to Stand 2 × 8 at an 8-repetition maximum
Standing Mini Squat 2 × 8 at an 8-repetition maximum
Standing Calf Raise 2 × 8 at an 8-repetition maximum
Standing Hip Flexion (Marching) 2 × 10 (sets/reps: our default)
Single Leg Balance 3 × 30 s (sets/reps: our default)
Seated Knee Extension Stretch (Heel Prop) short bouts, about 30 min a day in total with the flexion stretch, until 0–120°
Seated Knee Flexion Stretch short bouts, about 30 min a day in total with the heel prop, until 0–120°
Stationary Bike for motion, as tolerated (sets/reps: our default)
Walking Program build to 30 min, 5 days a week
Prone Quad Stretch 3 × 1 min, daily · from wk 5
Supine Hamstring Stretch 3 × 1 min, daily · from wk 5
Standing Calf Stretch (Gastrocnemius) 3 × 1 min, daily · from wk 5

2 × 8 repetitions without fatigue^[5] (yes/no check)
Resting pain < 5/10 (NPRS)^[5]
Active knee ROM better than 15–90°^[5] (yes/no check)

Phase 3 · Strengthen and return
wk 6–10

Progressive resistance, 2 × 8 at an 8-repetition maximum, including leg press and step work^{[6, 5]}
Balance and agility work: foam stance, side steps, backward walking^[5]
Walking program, then other cardio^[6]

No time-based limits in this phase.

Leg Press 2 × 8 at an 8-repetition maximum
Step Up 2 × 8 at an 8-repetition maximum
Lateral Step Up 2 × 8 at an 8-repetition maximum
Step Down (Forward) 2 × 8 at an 8-repetition maximum
Forward Lunge 2 × 8 at an 8-repetition maximum
Wall Squat (Wall Sit) 2 × 8, holding 5–10 s at the bottom
Standing Terminal Knee Extension with Resistance 2 × 8 at an 8-repetition maximum
Bridge (Bilateral) 2 × 8 at an 8-repetition maximum
Banded Side Step 2 × 10 steps each way (sets/reps: our default)
Bosu / Foam Balance Stance 3 × 30 s (sets/reps: our default)
Retro Walking (Backward Ambulation) 2 × 10 steps (sets/reps: our default)
Stationary Bike for motion, as tolerated (sets/reps: our default)
Walking Program build to 30 min, 5 days a week
Prone Quad Stretch 3 × 1 min, daily
Supine Hamstring Stretch 3 × 1 min, daily

Discharge from PT:

2 × 8 repetitions without fatigue^[5] (yes/no check)
Resting pain < 3/10 (NPRS)^[5]
Knee ROM 0–120°^[6] (yes/no check)
Normal gait without a device (yes/no check)
Reciprocal stairs (yes/no check)
Quadriceps strength ≥ 80% of the other leg

Return to low-impact activity:

About 3 months since surgery (mean return to low-impact sport about 13 wk)^[16]
Cleared by the surgeon (yes/no check)

How published protocols differ

Published protocols agree on walking with a walker from the first days, and differ most on when to drop the walker or cane, the final flexion goal and how to rest the knee in the first days.

Decision points across published total knee protocols (facts in our words, each linked to its source).
Decision point	This protocol	Sanford Health^[17]source ↗ · rev. Jul 2026 · checked Oct 2026	Mass General Brigham^[18]source ↗ · Jun 2025 · checked Oct 2026	South Shore Health^[19]source ↗ · rev. Jan 2021 · checked Oct 2026
Weight bearing	WBAT with a walker from day 0, unless the surgeon restricts it	No default; any modified weight bearing is checked with the physician	Follow the surgeon's order if restricted; no default	WBAT with a walker or crutches unless ordered otherwise
Off the walker or cane	Cane typically from wk 2, no device typically wk 3–6, each once criteria are met	Cane once quad control is adequate (wk 0–3); no device wk 3–6	Least device needed by the end of wk 1–4; normal gait with no device by the end of wk 4–8	Wean once a straight leg raise has no lag; many off devices by 6 wk
Final flexion goal	0–120° by wk 10	0–120° (wk 6–9, and at discharge)	Over 120° (wk 8–12)	0–110° by wk 6, then as much as possible
Resting position, first days	Elevated, knee bent 30–90°, first 7 days, with heel-prop bouts	Not stated	Nothing directly under the knee; heel prop	Towel roll under the ankle; nothing under the knee for long periods
Driving	Typically about wk 2 after a left TKA, wk 4 after a right, once car transfers and gas-to-brake are comfortable and off opioids	Ask the physician; no timing given	Not stated	Commonly 6 wk after a right knee, 4 wk after a left; never on narcotics
Return to activity	Low-impact activity from about 3 mo, with surgeon clearance	Wk 9+: golf, walking or biking programs; running and high impact via the physician	Months 3–6: low-impact recreation with physician clearance	Wk 12+: golf, doubles tennis, cycling; avoid high-impact and contact sports

Different numbers from the surgeon?

Match the surgeon's protocol →

Opens HEP Drop · Free during early access

Each value is a fact in our words, linked to its source with the version and the date we checked it. Not affiliated with or endorsed by the institutions listed.

References and basis

Reviewed by a licensed physical therapist (HEP Drop staff)Page reviewed Oct 2026Literature checked through Oct 2026Protocols checked Oct 2026Version 2026.10 · changelogHow we write protocols

What backs each recommendation

Our summary, in our own words, of what each source supports. "Strongest evidence" is the study design as published; a review that pools only cadaver studies is listed as a lab study. "Limited evidence" means no randomized trial or systematic review of patient studies is among that row's sources; we do not grade our own recommendations.

What backs each recommendation, Primary TKA
Recommendation	This protocol	Based on	Strongest evidence	What's uncertain
Phase 1 · Early motion · wk 0–2
First PT and getting up	within 24 h	[1] Bove 2026 [2] Cook 2008 [3] Masaracchio 2017	Systematic review
Weight bearing	as tolerated with a walker from day 0, unless the surgeon restricts it	[2] Cook 2008 [3] Masaracchio 2017 [10] Na 2020	Systematic review	The 2026 guideline gives no weight-bearing status^[1]; every program in the cited evidence lets patients bear weight as tolerated from the day of surgery or day 1^{[2, 3, 10]}.
Resting position	elevated, knee bent 30–90°, days 0–7	[1] Bove 2026 [9] Jette 2020 [6] Bade 2017	RCT	The guideline recommends resting with the knee bent to limit swelling^[1]; two of the compared protocols say nothing under the knee (see How protocols differ). This page pairs the resting position with heel-prop extension bouts^[6].
Walker to cane	typically from wk 2, once the criteria are met	[3] Masaracchio 2017	Systematic review	No study gives criteria for stepping down; the criteria are our clinical call. Fast-track programs try a cane on day 1 or 2, and one pathway moves to sticks at the 10–14 day visit^[3].
0–90°	by wk 2	[2] Cook 2008 [4] Mutsuzaki 2017	Cohort study Limited evidence
CPM	not used	[1] Bove 2026 [8] Jia 2024	Systematic review
Phase 2 · Motion and strength · wk 2–6
Off the cane	typically wk 3–6, once gait is normal without the cane		No published source Limited evidence	No study in the cited evidence gives criteria or timing for stopping the walking aid; the criteria and weeks are our clinical call, within the range of the compared protocols (wk 3–8).
Progressive strength	from wk 2, 2 × 8 at an 8-repetition maximum	[1] Bove 2026 [6] Bade 2017	RCT	The guideline gives no sets, reps or load^[1], and the high-intensity program did not beat the low-intensity one on its main outcome^[6].
NMES (optional)	daily, if used	[1] Bove 2026	Guideline Limited evidence	The guideline recommends NMES at least daily (moderate evidence); cost and access can be barriers^[1].
Driving	typically about wk 2 after a left TKA, wk 4 after a right	[10] Na 2020	Systematic review
About 0–110°	by wk 6	[4] Mutsuzaki 2017 [12] Schiavone Panni 2009	Cohort study Limited evidence	Flexion under 90° at 6 weeks is the usual point to consider manipulation^[12].
Phase 3 · Strengthen and return · wk 6–10
0–120°	by wk 10	[6] Bade 2017	RCT
Discharge from PT	typically about wk 10	[13] Graber 2023	Consensus Limited evidence	No source sets a strength cut-off for discharge after TKA; the quadriceps, gait and stair criteria are our clinical call.
Kneeling practice	from wk 12 (our default)	[14] Wylde 2019	Narrative review Limited evidence
Low-impact activity	from about 3 mo, with surgeon clearance	[16] Witjes 2016	Systematic review

Where evidence is limited

Off the cane: No study in the cited evidence gives criteria or timing for stopping the walking aid; the criteria and weeks are our clinical call, within the range of the compared protocols (wk 3–8).
NMES (optional): The guideline recommends NMES at least daily (moderate evidence); cost and access can be barriers^[1].
About 0–110°: Flexion under 90° at 6 weeks is the usual point to consider manipulation^[12].
Discharge from PT: No source sets a strength cut-off for discharge after TKA; the quadriceps, gait and stair criteria are our clinical call.

Bibliography

1.Bove AM, Carroll LA, Cone S, et al. Clinical practice guideline for physical therapist management of total knee arthroplasty: revision 2026. Phys Ther. 2026;106(7):pzag058.
Guideline (APTA CPG, revision 2026; replaces Jette 2020) · PMC13403188 (free full text) · doi:10.1093/ptj/pzag058 · CC BY-NC 4.0 · cited, not reproduced · Used for: First PT and getting up · Resting position · CPM · Progressive strength · NMES (optional)
2.Cook JR, Warren M, Ganley KJ, et al. A comprehensive joint replacement program for total knee arthroplasty: a descriptive study. BMC Musculoskelet Disord. 2008;9:154.
Cohort study (n = 74, one hospital joint replacement program, day-level) · PMC2596133 (free full text) · doi:10.1186/1471-2474-9-154 · CC BY 4.0 · cited · Used for: First PT and getting up · Weight bearing · 0–90°
3.Masaracchio M, Hanney WJ, Liu X, et al. Timing of rehabilitation on length of stay and cost in patients with hip or knee joint arthroplasty: A systematic review with meta-analysis. PLoS One. 2017;12(6):e0178295.
Systematic review (timing of first PT and length of stay; tables of day-by-day programs) · PMC5456061 (free full text) · doi:10.1371/journal.pone.0178295 · CC BY 4.0 · cited · Used for: First PT and getting up · Weight bearing · Walker to cane
4.Mutsuzaki H, Takeuchi R, Mataki Y, et al. Target range of motion for rehabilitation after total knee arthroplasty. J Rural Med. 2017;12(1):33–37.
Cohort study (n = 39 knees, ROM time course to 12 months (Japan)) · PMC5458350 (free full text) · doi:10.2185/jrm.2923 · CC BY-NC-ND 4.0 · cited, not reproduced · Used for: 0–90° · About 0–110°
5.Bade MJ, Stevens-Lapsley JE. Early high-intensity rehabilitation following total knee arthroplasty improves outcomes. J Orthop Sports Phys Ther. 2011;41(12):932–941.
Cohort study (n = 16, high-intensity program with 4 phases and progression rules) · PMC13040458 (free full text) · doi:10.2519/jospt.2011.3734 · © publisher · cited only
6.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 Res (Hoboken). 2017;69(9):1360–1368.
RCT (high- vs low-intensity outpatient rehab) · PMC5415445 (free full text) · doi:10.1002/acr.23139 · © publisher · cited only · Used for: Resting position · Progressive strength · 0–120°
7.Liang Z, Ding Z, Wang D, et al. Cryotherapy for Rehabilitation After Total Knee Arthroplasty: A Comprehensive Systematic Review and Meta-Analysis. Orthop Surg. 2024;16(12):2897–2915.
Systematic review (cryotherapy after TKA) · PMC11608804 (free full text) · doi:10.1111/os.14266 · CC BY 4.0 · cited
8.Jia Z, Zhang Y, Zhang W, et al. Efficacy and safety of continuous passive motion and physical therapy in recovery from knee arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res. 2024;19(1):68.
Systematic review (CPM plus PT vs PT alone) · PMC10787984 (free full text) · doi:10.1186/s13018-024-04536-y · CC BY 4.0 · cited · Used for: CPM
9.Jette DU, Hunter SJ, Burkett L, et al. Physical Therapist Management of Total Knee Arthroplasty. Phys Ther. 2020;100(9):1603–1631.
Guideline (APTA CPG 2020; superseded by Bove 2026, history only) · PMC7462050 (free full text) · doi:10.1093/ptj/pzaa099 · CC BY-NC 4.0 · cited, not reproduced · Used for: Resting position
10.Na A, Richburg K, Gugala Z. Clinical Considerations for Return to Driving a Car following a Total Knee or Hip Arthroplasty: A Systematic Review. Biomed Res Int. 2020;2020:8921892.
Systematic review (return to driving after TKA or THA) · PMC7364193 (free full text) · doi:10.1155/2020/8921892 · CC BY 4.0 · cited · Used for: Weight bearing · Driving
11.Husted H, Lunn TH, Troelsen A, et al. Why still in hospital after fast-track hip and knee arthroplasty? Acta Orthop. 2011;82(6):679–684.
Cohort study (n = 207 (109 TKA), fast-track, functional discharge criteria) · PMC3247885 (free full text) · doi:10.3109/17453674.2011.636682 · CC BY-NC 4.0 · cited, not reproduced
12.Schiavone Panni A, Cerciello S, Vasso M, et al. Stiffness in total knee arthroplasty. J Orthop Traumatol. 2009;10(3):111–118.
Narrative review (stiffness after TKA) · PMC2744731 (free full text) · doi:10.1007/s10195-009-0054-6 · © publisher · cited only · Used for: About 0–110°
13.Graber J, Churchill L, Struessel T, et al. Expert Consensus for the Use of Outpatient Rehabilitation Visits After Total Knee Arthroplasty: A Delphi Study. J Orthop Sports Phys Ther. 2023;53(9):566–574.
Consensus statement (US Delphi, outpatient PT visits after TKA) · PMC12010683 (free full text) · doi:10.2519/jospt.2023.11840 · © publisher · cited only · Used for: Discharge from PT
14.Wylde V, Artz N, Howells N, et al. Kneeling ability after total knee replacement. EFORT Open Rev. 2019;4(7):460–467.
Narrative review (kneeling after TKR) · PMC6667980 (free full text) · doi:10.1302/2058-5241.4.180085 · CC BY-NC 4.0 · cited, not reproduced · Used for: Kneeling practice
15.Wainwright TW, Gill M, McDonald DA, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. Acta Orthop. 2020;91(1):3–19.
Consensus statement (ERAS Society, hip and knee replacement) · PMC7006728 (free full text) · doi:10.1080/17453674.2019.1683790 · CC BY 4.0 · cited
16.Witjes S, Gouttebarge V, Kuijer PP, et al. Return to Sports and Physical Activity After Total and Unicondylar Knee Arthroplasty: A Systematic Review and Meta-Analysis. Sports Med. 2016;46(2):269–292.
Systematic review (return to sport after TKA and UKA) · PMC4728176 (free full text) · doi:10.1007/s40279-015-0421-9 · CC BY 4.0 · cited · Used for: Low-impact activity

Published protocols compared (17–19)

Compared, not endorsed. Not affiliated with or endorsed by the institutions listed. Versions and checked dates match the How published protocols differ table.

17.Sanford Health. Total knee arthroplasty rehabilitation guideline [PDF]. Revised Jul 2026.
Published protocol · Protocol PDF (www.sanfordhealth.org/-/media/org/files/medical-professionals/resources-and-education/6-total-knee-arthroplasty-rehabilitation-guideline.pdf) · checked Oct 2026 · Compared, not endorsed · Used for: How protocols differ · Key milestones: published ranges
18.Mass General Brigham. Rehabilitation protocol for total knee arthroplasty (TKA) [PDF]. Version Jun 2025.
Published protocol · Protocol PDF (www.massgeneralbrigham.org/content/dam/unified-xwalk/pdf/patient-education/english/rehabilitation-protocol-for-total-knee-arthroplasty.pdf) · checked Oct 2026 · Compared, not endorsed · Used for: How protocols differ · Key milestones: published ranges
19.South Shore Health. Total knee arthroplasty (TKA) rehabilitation protocol [PDF]. Revised Jan 2021.
Published protocol · Protocol PDF (d18unesthp5g3j.cloudfront.net/www.southshorehealth.org/assets/2021-02/total-knee-rehab-protocol.pdf) · checked Oct 2026 · Compared, not endorsed · Used for: How protocols differ · Key milestones: published ranges

Licenses and adaptation. All are licensed under CC BY 4.0 (creativecommons.org/licenses/by/4.0). No warranties are given by the original authors.

[4] Mutsuzaki 2017 is CC BY-NC-ND 4.0 and [1] Bove 2026, [9] Jette 2020, [11] Husted 2011 and [14] Wylde 2019 are CC BY-NC 4.0: we summarize their findings in our own words and reproduce no text, tables or figures. [5] Bade 2011, [6] Bade 2017, [12] Schiavone Panni 2009 and [13] Graber 2023 are not openly licensed (all rights reserved): we state their findings and numbers in our own words and reproduce no text, tables or figures.

Published protocols [17]–[19] are compared, not endorsed. Not affiliated with or endorsed by the institutions listed.

Changelog

Version	Date	What changed	Type	Recommendations affected	Reviewed by	Sources
2026.10	Oct 2026	First published version	—	All	Licensed PT	19

Cite this protocolHEP Drop. Total knee replacement rehabilitation protocol. Version 2026.10. Reviewed Oct 2026. hepdrop.com/p/tka

For specific clinical claims, cite the original sources above.

Total Knee Replacement Protocol · Primary TKA · Version 2026.10 · hepdrop.com/p/tka · The operating surgeon's protocol takes precedence.

Day 0–1	PT and up with a walker within 24 hours of surgery^{[1, 2, 3]}
Day 0–7	Rest with the leg elevated and the knee bent 30–90°, between heel-prop bouts^{[1, 9, 6]}
Day 0–14	Cryotherapy for early pain^{[1, 7]}
Day 0–wk 2	Weight bearing as tolerated with a walker, unless the surgeon restricts weight bearing^{[2, 3, 10]}
Day 1–3	Hospital discharge, typically day 1–3, once the list is met
Day 2–14	Consider NMES to the quadriceps, daily, at the highest tolerated intensity^[1]
Wk 2	0–90° target

Milestone	This protocol	Range in published protocols
Off the walker or cane	wk 3	wk 3–8^{[17, 18, 19]}, all three compared protocols include wk 6
Driving again	wk 4	wk 2–8^[10], most often about wk 4
Discharge from outpatient PT	wk 10	wk 8–15^[13], typical recovery about wk 10
Low-impact activity	from 3 mo	wk 9 to 6 mo^{[16, 17, 18, 19]}, mean about 13 wk

Total Knee Replacement Protocol

Timeline

Phase

Weight bearing

Motion

Strength

Restrictions

Milestones

First 14 days

First days

Weight bearing

Motion

Milestones

Phase 1 · Early motion

Key milestones by week

All phases

Phase 1 · Early motion

Phase 2 · Motion and strength

Phase 3 · Strengthen and return

How published protocols differ

References and basis

What backs each recommendation

Bibliography

Published protocols compared (17–19)

Changelog

Total Knee Replacement Protocol

Total Knee Replacement Protocol · exercises and sources

Exercises by phase * sets and reps are our default.

Phase 1 · Early motion wk 0–2

Phase 2 · Motion and strength wk 2–6

Phase 3 · Strengthen and return wk 6–10

Return to low-impact activity when

Key milestones vs published protocols

Sources