Exercises before and after knee replacement

It can feel counterintuitive to exercise a knee that already hurts. But a stronger quadriceps and hip going into surgery consistently correlates with an easier first few weeks coming out — there's simply more supporting muscle available while the knee heals. Prehab doesn't need to be intense; it needs to be consistent.

• Quad sets. Sitting with the leg straight, tighten the thigh muscle and push the back of the knee down into the surface below it. Hold five seconds, release. This is the single most useful pre-op exercise for most patients.
• Straight leg raises. Lying down, tighten the thigh and lift the whole leg a few inches, keeping the knee straight.
• Stationary cycling or pool walking. Low-impact ways to keep the joint moving and build general fitness without overloading it.
• Gentle range-of-motion work. Simply working toward the fullest comfortable bend and straighten each day keeps the joint from stiffening further before surgery.

A physiotherapist can tailor this to your specific knee — how much load it can currently tolerate matters more than following a generic program.

In the first 24–72 hours, the priorities are simple: get the leg moving, keep swelling down, and start waking the muscles back up. Typical early exercises include:

• Ankle pumps. Flexing the foot up and down regularly to support circulation and reduce clot risk.
• Quad sets and heel slides. The same pre-op exercises, resumed as soon as comfortable, gently re-engaging the muscles around the new joint.
• Assisted walking. Short, frequent walks with a walker or cane — little and often beats one long, painful attempt.
• Bending and straightening. Working toward specific range-of-motion targets your surgical team sets, usually aiming for close to full straightening early on, since that's harder to regain later than bending is.

As swelling settles, physiotherapy typically progresses to resistance work — mini-squats, step-ups, and stationary cycling — alongside continued range-of-motion exercises. This is usually the period where daily activities like stairs, longer walks, and getting in and out of a car start feeling noticeably easier.

Consistency matters more than intensity here. Short sessions done several times a day generally outperform one long session, especially early on.

Most patients continue strengthening and endurance work for three to six months, gradually returning to activities like hiking, golf, or cycling. For a broader view of what's realistic and when, see a realistic recovery timeline and returning to sport after a replacement.

Whether it's the weeks before surgery or the months after, the exercises that matter most are the unglamorous, repeated ones — quad sets, gentle range of motion, short frequent walks. Knees that get this steady, structured input tend to recover faster and further than knees left to "rest" their way back to normal.