Total Knee Replacement: Education, Expectations, and Progression

Pre-/Post-Op Total Knee Replacement:
Education, Expectations, and Progression

Total knee replacements are one of the most successful procedures in all of medicine. According to the Agency for Healthcare Research and Quality, in 2017, more than 754,000 knee replacements were performed in the United States. It’s also one of the most common pre and post operatively rehabbed conditions at Axes Physical Therapy.


The knee joint is made up of the lower end of the thighbone (femur), the upper end of the shinbone (tibia), and the kneecap (patella). The ends of these three bones are covered with articular cartilage, a smooth substance that protects the bones and enables them to move easily within the joint. The menisci are located between the femur and tibia. These C-shaped wedges act as “shock absorbers” that cushion the joint. All remaining surfaces of the knee are covered by a thin lining called the synovial membrane. This membrane releases a fluid that lubricates the cartilage, reducing friction to nearly zero in a healthy knee. Normally, all these components work in harmony. But disease or injury can disrupt this harmony, resulting in pain, muscle weakness, and reduced function. AAOS (American Academy of Orthopedic Surgeons) 1995-2021. 

The most common cause of knee pain and resultant disability is osteoarthritis. Osteoarthritis causes degeneration of the knee joint, resulting in “bone on bone” structure with subsequent pain and loss of function. Benefits of a Total Knee Replacement include reduced pain, increased mobility, and improved quality of life.

Osteoarthritis in kneww


Comparison of a healthy knee which allows all parts to work together and an arthritic knee and subsequent loss of joint spacing.

AAOS (American Academy of Orthopedic Surgeons) 1995-2021. 


Pre-operative Program

Your physical therapist can help and guide you through the process of your total knee replacement. Education and guidance in all phases of the process are essential in obtaining the most successful outcome following your surgery. Many patients receive a pre-op program to assist them with preparation of their surgery. This program will encompass a number of components including:

  1. Increasing knee/hip flexibility and strength.
  2. Preparing the individual in the use of assistive devices and transfer techniques.
  3. Assisting the patient in preparing their home and obtaining adapted devices as needed including securing stairway handrails, raising the toilet seat, shower bench or chair, and removal of all loose carpets.
  4. Answering questions about post-surgical issues i.e., scar management, precautions, expectations, concerns, etc.

Surgery and Recovery

Surgery times vary, but usually takes between 1-2 hours. The orthopedic surgeon will remove the arthritic/damaged bone and cartilage and then insert the prosthesis. After surgery it is normal for you to experience pain. This is a natural part of the healing process. Your doctor, nurses, and physical therapist will work to reduce your pain – this will help you recover faster. During your recovery time, there are a few warning signs to be aware of. These include infection (fever, chills, redness, drainage of the incision) and blood clots (sharp pain in the calf usually brought on by activity).

surgical knee replacementArthritic knee and post-op total knee replacement with femoral and tibial components in place with plastic spacer between the implants.

AAOS (American Academy of Orthopedic Surgeons) 1995-2021

Post-operative Physical Therapy

You will begin physical therapy soon after your surgery. Physical therapy following a total knee replacement is designed to increase knee ROM, improve strength, decrease pain, and improve function. Your physical therapist will give you specific exercises to address these areas. Regaining knee ROM is the primary concern initially following surgery. You will focus on regaining your ability to straighten and bend your knee. They will also work with you on functional activities such as gait training, stairs, and transfer training.

Pain is normal in the healing process after surgery – this will improve as your knee heals. It is also normal to have some numbness in the skin in the area around the incision. Sleeping will be difficult initially but will improve over time. You may also experience some clicking of the prothesis. This is very normal and for most people diminishes over time.

The take home message following total knee replacement is that your knee is NEW, but DIFFERENT! Your new knee must heal from surgery and pain following surgery will improve. Be patient with progress and work diligently on your exercises and you will be successful following your knee replacement.

Are you struggling with knee pain? Already had a surgical consult or wondering if you should have one? With 12, soon to be 13, Greater St. Louis area locations and an expert staff – we are here to help guide your care.

Request an appointment online today!

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