Days 1 to 3
Post-Op Hospital Phase
Milestones
- ●Stand and walk short distances with a walker within 24 hours of surgery.
- ●Achieve full knee extension (straightening the leg flat on the bed).
- ●Bend the knee to 90 degrees.
Physio Interventions
- →Ankle pumps to prevent blood clots.
- →Quad sets and glute squeezes to reactivate muscles.
- →Gait training with a walker; instruction on negotiating stairs.
Warning Signs
- ⚠️Severe calf pain or chest pain (signs of DVT/Embolism).
- ⚠️Inability to actively lift the leg.
- ⚠️High fever or excessive wound drainage.
Psychological Insight"Post-surgical pain and effects of anesthesia. Motivation is needed to move despite the pain to prevent stiffness."
Weeks 1 to 3
Early Outpatient Phase (Mobility)
Milestones
- ●Transition from a walker to a cane or walking unassisted indoors.
- ●Knee flexion (bending) reaching 100-110 degrees.
- ●Reduction in post-operative swelling and bruising.
Physio Interventions
- →Aggressive but safe passive and active-assisted knee bending (heel slides).
- →Patellar mobilizations.
- →Stationary cycling (partial or full revolutions depending on range).
Warning Signs
- ⚠️Knee becoming 'stuck' or losing range of motion (risk of arthrofibrosis).
- ⚠️Infection at the incision line.
Psychological Insight"Sleep is often severely disrupted due to discomfort. Patients may experience 'the day 10 dip' where fatigue sets in. Consistency with home exercises is non-negotiable."
Weeks 4 to 8
Strengthening & Endurance Phase
Milestones
- ●Walking without any assistive devices outdoors.
- ●Knee flexion reaching 115-120 degrees.
- ●Ability to drive a car (usually cleared around week 4-6 if right leg, sooner if left leg).
Physio Interventions
- →Closed-chain exercises (mini-squats, step-ups, leg press).
- →Balance and proprioception training.
- →Endurance walking or swimming (once incision is fully healed).
Warning Signs
- ⚠️Persistent limping (antalgic gait) developing into a habit.
- ⚠️Pain that worsens rather than improves with exercise.
Psychological Insight"Rapid improvements in daily function lead to high satisfaction. The 'new knee' starts feeling more natural."
Months 3 to 12
Return to Normal Life
Milestones
- ●Return to recreational activities (golf, cycling, hiking, dancing).
- ●Pain-free sleeping and daily living.
- ●Maximum medical improvement is usually reached around the 1-year mark.
Physio Interventions
- →Independent gym routines focusing on leg strength and whole-body fitness.
- →Education on avoiding high-impact activities (jogging, jumping) to preserve the implant.
Warning Signs
- ⚠️Sudden onset of instability or 'clunking' noises accompanied by pain.
- ⚠️Late-onset infections (rare).
Psychological Insight"Gratitude for the return of pain-free mobility. The patient successfully reintegrates into a physically active lifestyle."
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Dr. Karolin Rockson, PT (BPT), Ex. CMC - Vellore
Board: Indian Association of Physiotherapists (IAP)
Reg No: PT-84729