Physiotherapy After Knee Replacement at CMC Vellore: Week-by-Week TKR/THR Recovery Guide

Post-Knee Replacement Physiotherapy Near CMC Vellore

Total Knee Replacement (TKR) and Total Hip Replacement (THR) are among the most common major surgeries performed at CMC Vellore's Orthopaedics department. The procedure itself is only the first half of the treatment — physiotherapy-driven rehabilitation determines the final functional outcome.

What CMC's Orthopaedics Does

CMC Vellore's orthopaedic unit uses cemented and cementless prostheses from internationally validated implant systems. Standard TKR involves removing the arthritic bone surfaces and replacing them with metal and polyethylene components. Most patients are weight-bearing with assistance from Day 1 post-surgery. CMC's in-hospital physiotherapy team initiates early exercises during the admission, but intensive outpatient rehabilitation is required after discharge.

The Week-by-Week TKR Physiotherapy Programme

Week 1 (Discharge Day – Day 7): Pain Control & Basic Mobility

The primary goals are wound management, swelling control, and achieving basic mobility milestones.

Exercises from Day 1 of discharge:

• Ankle pumps: 20 reps, hourly. DVT prevention and circulatory stimulus.
• Quad sets: Straighten knee fully, squeeze quadriceps hard, hold 5 seconds. 20 reps × 3 sets. Essential for regaining terminal knee extension.
• Straight Leg Raises (SLR): Tighten quad, raise leg 30°, hold 3 seconds. 15 reps × 3 sets. Builds quad strength without bending the knee.
• Knee slides: Slide the heel toward the buttock while lying on back, to build initial flexion. Work toward 70–80° by end of Week 1.
• Sitting knee flexion: Sit at edge of bed, let gravity assist the knee to bend. 10 minutes, 3 times daily.

Walking: With rollator frame initially, progressing to single stick by end of Week 1 if quadriceps control is adequate.

Swelling management: Elevate the limb when not exercising. Ice pack 15–20 minutes, 3–4 times daily.

Week 2–4: Increasing Flexion & Strengthening

Milestones: 90° flexion by Week 2, climbing a step by Week 3.

Added exercises:

• Terminal knee extension (TKE) with band: Standing with band behind knee — straighten fully. Critical for regaining the last 0–10° of extension that prevents the characteristic post-TKR extension lag.
• Step-ups (low 10 cm step): Controlled ascent and descent. Functional stair training.
• Short-arc quads: Supported at 60° flexion, extend to full. 15 reps × 3 sets. Maximizes VMO (inner quad) activation.
• Hip abductor exercises: Side-lying hip abduction to prevent Trendelenburg gait pattern.
• Joint mobilization: Manual patellar mobilization (superiorly, inferiorly, medially, laterally) to prevent patellar fibrosis and improve flexion.

Walking: Progress from rollator to single stick. Begin outdoor walking on flat ground.

Week 4–8: Functional Independence

Milestones: Climbing full flight of stairs, driving (at 6–8 weeks), 110° flexion.

Advanced exercises:

• Mini squats (0–45°): Closed kinetic chain quad strengthening. Progress to 0–60° by Week 6.
• Leg press: Begin at light load, progress progressively.
• Stationary cycling: Begin at Week 4 when 100° flexion achieved. Excellent low-impact aerobic conditioning.
• Pool walking (if available): Water provides resistance without impact loading.
• Balance training: Single-leg balance, perturbation training on foam — rebuilds proprioception lost with end-stage arthritis.

Week 8–12+: Return to Full Activity

Most patients with good physiotherapy achieve:

• Stair climbing without assistance: 90% at Week 6
• Independent community walking: 100% at Week 8
• Return to low-impact sport (swimming, cycling, golf): Week 12
• Return to driving: Week 6–8

THR-Specific Precautions (First 6–12 Weeks)

Total Hip Replacement patients must avoid the posterior hip precautions:

• No hip flexion beyond 90°
• No internal rotation of the hip
• No crossing the legs

These restrictions prevent prosthetic dislocation. Our physiotherapists teach ADL modification (raised toilet seat, not bending to pick up items, dressing techniques) alongside exercise.

Why Outpatient Physiotherapy Near CMC Matters for TKR

CMC's in-hospital therapy begins the process, but the critical period is the first 6 weeks post-discharge. During this time:

• Scar tissue is forming around the joint — mobilization prevents restrictive fibrosis
• Quadriceps strength must be rebuilt — the prosthesis is mechanically stable but muscle control determines function
• Gait pattern must be corrected — untreated Trendelenburg or flexed-knee gait becomes habitual

Bethesda Physio & Rehab Clinic Neuro Rehab, being 1.2 km from CMC, can receive same-day discharge patients and begin this critical programme without the delays that reduce outcomes.