Hip and knee replacement surgery can significantly reduce pain and improve mobility for people living with advanced joint degeneration. However, surgery is only one part of the recovery process. Rehabilitation helps rebuild strength, restore movement, improve walking and support a safe return to everyday activities.

Recovery is different for every person. Your progress may be influenced by your health before surgery, the type of procedure performed, your surgeon’s instructions, your previous activity level and the activities you would like to return to.

This guide explains what you may expect from physiotherapy after a total hip or knee replacement.

When does physiotherapy start after joint replacement?

Rehabilitation usually begins soon after surgery. Where medically appropriate, physiotherapy may begin on the day of surgery or within the first 24 hours.

The National Institute for Health and Care Excellence recommends that rehabilitation be offered on the day of surgery where possible and no later than 24 hours after a primary hip or knee replacement. This should include mobilisation, advice about everyday activities and an appropriate home exercise program (NICE, 2020).

During your hospital stay, the initial focus is generally on:

• Getting in and out of bed safely
• Standing and walking with an appropriate aid
• Managing stairs where required
• Completing simple exercises
• Understanding any precautions provided by your surgical team
• Preparing to manage safely at home

Before leaving hospital, you should receive advice about your rehabilitation goals, home exercises and who to contact if you have concerns. Outpatient physiotherapy may then be recommended depending on your function, individual needs and progress with self directed rehabilitation (NICE, 2020).

What happens during the first few weeks?

During the early recovery period, it is normal to experience some pain, swelling, stiffness, weakness and reduced confidence with movement.

Many people initially use crutches, a walking frame or a walking stick. Your physiotherapist can assess your walking pattern and help determine when it is appropriate to reduce your reliance on these aids. Recovery rates vary according to factors such as general health, fitness, the procedure performed and any postoperative complications (NICE,2020).

Early physiotherapy may focus on:

• Managing pain and swelling
• Restoring hip or knee movement
• Improving muscle activation
• Practising safe walking
• Improving transfers such as getting out of a chair or bed
• Completing your prescribed exercises correctly
• Building confidence with everyday activities

Your exercises should be appropriate for your stage of healing. Doing more is not always better, particularly if increased activity results in a significant increase in pain, swelling or difficulty walking.

Weeks 2 to 6: restoring movement and confidence

During the first six weeks, the aim is usually to gradually improve mobility while respecting healing, your surgeon’s instructions and your individual response to exercise.

After a hip replacement

Physiotherapy may include:

• Hip and lower limb strengthening
• Walking retraining
• Balance exercises
• Improving hip mobility within the permitted range
• Practising stairs and everyday activities
• Education regarding any surgeon specific precautions

Exercise following total hip replacement has been associated with improvements in walking speed, hip strength, pain and functional outcomes (Wu et al., 2019). Physiotherapist directed rehabilitation has also demonstrated benefits for hip muscle strength, pain, movement and functional performance following surgery (Fatoye et al., 2020).

Hip precautions are not necessarily identical for every patient. They may vary depending on the surgical approach, the procedure performed and your surgeon’s preferences. Always follow the instructions provided by your surgical team rather than relying on a general list of restrictions.

After a knee replacement

The early focus commonly includes:

• Reducing swelling
• Regaining knee extension and flexion
• Activating and strengthening the quadriceps
• Improving walking quality
• Increasing confidence with stairs
• Restoring independence with everyday tasks

Swelling and temporary quadriceps inhibition can make the knee feel stiff, weak or difficult to control. Exercise based physiotherapy following knee replacement has been shown to improve short term physical function, pain and knee movement (Fatoye et al., 2021).

Progressive rehabilitation can be performed safely after knee replacement, although significant quadriceps inhibition during the early postoperative period may influence how quickly strengthening can be progressed (Bade et al., 2017).

Weeks 6 to 12: building strength and function

As healing progresses, rehabilitation usually becomes more focused on rebuilding strength, walking capacity, balance and confidence.

Exercises may gradually include:

• Leg press exercises
• Sit to stand exercises
• Step ups
• Squats within an appropriate range
• Hip and knee strengthening
• Stationary cycling
• Balance exercises
• Longer walking intervals
• Functional tasks related to work or home

A 2024 randomised controlled trial found that moderate intensity progressive resistance training completed before and after total hip replacement produced greater improvements in muscle strength, gait, balance and hip function than completing resistance training during only one stage of the surgical pathway (Chen et al., 2024).

Physiotherapy following total knee replacement has similarly been found to improve physical function, pain and range of movement during the early months of recovery (Fatoye et al., 2021).

The level of exercise should still be individualised. Your physiotherapist may adjust the program according to pain, swelling, movement, walking quality, strength and how well you recover between sessions.

What happens after 12 weeks?

By approximately three months, many people are moving more comfortably and have returned to a greater range of everyday activities. However, this does not necessarily mean rehabilitation is complete.

After hip replacement, many people return to most usual activities at approximately three months, although it can take up to 12 months to experience the full benefits of surgery. Strength and flexibility following knee replacement may also continue improving gradually for approximately 12 months (Healthdirect Australia, n.d.-a; Healthdirect Australia, n.d.-b).

Later rehabilitation may focus on:

• Returning to work
• Walking longer distances
• Improving stair capacity
• Returning to gardening
• Returning to golf or other recreational activities
• Improving general fitness
• Building confidence in the operated leg
• Establishing a sustainable long term exercise routine

Someone aiming to walk comfortably around the shops will require a different program from someone hoping to return to physically demanding work, hiking or regular gym training.

How is progress measured?

Recovery should not be assessed using pain alone.

Depending on your goals, your physiotherapist may monitor:

• Hip or knee range of movement
• Pain and swelling
• Walking aid use
• Walking quality and tolerance
• Lower limb strength
• Balance
• Sit to stand ability
• Stair and step performance
• Confidence with everyday activities
• Ability to return to work or recreation
• Patient reported function

Objective strength and functional testing can help identify ongoing differences between the operated and non operated leg. It can also help your physiotherapist progress exercises using measurable information rather than relying only on how an exercise looks or feels.

How often will I need physiotherapy?

There is no single physiotherapy schedule that suits every patient.

Some people recover well with a clear home exercise program and occasional physiotherapy reviews. Others may benefit from more regular individual or supervised rehabilitation, particularly where there is:

• Persistent weakness
• Difficulty regaining movement
• Ongoing swelling
• An altered walking pattern
• Reduced balance
• Difficulty managing everyday activities
• A physically demanding job
• A goal of returning to higher level exercise or recreation

NICE recommends supervised individual or group rehabilitation when someone is having difficulty with activities of daily living, has ongoing functional impairment or finds that self directed rehabilitation is not meeting their goals (NICE, 2020).

What should I bring to my first physiotherapy appointment?

Where possible, bring:

• Your surgeon’s referral
• Your hospital discharge summary
• Any postoperative rehabilitation protocol
• A current medication list
• Information about your surgical approach or procedure
• Your walking aid
• Any questions or concerns about your recovery

Wear comfortable clothing that allows your physiotherapist to assess the operated hip or knee and observe how you walk.

When should you seek medical assistance?

Contact your surgeon, doctor or hospital if you notice:

• Increasing redness around the wound
• Increasing swelling around the surgical area
• A wound that opens or begins discharging
• Fever
• Increasing pain that is not controlled by your medication
• A sudden decline in your ability to walk or function

A painful, red or swollen calf may indicate a possible blood clot. Chest pain, chest tightness or difficulty breathing requires urgent medical assessment. Call Triple Zero in an emergency (Healthdirect Australia, n.d.-b; Royal Brisbane and Women’s Hospital, 2026).

Physiotherapy should not simply continue as normal when there are concerns about a possible postoperative complication.

Hip and knee replacement rehabilitation at Trilogy Physiotherapy

At Trilogy Physiotherapy in Sinnamon Park, we provide individualised rehabilitation following hip and knee replacement surgery.

Your physiotherapist will assess your movement, strength, walking pattern, current function and personal goals before developing a rehabilitation program appropriate for your stage of recovery.

Our dedicated rehabilitation gym includes equipment such as:

• Leg presses
• Squat racks
• Cable machines
• Treadmills
• Exercise bikes
• Dumbbells
• Balance and functional rehabilitation equipment

We can also use dynamometry and force plate testing where appropriate to objectively assess strength and functional performance.

For suitable patients, supervised hip and knee replacement rehabilitation classes may provide an affordable way to continue strengthening and progressing beyond the early postoperative stage.

Our goal is to guide you from early mobility through to progressive strengthening, improved confidence and a safe return to work, exercise and everyday life.

We regularly support patients from Sinnamon Park, Jindalee, Mount Ommaney, Seventeen Mile Rocks, Oxley, Westlake and surrounding areas of Brisbane’s western suburbs.

To book an appointment, call 07 3148 8785 or book online.

This article provides general information only. Your rehabilitation should follow the instructions of your surgeon and treating healthcare team.

References

Bade, M. J., Struessel, T., Dayton, M., Foran, J., Kim, R. H., Miner, T., Wolfe, P., Kohrt, W. M., Dennis, D. and Stevens-Lapsley, J. E. (2017). Early high intensity versus low intensity rehabilitation after total knee arthroplasty: A randomised controlled trial. Arthritis Care & Research, 69(9), 1360–1368. doi: 10.1002/acr.23139.

Chen, G., Yu, D., Wang, Y., Ma, Z., Bi, M., Lu, L., Zhang, S., Liu, J., Chen, H., Shen, H., Zhang, H., Luo, X., Si, Y. and Zhang, P. (2024). A prospective randomised controlled trial assessing the impact of preoperative combined with postoperative progressive resistance training on muscle strength, gait, balance and function in patients undergoing total hip arthroplasty. Clinical Interventions in Aging, 19, 745–760. doi: 10.2147/CIA.S453117.

Fatoye, F., Wright, J. M., Yeowell, G. and Gebrye, T. (2020). Clinical and cost effectiveness of physiotherapy interventions following total hip replacement: A systematic review and meta analysis. Rheumatology International, 40(9), 1385–1398. doi: 10.1007/s00296-020-04597-2.

Fatoye, F., Yeowell, G., Wright, J. M. and Gebrye, T. (2021). Clinical and cost effectiveness of physiotherapy interventions following total knee replacement: A systematic review and meta analysis. Archives of Orthopaedic and Trauma Surgery, 141(10), 1761–1778. doi: 10.1007/s00402-021-03784-5.

Healthdirect Australia (n.d.-a). Hip replacement. Healthdirect Australia.

Healthdirect Australia (n.d.-b). Knee replacement. Healthdirect Australia.

National Institute for Health and Care Excellence (NICE) (2020). Joint replacement: Primary hip, knee and shoulder. NICE Guideline NG157.

Royal Brisbane and Women’s Hospital (2026). Total knee replacement: Surgical wards patient guide. Metro North Health.

Wu, J. Q., Mao, L. B. and Wu, J. (2019). Efficacy of exercise for improving functional outcomes for patients undergoing total hip arthroplasty: A meta analysis. Medicine, 98(10), e14591. doi: 10.1097/MD.0000000000014591.

Read more…

To learn more about managing hip and knee arthritis before surgery, read our blog on physiotherapy for osteoarthritis.

To understand how rehabilitation can begin before an operation, read What’s the Difference Between Rehab and Prehab?.

Concerned about clicking, cracking or grinding in your knee? Read Why Does My Knee Click? Should I Be Worried?.