Rehabilitation Protocols for Hip and Knee Replacement

Phase 1: Immediate Post-Operative (Days 0 to 14)

Goals:

Pain management, swelling control, early mobility, wound healing.

Exercises (2 to 3 times daily):

• Ankle pumps (30 repetitions, hourly when awake)
• Quadriceps sets (tighten the thigh, hold 5 seconds, 10 reps)
• Gluteal squeezes (10 reps)
• Heel slides (gently bend and straighten the hip/knee, 10 reps)
• Standing hip flexion (lifting the knee gently, 10 reps)
• Walking with walker: 5 to 10 minutes, multiple times daily

Precautions:

• Use walker as instructed
• Ice after exercise sessions (20 minutes)
• Follow wound care instructions

Phase 2: Early Recovery (Weeks 2 to 6)

Goals:

Wean from assistive devices, improve range of motion, begin strengthening.

Exercises (daily):

• Continue Phase 1 exercises with increasing repetitions
• Standing hip abduction (lift leg out to side, 10 to 15 reps)
• Standing hip extension (lift leg backward, 10 to 15 reps)
• Mini squats (to comfortable depth, 10 reps)
• Heel raises (10 to 15 reps)
• Stationary cycling (low resistance, once cleared)
• Walking program: gradually increase to 20 to 30 minutes

Milestones:

• Transition from walker to cane (typically weeks 2 to 3)
• Walking without assistive device (typically weeks 3 to 6)
• Begin outpatient physical therapy if prescribed

Phase 3: Strengthening (Weeks 6 to 12)

Goals:

Build strength, return to activities, improve endurance

Exercises:

• Progressive resistance exercises (bands, light weights)
• Single-leg balance exercises
• Step-ups and step-downs
• Bridge progressions
• Stationary cycling with moderate resistance
• Swimming or water walking (once incision fully healed)
• Walking program: 30+ minutes daily

Phase 4: Return to Activity (Months 3 to 6)

Goals:

Full return to daily activities and recreational sports

Activities:

• Continue strengthening with progressive resistance
• Low-impact cardio: walking, cycling, swimming, elliptical
• Golf, hiking, doubles tennis as tolerated
• Core and balance training
• Independent home exercise program

Phase 1: Immediate Post-Operative (Days 0 to 14)

Goals:

Pain and swelling management, early range of motion, mobility.

Exercises (3 times daily):

• Ankle pumps (30 repetitions, hourly when awake)
• Quadriceps sets (tighten thigh, hold 5 seconds, 10 reps)
• Straight leg raises (10 reps, if able)
• Heel slides (bend and straighten knee, 10 to 15 reps)
• Short arc quadriceps extensions (10 reps)
• Walking with walker: 5 to 10 minutes, multiple times daily

Range of Motion Goals:

• 0 degrees extension (fully straight) by week 1
• 70 to 90 degrees flexion (bend) by week 2

Priorities:

• Ice and elevation after every exercise session
• Achieve full knee extension (ability to straighten completely) as early as possible. This is the single most important early goal

Phase 2: Early Recovery (Weeks 2 to 6)

Goals:

Restore range of motion, begin strengthening, improve function

Exercises (daily):

• Continue Phase 1 exercises with increasing reps
• Wall slides (sliding back down a wall to bend the knee)
• Terminal knee extensions
• Step-ups (low step initially)
• Standing hamstring curls
• Stationary cycling (when flexion permits, low resistance)
• Walking program: 15 to 30 minutes, flat surfaces

Range of Motion Goals:

• 0 degrees extension (maintain full straightening)
• 100 to 110 degrees flexion by week 4
• 110 to 120 degrees flexion by week 6

Milestones:

• Transition from walker to cane (weeks 2 to 4)
• Begin outpatient physical therapy (weeks 1 to 3)
• Driving (left knee: 2 to 3 weeks; right knee: 4 to 6 weeks)

Phase 3: Strengthening (Weeks 6 to 12)

Goals:

Build strength, improve endurance, restore confidence

Activities:

• Progressive resistance training (bands, machines, light weights)
• Leg press (light to moderate resistance)
• Squats to comfortable depth
• Step-ups and step-downs (increasing height)
• Balance and proprioception exercises
• Stationary cycling with moderate resistance
• Pool exercises (once incision healed)
• Walking program: 30+ minutes

Phase 4: Return to Activity (Months 3 to 6)

Goals:

Full return to daily activities, recreational sports

Activities:

• Continue progressive strengthening
• Low-impact cardio and fitness activities
• Golf, cycling, hiking, swimming as tolerated
• Core and balance training
• Transition to independent long-term exercise program