Physiotherapy After Hip or Knee Replacement Surgery

Total joint replacement (TJR) is a surgical procedure that replaces joints that have become damaged due to long-term wear and tear. These include major joints like the hip, knee, shoulder, and wrist — but hip (THR) and knee (TKR) replacements are the most common.

After surgery, starting physiotherapy as early as possible is essential. It accelerates recovery by helping with pain, mobility, strength, and function. The goal is to help patients regain their optimal quality of life and independence.

Physiotherapy improves long-term mobility and function by guiding patients through each recovery phase. Physiotherapists assist with using walking devices, educate on home-based rehabilitation strategies, and work toward restoring pre-surgery mobility and function.

1. Understanding Hip and Knee Replacement Surgery

Before starting rehabilitation, it’s helpful to first understand why joint replacement surgery is needed, what it involves, and what affects recovery.

Why Is Hip or Knee Replacement Surgery Needed?

The most common reason for surgery is arthritis. However, joint replacements are typically performed due to:

Arthritis, either osteoarthritis and rheumatoid arthritis
Injury or trauma to the joint
Joint degeneration from overuse over time

What Happens During the Procedure?

Before surgery, patients are placed under general anesthesia so they are unconscious and the area being operated on is numbed.

The surgeon creates an incision over the affected joint, removes the damaged joint, and replaces it with a prosthetic component.

This prosthesis is carefully aligned for optimal function, and the incision is then closed with stitches or staples.

What Does Recovery Look Like?

Recovery timelines vary from person to person. Some of the key factors that influence healing include:

Age and overall health
Strength and range of motion before surgery
Adherence to the rehabilitation program

2. The Role of Physiotherapy in Recovery

Physiotherapy is a critical part of the post-surgical process.

It helps in reducing pain, restoring strength and range of motion, improving mobility, and preventing complications that can delay or hinder healing.

Physiotherapists are especially important in the early stages of recovery, where their guidance helps prevent further harm.

For example, blood clots are a known risk after surgery, and physiotherapists help reduce this risk through early mobilization. Moving early and often also helps to:

Minimize joint stiffness
Prevent muscle loss around the operated area
Improve circulation and promote healing

After surgery, it’s common for patients to experience a significant loss of strength and range of motion. These issues are addressed through structured rehabilitation that includes both active range of motion and progressive strengthening exercises.

Due to weakness and discomfort in the operated leg, patients often develop poor balance and altered movement patterns. Physiotherapists work to restore proper movement by:

Guiding patients through balance and stability exercises
Teaching correct movement techniques
Educating patients on safe, effective ways to complete daily tasks

With consistent physiotherapy, patients can rebuild strength, confidence, and coordination—laying the groundwork for long-term recovery and joint health.

3. Key Phases of Physiotherapy

Physiotherapy after hip or knee replacement is typically divided into three key phases. Each phase builds on the last, progressing from gentle movement to more advanced exercises that help restore full function and mobility.

A. Early Post-Surgery (Hospital and Initial Recovery at Home)

Rehabilitation begins immediately after the operation. The first phase starts in the hospital and continues at home after discharge, since limited mobility often prevents patients from attending clinic sessions right away.

This phase includes:

Gentle movements and circulation exercises to improve blood flow and reduce the risk of complications
Passive and active range of motion exercises to prevent stiffness in the joint capsule
Early mobility through standing and walking as tolerated, to support joint function and reduce deterioration

Early movement is vital. It helps prevent post-operative complications, promotes healing, and sets the foundation for a smoother and faster recovery.

B. Intermediate Recovery (First 6–12 Weeks)

This phase focuses on rebuilding strength, improving weight-bearing ability, and correcting walking patterns and posture.

Physiotherapy during this time will involve:

Strengthening the muscles around the affected joint
Progressively increasing the number of reps, resistance, or range of motion in exercises
Incorporating movements that load more weight onto the affected leg as tolerated

Patients often walk with a limp during this period. Addressing and correcting this early is important to ensure proper alignment and prevent long-term complications caused by compensatory movement patterns.

Additional focus areas include:

Stretching muscles that may have become stiff from inactivity
Beginning functional movement training to improve body mechanics for everyday tasks — such as climbing stairs or getting in and out of a chair

C. Long-Term Rehabilitation (Beyond 3 Months)

The final stage of rehabilitation typically begins around the three-month mark. The goal is to help patients safely return to their regular activities, work, and hobbies — with confidence and stability.

This phase includes:

Advanced strengthening of key muscle groups, including the quadriceps, hamstrings, and gluteus maximus/medius
Careful progression to avoid placing unnecessary strain on the operated joint
Endurance training, using high-repetition exercises and cardio equipment such as a stationary bike or treadmill to build muscular and cardiovascular stamina

Balance and coordination are also retrained using tools like a balance board or BOSU ball. Exercises may be progressed by:

Standing on one leg
Performing movements with eyes closed
Using unstable surfaces to challenge the body further

Finally, physiotherapists will introduce exercises tailored to each patient’s lifestyle and goals; whether that’s returning to a sport, resuming work tasks, or simply walking longer distances without pain.

These movements are adjusted to reflect the specific demands of everyday life.

4. How Physiotherapy Prevents Long-Term Issues

After surgery, it’s common for patients to unconsciously adjust how they stand or walk to avoid pain. While this is a natural response, these habits can linger, even after the pain has improved, and could lead to future joint problems if left unaddressed.

Physiotherapists play a key role in identifying and correcting these patterns through movement screening and functional assessments.

By observing how a patient moves, a physiotherapist can create a tailored plan to help restore optimal alignment and muscle function.

One of the most common examples is when patients begin to favour their non-operated leg, placing most of their weight on that side. While it may feel more comfortable in the short term, this can lead to:

Overuse and strain on the “good” leg
Muscle imbalances and improper joint loading
Increased risk of pain and injury in the future

With physiotherapy, patients are retrained to redistribute their weight properly and use both legs in a more balanced way. These adjustments help preserve joint health, reduce the risk of future issues, and ultimately improve long-term quality of life.

5. Tips for a Successful Physiotherapy Journey

Successfully recovering from a total hip or knee replacement requires commitment to a structured rehabilitation plan.

This includes closely following the guidance provided by your physiotherapist and consistently completing the individualized home exercise program. These home programs typically include:

Specific exercises with recommended repetitions and sets
Stretches to improve flexibility
Daily walks using a walking aid, when appropriate

Following this plan helps prevent setbacks and supports ongoing improvement in strength, mobility, and function.

If any setbacks or concerns arise during recovery, it’s important to communicate them to your physiotherapist. They will assess the issue and adjust your program to ensure progress continues without causing further harm.

Over time, your physiotherapist will also help adapt exercises to suit your personal needs and daily routine.

For example, patients who spend long hours sitting at a desk may be given seated exercise options to help them stay active and consistent with their rehab.

Physiotherapy: Your Partner in Long-Term Recovery

To recap, physiotherapy plays an essential role in recovering from a total joint replacement. It supports every stage of healing by:

Managing pain
Restoring range of motion
Rebuilding strength and mobility
Improving balance and coordination
Minimizing the risk of complications
Providing education for long-term self-management

Having worked with many individuals recovering from hip or knee replacements, I’ve seen firsthand how challenging, and rewarding, the journey can be.

It’s important to stay focused on the bigger picture, take things one step at a time, and remain consistent and patient with your progress.

Professional physiotherapy guidance makes all the difference.

With the support of a trained physiotherapist, your rehabilitation plan will be safe, personalized, and effective, helping you regain confidence and return to the activities that matter most — with your long-term joint health in mind.

Ready to start your recovery journey?

Book an appointment with one of our physiotherapists and take the first step toward confident movement.

Frequently Asked Questions (FAQs)

When should I start physiotherapy after hip or knee replacement surgery?

Physiotherapy usually begins immediately after surgery, often while you’re still in the hospital. Early movement is important to reduce complications, improve circulation, and start regaining joint mobility. Your physiotherapist will guide you on when and how to safely begin.

How long does recovery take after a hip or knee replacement?

Recovery timelines vary depending on your age, overall health, and how closely you follow your rehab plan.

Generally:

Early recovery lasts 6–12 weeks
Full recovery can take 3–6 months or longer for some patients

What are the most important exercises after surgery?

The most important exercises after surgery focus on:

Restoring range of motion
Strengthening surrounding muscles (quads, glutes, hamstrings)
Improving balance and coordination
Re-training safe movement patterns

Your physiotherapist will personalize your exercise plan based on your progress and needs.

Can I do my physiotherapy exercises at home?

Yes. In fact, a home exercise program is a key part of recovery.

Your physiotherapist will give you detailed instructions, including the frequency, sets, and reps. Staying consistent with your home program is critical to your long-term success.

Do I need special equipment at home for my exercises?

Not usually. Most physiotherapy exercises can be done with everyday items or simple equipment like a resistance band, a chair, or a step. If anything specific is needed, your physiotherapist will let you know and help you find alternatives when needed.

What happens if I skip physiotherapy after joint replacement surgery?

Skipping physiotherapy increases your risk of:

Joint stiffness and muscle weakness
Poor mobility and balance
Compensatory movement patterns, which may lead to future joint problems

Physiotherapy ensures your recovery is safe, structured, and optimized for lasting results.

Is it normal to still feel pain during physiotherapy?

Some discomfort is normal, especially in the early stages.

However, sharp or worsening pain should be reported to your physiotherapist. They’ll help you adjust your program so you can keep progressing without causing harm.

What if I’m feeling discouraged during recovery?

It’s completely normal to feel discouraged at times — recovery can be challenging. Progress might feel slow, but small improvements add up.

Your physiotherapist is there to support you, adjust your program when needed, and keep you moving forward safely and confidently.