Exercise After Knee or Hip Replacement: A Week-by-Week Guide

A practical return-to-activity timeline after knee or hip replacement, what prehab evidence shows, which sports are safe, and the red flags to report.

Most people start walking within a day or two of a knee or hip replacement, return to light daily tasks within a few weeks, and are back to low-impact exercise such as cycling, swimming and golf by about three months. Full recovery of strength can take 6 to 12 months. Your surgeon’s protocol overrides any general timeline, and some red flags need same-day medical review.

This guide gives a typical sequence, what prehab adds, how to build strength safely, and what to report.

What does the evidence say about rehab after the operation?

A systematic review and meta-analysis of 18 randomised trials with 1,739 people after total knee replacement found that physiotherapy exercise after discharge improved physical function and pain compared with minimal physiotherapy, with benefit at 3 to 4 months and, in higher-quality studies, up to 6 months. A separate review of exercise after hip replacement for osteoarthritis found that later-phase exercise programmes improved both impairment and function, though trials varied in quality and method. Clinical practice guidelines for physical therapist management of knee replacement likewise cover the whole pathway, from preparation before surgery through to progressive rehabilitation afterwards.

The practical message is that rehabilitation continues long after the hospital physiotherapist signs you off. Many people stop at the point where they can walk and manage the stairs, and never regain full strength.

Does exercise before surgery (prehab) help?

Prehabilitation means building strength, range of motion and fitness before the operation. Systematic reviews of knee replacement report that preoperative exercise improves knee flexion, strength and function, and may improve early postoperative outcomes and quality of life (Wang et al. 2021). A review for hip replacement also examined exercise and education before surgery, though the evidence is less consistent. Across the literature, the main limitation is that programmes differ in content, duration and setting, so we cannot say exactly which prehab is best.

What this means in practice:

• If surgery is weeks away, 2 to 3 sessions a week of leg strengthening, balance and walking is low-risk and likely to help.
• Do not push into pain. Your goal is to arrive stronger and more mobile, not exhausted.
• Practise the post-operative exercises and using your walking aid in advance.
• Control other risks: stop smoking, manage blood sugar, and aim for a healthy weight.

See our guide to prehab before surgery for sample sessions.

What is a typical return-to-activity timeline?

These time frames are typical, taken from surgeon and patient-education sources. Individual protocols vary by approach, bone quality, whether the implant is cemented and your general health.

Do not treat the week numbers as a pass or fail. Progress by milestones: swelling settled, wound healed, good control when walking, and range of motion improving.

What exercises build strength safely?

The most useful early exercises target the muscles around the joint.

1. Ankle pumps and quadriceps sets (tightening the thigh with the leg straight), 10 repetitions, several times a day from day one.
2. Heel slides and seated knee bends for range of motion, as prescribed.
3. Straight leg raises and hip abduction lying on your side, 2 sets of 10, as cleared.
4. Sit-to-stand from a chair of normal height, 2 sets of 5 to 10. See the sit-to-stand test.
5. Glute bridges, progressing from two feet to one foot. Technique: how to do a glute bridge.
6. Step-ups and step-downs on a low step, 2 sets of 8. See how to do step-ups and how to do a step-down.
7. Single-leg stand with support, building to 20 to 30 seconds. See how to do a single-leg stand.
8. Resistance machine or band work (leg press, hamstring curl, row) from about 8 to 12 weeks if cleared.

Progress by adding repetitions first, then light load. Pain during exercise should be mild and settle within an hour. Increased swelling the next day is a signal to ease back. For how to progress, see progressive overload for older adults, and for knee issues, exercise for knee osteoarthritis.

Which activities are safe and which are not?

The American Association of Hip and Knee Surgeons (AAHKS) patient guidance and the Hip Society and AAHKS consensus survey on return to athletic activity after hip replacement (Klein et al. 2007) support the following broad pattern.

AAHKS advises that patients can begin returning to sport within the first three months, that low-impact sports are recommended, medium-impact sports need caution, and high-impact sports should be avoided. Surgeons differ on individual cases, so ask about your own goals, including recreational badminton, which is popular in Malaysia.

For the hip, follow your surgeon’s movement precautions. These depend on the surgical approach and may limit deep flexion, crossing the legs and twisting for a period. Low chairs, squat toilets and sitting cross-legged on the floor are everyday situations in many Malaysian homes, so ask early how to manage them and whether a raised seat or a toilet frame is needed.

What changes in the Malaysian setting?

A few local points are worth planning for.

• Floor-level living. Many homes have low seating and floor mats. Practise getting up from a chair first, and ask your physiotherapist when it is safe to resume floor sitting. Our guide on how to get up from the floor helps later.
• Heat and humidity. Swelling can increase in hot weather. Elevate your leg, walk early in the morning or in an air-conditioned mall, and see mall walking in the Klang Valley.
• Stairs and wet floors. Bathroom tiles are slippery. Use non-slip mats and handrails; see reducing fall risk at home.
• Access to rehab. The number of supervised physiotherapy sessions varies between hospitals and private clinics, so ask what is provided and plan a home programme. Our exercise for limited mobility hub has more.

What does a sample week look like in weeks 4 to 8?

This is an example only, for someone walking without aids with surgeon approval. Adjust it to your protocol.

Use a simple rule for pain: a rating up to 3 or 4 out of 10 during exercise that settles within an hour is acceptable. Pain above 5 out of 10, or swelling that lasts into the next day, means you did too much and should cut back for a few days. Ice and elevation after sessions help many people.

What should you do about swelling, stiffness and sleep?

Swelling is normal for weeks and sometimes months, especially after a knee replacement. Elevate the leg above heart level, avoid long periods sitting or standing, and break up car or flight journeys with walking. Stiffness is worst in the morning and after sitting, so start with gentle range-of-motion work before walking. Night discomfort is common early on; ask your surgeon about pain relief rather than skipping exercise because of it.

Mental readiness matters too. Many people feel fearful about loading the new joint. A graded programme with clear milestones, and short wins such as walking to the shops or climbing a flight of stairs, builds confidence. Our fitness confidence after 40 article offers more.

How do hip and knee recovery differ?

The two operations share the same principles but have different priorities.

After a knee replacement, the main challenges are swelling, regaining bend (flexion) and full straightening (extension), and quadriceps strength. Targets for bend vary between surgeons, so use the goals your own therapist sets. Stiffness that is not improving at 6 to 8 weeks should be reviewed early, because it is easier to treat sooner.

After a hip replacement, the early focus is protecting the joint from dislocation according to your approach, then restoring hip abductor and glute strength so that you walk without a limp. Weak abductors cause the pelvis to drop on the operated side, which shows up as a waddling gait. Side-lying leg lifts, band walks and bridges are helpful once permitted. Avoid sitting in very low chairs early on, and use a raised toilet seat if advised.

In both cases, a reliable sign that you are progressing is that daily tasks become easier, such as getting out of a car, climbing stairs with alternating feet and walking 30 minutes without increasing pain. Driving timing is a surgeon decision that depends on the side operated, the type of car and how well you can brake safely.

How to progress safely

1. Follow your restrictions. Range, weight-bearing and movement limits exist for a reason, and your team will tell you when they change.
2. Master before you load. Perform each exercise slowly and correctly at low resistance, then add load.
3. Build the muscles around the joint. A strong thigh supports a new knee, and strong hip and glute muscles support a new hip. Our guide to how to do a glute bridge and how to do step-ups shows common building blocks, once cleared.
4. Change one variable at a time, such as repetitions, load, range or walking time.
5. Respect pain and swelling. Mild muscle fatigue is normal. Sharp pain, or swelling that increases and lingers into the next day, means ease back.
6. Balance is part of rehab. Surgery and a long period of pain reduce balance. Include balance work once your team allows.
7. Keep going with a longer-term plan. After formal physiotherapy ends, keep a regular programme: two strength sessions and regular walking, in line with the WHO advice for adults to do muscle strengthening on two or more days a week.

When can I move to gym-based training?

Once your surgeon and physiotherapist agree, typically after the 8 to 12 week mark, gym-based strength training is a good way to rebuild the leg. Start with machines because they control the movement, then move to free weights as stability returns.

1. Begin at a load you can lift 12 to 15 times with good form.
2. Train the legs twice a week and leave 48 hours between sessions.
3. Add load only when you can finish all sets without pain, swelling or compensation.
4. Include balance work and walking on varied surfaces.
5. Review your plan with the physiotherapist every 4 to 6 weeks.

Keep up the habit for life. Strength training protects the new joint, bone and balance, and it is the easiest way to avoid falling. Staying active also helps control weight, which lowers load on the implant. See gym for seniors in the Klang Valley for places that suit older beginners.

What are the red flags to report?

Contact your surgeon or go to emergency care for:

• New or worsening calf swelling, warmth, redness or deep leg pain. Joint replacement patients are at highest risk of a deep vein clot from about 2 to 10 days after surgery, and the risk remains raised for around 3 months.
• Sudden shortness of breath, chest pain or coughing blood. This is an emergency; call 999.
• Fever, spreading redness, wound drainage or a wound that opens, which can signal infection.
• A sudden inability to bear weight, a new deformity, a sense of the joint giving way or a loud pop with pain. In a hip, a leg that looks shorter or turned outward needs urgent review.
• Pain that is increasing instead of improving after the first weeks, or night pain not eased by rest.
• Calf pain, numbness or a cold, pale foot.

Early walking, prescribed blood thinners and compression stockings reduce clot risk. Take your blood thinner as directed. Also tell any dentist or doctor that you have a joint implant.

How long until strength returns?

Strength recovers slower than the wound heals. Strength in the operated leg often lags behind the other side for months, so continue strength work beyond formal rehab. Once you have your surgeon’s clearance, two to three sessions a week with progressive loading keep the gains. Our strength training for beginners over 40 and lifting safely as you age are good next steps.

Why home-based support can help

After surgery, getting to a clinic can be the hardest part of the day, and your own stairs, bathroom and bed are where function needs to return. Training at home removes the travel barrier and makes each exercise relevant to daily life. We coordinate with your surgeon and physiotherapist, continue the progressive work and focus on strength, balance and confidence. This sits within our wider adaptive and rehab approach.

Key takeaways

• Start with walking and prescribed exercises right away; low-impact sport is typically back by about 12 weeks.
• Prehab improves knee function and strength before surgery, though the best programme is unclear.
• Avoid high-impact sports unless your surgeon agrees.
• Report calf swelling, breathlessness, fever, wound problems or sudden loss of function.