Rehabilitation — Your Role in Recovery

Part of The Joint Replacement Guide — Phase 5: Recovery and Rehabilitation · Article 31 of 44 · Hip & Knee

Key Points

  • Rehabilitation helps you regain movement, strength, balance and confidence after joint replacement.
  • Regularly following the rehabilitation plan agreed with your clinical team can support recovery, but outcomes are influenced by many factors and difficulties with rehabilitation are not a personal failure.
  • Many people recover successfully with a supported, self-directed programme; supervised physiotherapy is particularly helpful when progress or everyday function is causing concern.
  • Recovery usually develops over weeks and months and is rarely completely smooth or predictable.
  • Mild discomfort can occur during exercise, but you should not feel expected to push through sharp, severe or progressively worsening pain.

Surgery and Rehabilitation Work Together

Joint replacement addresses the damaged surfaces of the joint. Rehabilitation then helps your muscles, movement and confidence recover so that you can make practical use of the new joint.

Your participation matters, but it is only one part of the outcome. Recovery is also influenced by your health and function before surgery, the condition of the muscles and other tissues around the joint, the operation itself, pain control, complications and the support available to you afterwards. If illness, pain or another difficulty prevents you from following the programme, tell your clinical team so that it can be reviewed or adapted—it should not be regarded as a personal failure.

How Rehabilitation Usually Progresses

Although every recovery is different, rehabilitation commonly develops through broad stages:

  • The first few days focus on getting in and out of bed safely, walking with an appropriate aid, managing everyday activities and beginning simple exercises.
  • The following weeks focus on gradually increasing walking and function, improving strength and—for knee replacement in particular—regaining a useful range of movement.
  • The following months focus on further strength, balance, confidence and a gradual return to appropriate work, leisure and recreational activities.

These are broad phases rather than deadlines. Recovery after hip and knee replacement is not identical, and your programme should be tailored to the operation you have had, your starting level of function and the goals that matter to you.

Self-Directed and Supervised Rehabilitation

Before leaving hospital, you should receive advice about exercises, rehabilitation goals and whom to contact if you need support. NICE advises that self-directed rehabilitation is effective for many people after an uncomplicated primary hip or knee replacement.[1]

This does not mean that you are simply left to manage alone. Supervised group or individual rehabilitation should be offered when you are having difficulty with everyday activities, have an ongoing functional problem requiring specific treatment, or find that self-directed rehabilitation is not helping you meet your goals.[1] Evidence suggests that routine supervised physiotherapy does not produce a clinically important additional benefit for every patient, although selected patients may benefit substantially from it.[2,3]

Regular Practice, Sensibly Progressed

Following the exercises and activity plan agreed with your physiotherapist is generally more useful than doing occasional, overly strenuous sessions. The appropriate frequency and intensity will depend on the exercise, your stage of recovery and your individual circumstances; rest and recovery may also form part of the plan.

Some temporary muscular aching, stiffness or swelling after activity can be expected. Sharp or severe pain, pain that continues to worsen, or a marked and persistent loss of function should be reported rather than exercised through. Contact your clinical team promptly if you are concerned, particularly if symptoms are accompanied by wound changes, fever, increasing calf swelling, chest pain or breathlessness.

Progress Is Not Always a Straight Line

It is common to have better and worse days. Pain, swelling, sleep and energy levels can fluctuate, and progress may sometimes appear to pause. A short plateau does not necessarily mean that anything is wrong.

However, you do not need to wait passively if you feel you are falling behind your agreed goals. Contact your physiotherapy or surgical team so that they can assess whether your programme needs adjusting and check for a treatable cause.

In More Depth

Research supports exercise and rehabilitation as important parts of recovery after hip and knee replacement, particularly for restoring strength and physical function. However, studies use varied programmes and do not establish one ideal approach for every patient. Structured exercise may improve early recovery, while evidence comparing different rehabilitation settings and levels of supervision suggests that more intensive or formally supervised treatment is not automatically better for everyone.[2–4]

The most balanced message is therefore that your active involvement can make a valuable contribution, while rehabilitation should remain individualised, supported and responsive to your progress. A good recovery is a partnership between you and your clinical team—not a test of effort or willpower.

This article provides general information and does not replace individual clinical advice. Follow the rehabilitation plan provided by your own clinical team and contact them if pain, function or other symptoms are causing concern.

References

  1. National Institute for Health and Care Excellence. Joint replacement (primary): hip, knee and shoulder. NICE guideline NG157, recommendations 1.10.1–1.10.6. Published 4 June 2020; last reviewed 19 December 2024. Available at: https://www.nice.org.uk/guidance/ng157/chapter/Recommendations
  2. Florez-Garcia M, et al. Not all patients need supervised physical therapy after primary total knee arthroplasty: a systematic review and meta-analysis. Archives of Orthopaedic and Trauma Surgery. 2023. Available at: https://pubmed.ncbi.nlm.nih.gov/36968854/
  3. Chaudhry YP, et al. Unsupervised home exercises versus formal physical therapy after primary total hip arthroplasty: a systematic review. Cureus. 2022;14(9). Available at: https://pubmed.ncbi.nlm.nih.gov/36159349/
  4. Konnyu KJ, et al. Rehabilitation for total hip arthroplasty: a systematic review. American Journal of Physical Medicine & Rehabilitation. 2023;102(1):11–18. Available at: https://pubmed.ncbi.nlm.nih.gov/35302955/

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