Written by: Dr. Samantha Smith PT, DPT (Physical Therapist & Knee Replacement Specialist)
Knee replacements continue to be one of the most common elective surgeries to date in 2025. Patients are also receiving more specialized surgeries and care due to new cutting-edge techniques such as the use of robotics and minimally invasive procedures. Most knee replacement patients are experiencing great outcomes due to these new technologies allowing for a more active lifestyle, less knee pain, and higher level of function. Patients even can return to recreational activities post total knee replacement such as pickleball, golfing, weight lifting and biking. However, there is still a 20% chance you may not be satisfied with your knee replacement after the 1 year recovery mark. Many knee replacement patients wish they knew more about the recovery prior to surgery to prepare them. Properly preparing for your knee replacement is key to post operative success. A recent 2025 meta-analysis (which is considered the highest levels of research evidence) found that pre-hab exercise and learning about the surgery reduced postoperative pain levels and improved knee bending and straightening. In this article, we will discuss “what I wish I knew before knee replacement surgery” and give many tips on how to prepare. Many of the discussions involve real testimonials from real patients.
Why you should prepare for your knee replacement
A total knee replacement or partial knee replacement involves a 1 year and 6 month recovery, respectively. Some patients even experience symptoms of swelling, knee tightness and knee stiffness for up to 2 years that hinders their mobility. Because recovery can take over a year, preparing your body and mind pre-surgery can set you up for success in many different ways. Many patients who do not prepare for a knee replacement surgery are shocked at the length of recovery. Many patients will ask their surgeon or physical therapist why they are still having pain at 6 weeks post op, which is considered very, very early in recovery. At 6 weeks post surgery, the knee is only 10-20% healed. Here’s a good timeline for healing (screenshot this!):
25% healed by 1-3 months post surgery:
At this time, the knee is still very swollen, stiff and tight. You will have significant reduction in mobility during this first phase of recovery.
50% healed by 3-6 months post surgery:
Most knee replacement patients will have improved symptoms by this time. You will have less knee pain and soreness, but swelling and stiffness may still linger, especially after a long day. Many patients experience increased discomfort in the knee if they do too much activity.
75% healed by 6-9 months post surgery:
At this time, you will have less knee stiffness and swelling overall. You should be able to do most daily activities such as walking and exercising without discomfort.
100% healed by 12-16 months post surgery:
Your whole body should feel adapted to your new knee prosthesis. You may have an occasional pain with twisting, quick movements or after long days. Overall, you should feel your new knee is much better than your old knee!
As you can see from the above timeline, knee pain can continue for several months post surgery. Setting realistic expectations and knowing what to expect post surgery can set you up for success post knee replacement surgery. Don’t forget to access the free guide on what to expect.
Patient Testimonial’s
In our Facebook support group, we asked the members who already had surgery “what do you wish you knew prior to surgery”. The responses were very clear: prepare your body, prepare your mind and have a realistic view of what the recovery will be like. Here are some of the most popular comments from the post:
It is clear that preparing yourself for this long recovery is important. Not only do real patients agree with this, but the research also shows that patients have better outcomes if they participate in prehab exercises (exercise pre-surgery to help prepare your body) and they learn about the surgery, their options, and prepare with the necessary equipment to make recovery easier. The number one biggest regret among patients is not preparing better for surgery.
Prehab exercises
Prehab exercises are exercises to do prior to a surgery to adequately prepare your body. During a total knee replacement, the muscles of the legs become severely weakened due to various reasons such as tourniquet use, swelling in the knee, pain and surgical trauma. We know this to be true among all knee replacement patients. While the post surgical weakness cannot be totally avoided, we can make the post surgery experience a little easier by preparing the body ahead of time. Giving yourself at least 6 weeks prior to surgery to strengthen the muscles of the legs, arms and core can give you a head start with your knee replacement recovery. You will need strong arms to use the walker post surgery, to help lift your leg, and to push yourself up in bed. You also will need a strong core to help maintain good posture while using the walker or cane, sit up in bed and walk properly.
Pre-surgery exercises can be tough for some individuals with. knee arthritis due to severe knee pain, especially with walking or squatting. If you have severe knee pain, start out with simple exercises to help contract the quad muscles, glutes and calves. You can start with a simple laying down workout routine and build from there.
Straight leg raises: in the laying position, lift leg up with knee straight.
Quad sets: push knee down and squeeze quad muscle. Hold contraction for 5 seconds.
Bridges: in laying position, bend both knees then push hip up towards ceiling.
Ankle pumps: point toes forward then flex toes towards face.
Heel slides: in laying position, bend knee towards chest while keeping foot on the ground.
If the exercises above are too easy, performing more challenging exercises can be done. It is good to find an exercise program that is challenging, but doable. The goal should not be to increase pain at this time.
Seated kicks: sitting in a chair, kick leg out in front of you until knee is straight.
Hip abduction: in the standing position, kick leg out to side while keeping knee straight.
Mini squats: in standing, bend knees while hips move backwards. Then stand back up with legs straight.
Heel raises: in standing, push up on your tippy toes and then return to normal standing.
If you are looking for a more thorough exercise program to complete pre-surgery, the 6 Week Pre Surgery Exercise Class is a great class to help you prepare your full body for surgery.
Swelling & Stiffness
Another common complaint that is very popular among knee replacement patients is the ongoing swelling and stiffness in the knee for several months post knee replacement surgery. Swelling is known to last for at least 6-9 months, but for some even lasting 12-16 months, depending on their medical history. If you have a history of heart disease, diabetes, lymphema or kidney disease, you may find swelling lasting longer than expected. Swelling is a normal response after a knee replacement, but it can cause a lot of discomfort, frustration and difficulty with strengthening and bending the knee.
Stiffness is another very common and frustrating symptom that lasts several months and even years for some patients after a total knee replacement. There are many reasons for stiffness and each patient is different. Stiffness in the beginning phases of recovery is typically related to increased pressure in the knee joint from fluid accumulation. After swelling improves, weakness can be the sole cause of lingering stiffness. The muscles of the knee need to re-adjust to the new prosthetic and they need to gain strength. Both of which takes several months and up to a year.
