TKA Recovery Months 2–3: What to Expect and How to Keep Making Progress
Introduction
If you’ve made it through the first month after a total knee replacement (TKA), congratulations. The early inflammation and surgical pain are beginning to settle, but the work is far from over. Months 2 and 3 of TKA recovery can be deceptively difficult. This is often the phase where initial motivation wears off, progress slows, and self-doubt creeps in. I sometimes refer to this as the "messy middle"—a time where perseverance becomes just as important as physical effort.
You might feel like your progress has stalled or that gains aren't as obvious anymore. This is normal. During this time, your body is still healing deep in the joint, even if outward signs of improvement are harder to see. The goal now is to transition from healing to rebuilding. This article will guide you through what to expect and what you can do to continue making steady gains in strength, function, and confidence.
⚡Still in the first month after total knee replacement? Check out our first month guide for managing TKA.
Month 2: Building Momentum
Goals
Continue to improve range of motion
Build strength through functional movement
Continue controlling swelling and inflammation
What You Should Focus On
1. ROM Exercises
Even if you’ve already regained decent range of motion, now is not the time to stop. Frequent movement helps prevent scar tissue from limiting your knee’s mobility. Focus especially on knee extension, which often lags behind flexion, and can be difficult to get later on. One effective method: long-duration, low-load stretching. Try lying on your back with your heel on a coffee table and letting gravity gently stretch your knee into extension for 5–10 minutes at a time.
2. Stretching:
This is separate and distinct from ROM exercises. ROM exercises are focused on improved joint motion where as stretching exercises improve the pliability and length of the surrounding muscular and connective tissues. At this stage, regular stretching of the hamstrings, calves, hip rotators, hip flexors, lateral hip, and quad should be included in your exercise routines. Typical stretching exercises have holds of 30-45 seconds, and 2-3 repetitions for each muscle.
3. Strengthening (Closed Kinetic Chain Focus)
Month 2 is when we shift more fully into closed chain exercises, which are movements where the foot is in contact with the ground or a solid surface. These include mini-squats, sit-to-stands, and step-ups. These movements are safer and more functional than open chain exercises (like leg extensions), as they replicate daily activities and place less shear force on the knee joint, and translate better to an improved ability to perform daily tasks.
4. Swelling Control
Swelling may still be present, especially after increased activity. Continue using ice, elevation, and light compression after exercise sessions or long days. Swelling will reduce with consistent movement and improved circulation.
5. Patellar Mobilization
If you're dealing with stiffness, your kneecap (patella) might not be gliding properly. Gentle self-mobilization of the patella can reduce discomfort and improve ROM. Ask your physical therapist to teach you safe techniques.
Mid Month 2 to Early Month 3: Gaining Confidence
Goals
Reduce dependency on assistive devices
Normalize walking patterns
Improve dynamic balance
Key Strategies
1. Progressive Strengthening
Now is the time to ramp up difficulty. Add light resistance, such as resistance bands or light ankle weights, to you exercises can increase difficulty. Step-ups can progress to higher surfaces. Always prioritize form over load. Remember to progress frequency and duration (reps) of exercises prior to progressing difficulty.
⚡See our full article on rehab exercise progressions to better understand how to safely and properly progress your exercises.
2. Balance and Proprioception Drills
Balance becomes a key focus now. Balance is very much a skill that can get rusty, but with practice can get tuned up. Also, the stakes are high, falls can be one of the most devastating setbacks that can occur when recovering from a total knee replacement. Always remain near something sturdy to reach out if needed. Your body naturally uses receptors in your joints to assist with balance and coordination, but now with those receptors removed (and replaced with hardware), it is important for your body to relearn what your leg feels like to adapt to the unexpected.
Some Sample Exercises:
One-legged stands at a kitchen counter
Standing with your feet close together
Heel-to-toe walks
Simple lateral stepping drills
3. Walking Progression
By now, most patients have transitioned from a walker to a cane—or walking independently. If you’re still using a walker at this stage, consult with your PT. A simple walking drill you can do: alternate laps around your home or driveway, one lap with a cane focusing on proper form, then one without to replicate that same pattern. This method promotes neuromuscular carryover and reduces compensation habits.
Remember that each step has two distinct phases: Stance phase (when you are bearing weight on the leg) and swing phase (when it is swinging in the air for the next step placement).
Common Pitfalls and Things to Look for:
Too much lateral trunk lean towards the effected leg when it is in stance - try to remain comfortably upright without the trunk swaying too much side to side
Uneven step lengths - be sure that how far you reach with one foot is equal to the other
Arm swing - don’t forget to relax your arms to allow for the soft natural reciprocal arm swing (opposite arm/leg)
Walking too slow - just like riding a bike, walking too slow can be more difficult that walking at a good functional velocity
Decreased knee bending during swing - make sure that you are effectively bending (doesn’t have to be very much) while the leg is in swing phase. This will help cut down on lateral leaning or circumducting (swing the leg out wide while bringing it forward)
Landing flat footed - attempt to strike the ground initially with your heel and not on a flat foot. Oftentimes a flat foot strike is due to a lack of straightening of the knee.
Month 3: Regaining Functionality
Goals
Return to normal daily activities
Improve cardiovascular endurance
Tackle stairs and uneven surfaces
Focus Areas
1. Functional Strengthening
Exercises now mimic real-life tasks. Sit-to-stands from low surfaces, supported lunges, and resistance band step-outs all help rebuild strength in the right ranges. These movements should feel increasingly controlled and coordinated.
2. Stair Climbing Practice
Start with a railing and lead with your stronger leg going up, surgical leg going down. Over time, aim for reciprocal stair climbing (alternating legs) without a rail. This is a major milestone and often signals readiness to return to full independence.
3. Low-Impact Cardio
Recumbent or upright bikes, water walking, and longer daily walks all help rebuild stamina. Avoid high-impact activities unless cleared by your physician or PT. Cardiovascular activity has been shown to improve functional activity tolerances, as well as, decrease pain.
Tips for Managing Common Challenges
Range of Motion Plateaus
This is a normal part of recovery. To break through, increase stretching frequency and duration. Use heat before stretching if stiffness is limiting.
Persistent Stiffness
Introduce patellar mobilization, soft tissue massage, and longer holds in extension or flexion. Be consistent, even small gains accumulate.
Considering MUA (Manipulation Under Anesthesia)
If you're stuck below 90° of flexion or lacking full extension despite consistent effort, your surgeon may recommend MUA. This procedure can help break through scar tissue but should always be followed with aggressive rehab.
Myths and Misconceptions
Myth: More pain equals better progress.
Truth: Discomfort is expected, but sharp or lingering pain is not productive and may indicate irritation which can lead to inflammation/pain/swelling.
Myth: You will improve every single week.
Truth: Progress is not always linear. Expect good and bad days, even good and bad weeks.
Myth: Everyone recovers at the same pace.
Truth: Age, body type, pre-op condition, and comorbidities all affect recovery speed.
When to Consult Your PT or Surgeon
Signs of Good Progress
Flexion over 100° and full extension
Walking without assistive device and no significant limp
Improved sleep and ability to tolerate daily tasks
Red Flags to Watch For
Increasing swelling week to week
Sudden drop in motion or return of severe pain
Pain that limits sleep or daily movement
Signs of infection (fever, warmth, redness, drainage)
Additional Resources:
Knee Recovery Tracker:
Download your free Knee Recovery Tracker to stay organized and motivated throughout your journey!
Research Summaries:
References
Bade MJ, Kohrt WM, Stevens-Lapsley JE. Outcomes before and after total knee arthroplasty compared to healthy adults. J Orthop Sports Phys Ther. 2010;40(9):559-567. doi:10.2519/jospt.2010.3317.
van der Wilk, S., Hoorntje, A., Blankevoort, L. et al. Physical activity after revision knee arthroplasty including return to sport and work: a systematic review and meta-analysis including GRADE. BMC Musculoskelet Disord 24, 368 (2023). https://doi.org/10.1186/s12891-023-06458-y
Pozzi F, Snyder-Mackler L, Zeni J Jr. Physical exercise after knee arthroplasty: a systematic review of controlled trials. Eur J Phys Rehabil Med. 2013;49(6):877-892.
Jette DU, Hunter SJ, Burkett L, et al. Physical therapist management of total knee arthroplasty. Phys Ther. 2020;100(9):1603–1631. doi:10.1093/ptj/pzaa098.
Ambrose KR, Golightly YM. Physical exercise as non-pharmacological treatment of chronic pain: Why and when. Best Pract Res Clin Rheumatol. 2015;29(1):120-130. doi:10.1016/j.berh.2015.04.022
Written by Christian Hill, PT, DPT, CDNT – Licensed Physical Therapist with over 10 years in orthopedic rehab.
This article is for educational purposes only and is not a substitute for professional medical advice. Always consult with your healthcare provider before beginning any new rehabilitation or treatment plan.
