The Importance of Early Physical Therapy After Total Knee Replacement:

Improving Pain, Function and Reducing Costs

By Dr. John Mishock, PT, DPT, DC 

 

Total knee replacement (TKR) is one of the most common and successful orthopedic surgeries in the United States, with over 800,000 procedures performed annually (American Academy of Orthopaedic Surgeons [AAOS], 2023). While the surgery itself is highly effective, the success of the procedure largely depends on postoperative rehabilitation, particularly the timing and intensity of physical therapy (PT).

Research consistently shows that early physical therapy following TKR improves pain management, accelerates functional recovery, and reduces overall healthcare costs. Despite this evidence, some patients delay or limit their rehab due to concerns about discomfort, cost, or logistical challenges. However, avoiding or delaying PT can lead to stiffness, weakness, and prolonged disability.

Early Physical Therapy: Faster Recovery, Less Pain

Reducing Pain Through Early Mobilization 

One of the primary concerns after TKR is post-surgical pain. Many patients believe that resting and avoiding movement will reduce discomfort, but the opposite is true. Early mobilization through structured physical therapy significantly reduces pain levels and dependence on pain medications.

• A study by Gandhi et al. (2020) found that patients who began PT within 24 hours of surgery reported significantly lower pain levels at 6 and 12 weeks compared to those who delayed therapy.
• Early PT decreases opioid use—a major benefit given the risks of opioid dependence. Research by Chughtai et al. (2018) demonstrated that patients engaging in early PT required 22% fewer opioid prescriptions compared to those with delayed rehab.
• Mobilization helps prevent scar tissue formation, which can contribute to post-surgical stiffness and chronic pain if left unaddressed (Fitzgerald et al., 2019).

Improving Function and Long-Term Mobility

Total knee replacement aims to restore functional movement, strength, and range of motion (ROM), and the timing of PT significantly impacts these outcomes.

• A systematic review by Liao et al. (2022) found that patients who initiated PT within 48 hours of surgery regained functional independence faster than those who delayed rehab beyond one week.
• A 2019 study in the Journal of Orthopaedic & Sports Physical Therapy (JOSPT) found that early PT resulted in a 35% greater improvement in knee flexion and extension compared to those who started therapy later.
• Early PT also enhances balance and walking mechanics, reducing fall risk—a major complication following TKR, especially in older adults (Wang et al., 2021)

The Cost-Saving Benefits of Early Physical Therapy

Beyond the physical benefits, early PT significantly reduces healthcare costs by preventing complications, reducing hospital readmissions, and decreasing the need for long-term care.

• A 2020 study in Health Economics found that patients who received early outpatient PT had an average of $1,500 to $3,000 lower total healthcare costs within the first six months post-surgery.
• Hospital readmissions due to stiffness, infections, or poor mobility are costly. Research by Bini et al. (2018) found that patients who delayed PT had a 47% higher readmission rate, primarily due to poor mobility and complications related to inactivity.
• Early therapy reduces the need for prolonged skilled nursing or in-home health services, both of which contribute to the rising costs of post-surgical care (Clement et al., 2021).

 

Best Practices for Early Physical Therapy After TKR

Based on the available research, the most effective early rehabilitation strategies include:

• Initiating PT within 24-48 hours post-surgery to begin gentle mobilization and prevent stiffness.
• Emphasizing early weight-bearing exercises to improve balance and functional independence.
• A combination of manual therapy, neuromuscular re-education, and progressive resistance exercises to rebuild strength and improve gait mechanics.
• Patient education on movement strategies, pain management, and home exercises to maximize long-term success.

Conclusion: Movement Is Medicine

The evidence is clear: early physical therapy is essential for optimizing pain relief, restoring function, and minimizing healthcare costs following total knee replacement. Patients who engage in structured rehabilitation recover faster, experience less pain, and reduce their risk of long-term disability.

At Mishock Physical Therapy & Associates, we specialize in individualized post-surgical rehabilitation plans to ensure every TKR patient regains mobility and returns to an active lifestyle as quickly as possible. If you or a loved one is undergoing knee replacement surgery, don’t wait—start your rehabilitation journey early and experience the benefits of movement-based recovery.

We can help!

If pain is limiting you from doing the activities you enjoy, give Mishock Physical Therapy a call: locations in Gilbertsville (610-327-2600), Skippack (610-584-1400) , Phoenixville (610-933-3371), Boyertown (610- 845-5000), Limerick (484-948-2800)  at www.mishockpt.com or request your appointment by clicking here.

Dr. Mishock is one of only a few clinicians with doctorate-level degrees in both physical therapy and chiropractic in the state of Pennsylvania. He has also authored two books; “Fundamental Training Principles: Essential Knowledge for Building the Elite Athlete”, “The Rubber Arm; Using Science to Increase Pitch Control, Improve Velocity, and Prevent Elbow and Shoulder Injury” both can be bought on Amazon or train2playsports.com.