Guideline Video

Guideline Resources

  • Total Knee Arthroplasty Physical Therapist Guide
  • American Physical Therapy Association
  • July 27, 2026
  • Summary
  • Full-text

Video Transcription

Just published July 27th, 2026, the American Physical Therapy Association’s newest guideline on Total Knee Arthroplasty Physical Therapist Guide.

The purpose of this guideline is to improve patient outcomes after total knee arthroplasty (TKA). Guideline implementation may help to reduce unwarranted variation in care and improve uptake of best-evidence interventions.

In today’s rapid update, we’ll just be going over a summary of recommendations so for the full guideline, make sure to check it out on guidelinecentral.com

Let’s get started. 

Starting with the section on Preoperative physical therapy

  • Physical therapists should design and implement preoperative exercise programs for patients undergoing TKA to improve pre- and postoperative outcomes, including strength, flexibility, and endurance. Preoperative education may also incorporate neuroscience-based strategies to help manage pain and reduce procedure-related anxiety. 

Next the section on range of motion (ROM) interventions

  • Physical therapists should not use continuous passive motion (CPM) for patients who have undergone primary, uncomplicated TKA. 
  • Physical therapists should not routinely use bracing or splinting in the early postoperative period to increase knee ROM for patients who have undergone primary, uncomplicated TKA. 
  • Physical therapists should design and implement treatment interventions for patients undergoing TKA that include passive, active-assistive, and active ROM exercises to optimize recovery and improve functional outcomes of the affected knee. 
  • Physical therapists may use manual therapy with exercise and/or devices to augment active-assistive exercise to improve ROM in the early postoperative period. 

On to the section on Nonpharmacological pain interventions

  • Physical therapists should teach and encourage use of cryotherapy for early postoperative pain management for patients who have undergone TKA. 
  • Physical therapists may use transcutaneous electrical nerve stimulation, Kinesio Taping, manual therapy, and/or psychologically informed techniques to decrease pain after TKA. 

Moving on to the section on Swelling/edema management strategies

  • To minimize risk of immediate postoperative swelling/edema, physical therapists and/or other team members should prescribe cryotherapy treatment and teach positioning of the surgical limb in an elevated position with 30 to 90 degrees of knee flexion during the early postoperative period after TKA. 
  • Physical therapists may consider Kinesio taping after uncomplicated TKA to reduce postoperative swelling/edema; however, evidence is mixed regarding its benefit. 
  • In the absence of sufficient quality evidence, it is the opinion of this work group that physical therapists should not routinely use manual lymphatic drainage, compression dressings, or CPM to reduce postoperative swelling/edema following TKA, as these interventions have not been proven effective. 

Then the section on Physical activity interventions

  • Physical therapists should encourage early physical activity and develop a plan to progressively increase physical activity based on safety, functional tolerance, physiological response, and collaborative goal setting with patients who have undergone TKA.

On to the section on Movement pattern retraining interventions

  • Physical therapists should include motor function training in their interventions for patients who have undergone TKA. Interventions can include dynamic balance training, computer or app-assisted gait retraining, and movement training with feedback.

Next the section on Neuromuscular electrical stimulation interventions

  • Physical therapists should apply neuromuscular electrical stimulation at least daily to the quadriceps for patients who have undergone TKA, initiated in the early postoperative period at the highest tolerable intensity, to improve quadriceps muscle strength, gait performance, and performance-based outcomes. 

Then the section on Strength training interventions

  • Physical therapists should design, implement, and teach patients who have undergone TKA progressive strength training and exercise programs beginning in the early postacute period to improve function, strength, and ROM. 

Now on to the section on Physical therapy delivery methods

  • Supervised physical therapist management should be provided for patients who have undergone TKA. The optimal setting should be determined by patient safety, mobility, and environmental and personal factors. 
  • Physical therapists may use group-based or individual-based physical therapy sessions for patients who have undergone TKA. 
  • Physical therapists and patients should consider use of digital health tools after TKA, either in addition to in-clinic care or as an alternative to in-clinic care. 

Then the section on Accelerated postoperative rehabilitation protocols

  • Physical therapy, including early mobilization, should start within 24 h of surgery for patients who have undergone TKA. 

On to the section on Postoperative care settings

  • When possible, postoperative physical therapy after TKA may take place in an outpatient setting rather than in inpatient rehabilitation or at home. 

And last the section on Postoperative care coordination protocols

  • In the absence of sufficient information, it is the opinion of this work group that physical therapists should collaborate in pre- and postoperative care coordination within an interdisciplinary team to optimize outcomes in patients undergoing TKA.

And there you have it. Make sure to check out the full guideline from the American Physical Therapy Association and other related clinical decision support tools at guidelinecentral.com.

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