Short answerNo single step speeds recovery a lot. Exercise in the first months helps, and a home program works as well as clinic visits. Tranexamic acid reduces bleeding. Drains, tourniquets and machines that bend the knee for you did not help in trials.

Evidence grade

Does not helpNot enough evidenceHelps a littleGood evidence

A few things help a little, several common ones do not

What this page compares

Many things are done before, during and after a knee replacement in the hope of a faster, easier recovery. This page brings together what the trials found for each, with a link to the full page. Most of these have been tested against usual care, not against each other.

Before the operation

Exercise before surgery (prehab). Not enough evidence yet. It may help a little, but the trials do not agree. Some found a shorter hospital stay and some found no clear gain . See Does exercise before knee or hip replacement help recovery?

During the operation

Tranexamic acid. Good evidence it helps. It cut blood loss and the need for a blood transfusion, without more blood clots in the legs . See Does tranexamic acid reduce blood loss in joint replacement?
Spinal rather than general anaesthesia. Probably helps a little. A large review found fewer complications with spinal or epidural anaesthesia, mostly from observational studies . See Is spinal anaesthesia better than general anaesthesia?
Tourniquet. Probably does not help. It shortens the operation by a few minutes, but probably brings more pain on the first day and more serious complications . See Does a tourniquet help in knee replacement?
Subvastus (muscle-sparing) approach. Probably helps a little, for a short time. It may give a slightly easier first week, and after that results look the same as the standard approach . See Does the subvastus approach speed recovery?
Wound drains. Probably does not help. Drains did not lower infection or wound problems, and more people needed a blood transfusion . See Do drains after joint replacement help?
Robotic surgery. Places the implant a little more accurately, but patients did not report better pain or function. See Does robotic knee replacement give better results?

After the operation

Aspirin to prevent blood clots. Not enough evidence yet. Two large trials point in different directions. Aspirin worked as well as rivaroxaban after a short course of rivaroxaban , but aspirin on its own did worse than enoxaparin injections in a larger Australian trial . See Is aspirin enough to prevent blood clots after joint replacement?
Ice and cold therapy. Not enough evidence yet. It may help a little in the first days, with less blood loss, pain and swelling and a better knee bend, but the evidence is of low certainty . See Does ice help after knee replacement?
Continuous passive motion machines. Probably does not help. Machines that bend the knee for you made little difference to knee bend, pain or function . See Do continuous passive motion machines help after knee replacement?
Physiotherapy exercise. Probably helps a little. Exercise improved function and pain at three to four months compared with minimal physiotherapy, and home programs did as well as clinic visits . See Does physiotherapy help after knee replacement?

The bigger picture

No single step makes recovery dramatically faster. The things with the clearest benefit are about safety, such as tranexamic acid to reduce bleeding, and about effort, such as keeping up the exercises in the first months. Several things that used to be routine, such as drains, tourniquets and continuous passive motion machines, did not help in trials. Recovery from a knee replacement takes months, and most of the gain comes from steady exercise and walking.

Risks and effort

The effort is mostly yours. Exercises are needed several times a week for at least three months. Some soreness and swelling are expected. Tell your surgeon early if the knee becomes red, hot, increasingly painful or very stiff, or if your calf becomes swollen and painful.

What usually works instead

Follow your surgical team’s plan for blood clot prevention and pain relief, start the exercises you are given, and walk a little more each day. See Total Knee Replacement.

Questions people ask

What is the fastest way to recover from a knee replacement?

There is no shortcut. In trials, regular exercise in the first months improved function and pain, and a home program did as well as clinic visits. Ice may help a little in the first days. Machines that bend the knee for you did not help.

What are the mistakes to avoid after a knee replacement?

The common ones are stopping the exercises too early, waiting too long to report a stiff knee, and ignoring swelling, redness or pain that is getting worse. Follow the blood clot prevention plan you are given.

Do I need to go to physiotherapy sessions?

Exercise matters more than where you do it. In the trials, a home program with a physiotherapy check did as well as clinic visits for function and pain.

Can I ice my knee too much?

The trials did not test this. They used cold packs or cold therapy devices in the first days after surgery. Protect your skin with a cloth and follow the instructions you are given.

Does exercise before surgery make recovery faster?

It may help a little, but the trials do not agree. It is still worth staying as active and strong as you can before the operation.

Sources

Select a source to read what the study or guideline found, in plain words, with a link to the original.

Sources

Systematic review

1Review of exercise before knee replacement

Who and when. Su, Zhou, Qiu and Wu, published in the Journal of Orthopaedic Surgery and Research in 2022.

What they did. They pooled 19 studies with 1,008 people who exercised before knee replacement.

What they found. Hospital stay was shorter and knee bending better after exercise. There was no clear difference in pain, walking tests or function scores.

What it means. The two reviews differ on hospital stay, and the programs varied a lot in type, length and supervision.

Su W, Zhou Y, Qiu H, Wu H. The effects of preoperative rehabilitation on pain and functional outcome after total knee arthroplasty: a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2022;17:175.

Read the review →

Meta-analysis

2Review of tranexamic acid in knee and hip replacement

Who and when. Gandhi, Evans, Mahomed and Mahomed, published in BMC Research Notes in 2013.

What they did. They pooled 33 randomised trials with 1,957 people having a first knee or hip replacement. Tranexamic acid, mostly given into a vein, was compared with placebo or nothing.

What they found. Blood loss was lower with tranexamic acid. The odds of needing donor blood were about 85 percent lower in knee replacement and about 67 percent lower in hip replacement. Clot rates in the leg veins were no higher.

What it means. The drug clearly reduces bleeding. The authors said larger trials are still needed to confirm safety, because other complications were poorly reported.

Gandhi R, Evans HMK, Mahomed SR, Mahomed NN. Tranexamic acid and the reduction of blood loss in total knee and hip arthroplasty: a meta-analysis. BMC Res Notes. 2013;6:184. doi:10.1186/1756-0500-6-184

Read the review →

International consensus

3ICAROS consensus on anaesthesia for hip and knee replacement

Who and when. Memtsoudis and colleagues for the International Consensus on Anaesthesia-Related Outcomes after Surgery group, published in the British Journal of Anaesthesia in 2019.

What they did. An international expert group reviewed 94 studies comparing neuraxial anaesthesia (spinal or epidural) with general anaesthesia in hip and knee replacement and pooled the results.

What they found. Neuraxial anaesthesia had lower odds of nearly all complications measured, or no difference. Urinary retention was higher. After hip replacement the odds of death were lower (odds ratio 0.67). After knee replacement the gap in death was not clear.

What it means. The group recommended neuraxial anaesthesia for hip replacement and preferred it for knees, calling the evidence low to moderate and the knee recommendation weak. Most studies were not randomised.

Memtsoudis SG, Cozowicz C, Bekeris J, Bekere D, Liu J, Soffin EM, et al. Anaesthetic care of patients undergoing primary hip and knee arthroplasty: consensus recommendations from the International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) based on a systematic review and meta-analysis. Br J Anaesth. 2019;123(3):269-287. doi:10.1016/j.bja.2019.05.042

Read the consensus →

Cochrane review

4Cochrane review of tourniquets in knee replacement

Who and when. Ahmed and colleagues, Cochrane Collaboration, published in 2020.

What they did. They pooled 41 randomised trials with 2,819 people having knee replacement with or without a tourniquet. The certainty of the evidence was moderate.

What they found. On day one pain was about 1.25 points higher on a 10 point scale with a tourniquet. The operation was a few minutes shorter and the stay about a third of a day longer. At 12 months function was probably much the same. Serious side effects were probably more common with a tourniquet.

What it means. The reviewers said routine use is difficult to justify.

Ahmed I, Chawla A, Underwood M, Price AJ, Metcalfe A, Hutchinson C, et al. Tourniquet use for knee replacement surgery. Cochrane Database Syst Rev. 2020;(12):CD012874. doi:10.1002/14651858.CD012874.pub2

Read the review →

Meta-analysis

5Review of subvastus and parapatellar approaches

Who and when. Berstock, Murray, Whitehouse, Blom and Beswick, published in EFORT Open Reviews in 2018.

What they did. They pooled 20 randomised trials covering 1,893 knee replacements comparing the medial subvastus approach with the medial parapatellar approach.

What they found. In the first days the subvastus group regained a straight leg raise about 1.7 days sooner, had pain 0.8 points lower on day one, bent the knee about 7 degrees further at one week, needed fewer lateral releases and lost about 57 mL less blood. The operation took about 10 minutes longer.

What it means. After the early weeks the two approaches gave similar results. The benefit is early only.

Berstock JR, Murray JR, Whitehouse MR, Blom AW, Beswick AD. Medial subvastus versus the medial parapatellar approach for total knee replacement: a systematic review and meta-analysis of randomized controlled trials. EFORT Open Rev. 2018;3(3):78-84. doi:10.1302/2058-5241.3.170030

Read the review →

Cochrane review

6Cochrane review of drains after orthopaedic surgery

Who and when. Parker, Livingstone, Clifton and McKee, Cochrane Collaboration, published in 2007.

What they did. They pooled 36 studies with 5,464 people having orthopaedic surgery with or without a drain.

What they found. There was no significant difference in wound infection after hip or knee replacement. Blood transfusion was needed more often with drains. Dressings needed reinforcing more often without them.

What it means. The wider review agrees with the first. Drains do not reduce infection and can increase transfusion.

Parker MJ, Livingstone V, Clifton R, McKee A. Closed suction surgical wound drainage after orthopaedic surgery. Cochrane Database Syst Rev. 2007;(3):CD001825.

Read the review →

Randomised trial

7EPCAT II trial of aspirin or rivaroxaban

Who and when. Anderson and colleagues, Canadian hospitals, published in the New England Journal of Medicine in 2018.

What they did. They enrolled 3,424 people having hip or knee replacement. Everyone took rivaroxaban for five days, then continued it or switched to aspirin for 9 days after knee replacement or 30 days after hip replacement.

What they found. Symptomatic clots occurred in 0.64 percent with aspirin and 0.70 percent with rivaroxaban. Aspirin was not worse. Major bleeding was 0.47 and 0.29 percent, a gap that was not significant.

What it means. After a short course of a stronger blood thinner, aspirin was as good at preventing clots in this trial.

Anderson DR, Dunbar M, Murnaghan J, Kahn SR, Gross P, Forsythe M, et al. Aspirin or rivaroxaban for VTE prophylaxis after hip or knee arthroplasty. N Engl J Med. 2018;378(8):699-707. doi:10.1056/NEJMoa1712746

Read the trial →

Randomised trial

8CRISTAL trial of aspirin or enoxaparin

Who and when. Sidhu and colleagues, Australian hospitals, published in JAMA in 2022.

What they did. They enrolled 9,711 people having hip or knee replacement for osteoarthritis in 31 Australian hospitals. Hospitals gave aspirin or enoxaparin injections from the start, for 35 days after hip replacement and 14 days after knee replacement.

What they found. Within 90 days a symptomatic clot occurred in 3.45 percent with aspirin and 1.82 percent with enoxaparin. Aspirin did not meet the test of being no worse. Much of the gap came from clots below the knee.

What it means. Used from the start, aspirin was less effective than enoxaparin in this trial.

Sidhu VS, Kelly TL, Pratt N, Graves SE, Buchbinder R, Adie S, et al. Effect of aspirin vs enoxaparin on symptomatic venous thromboembolism in patients undergoing hip or knee arthroplasty: the CRISTAL randomized trial. JAMA. 2022;328(8):719-727. doi:10.1001/jama.2022.13416

Read the trial →

Cochrane review

9Cochrane review of cold therapy after knee replacement

Who and when. Aggarwal, Adie, Harris and Naylor, Cochrane Collaboration, published in 2023.

What they did. They pooled studies of cold therapy against placebo or none after knee replacement, with 1,839 people aged 64 to 74. Most outcomes were measured within 48 hours of surgery.

What they found. Cold therapy may reduce blood loss, pain and swelling in the short term. The knee bent 8 degrees further at discharge (71 against 63 degrees) and function was about 13 points better at two weeks.

What it means. The evidence is of very low certainty for side effects, and the studies were small and varied. The search runs to May 2022.

Aggarwal A, Adie S, Harris IA, Naylor J. Cryotherapy following total knee replacement. Cochrane Database Syst Rev. 2023;(9):CD007911. doi:10.1002/14651858.CD007911.pub3

Read the review →

Cochrane review

10Cochrane review of continuous passive motion machines

Who and when. Harvey, Brosseau and Herbert, Cochrane Collaboration, published in 2014.

What they did. They pooled 24 randomised trials with 1,445 people who had a knee replacement for arthritis, comparing use of a machine that bends the knee with no machine.

What they found. At six weeks the knee bent about 2 degrees further and pain was about 0.4 points lower on a 10 point scale. At six months function and quality of life were much the same. Side effects were similar.

What it means. The reviewers concluded the machines have no clinically important effects that justify routine use.

Harvey LA, Brosseau L, Herbert RD. Continuous passive motion following total knee arthroplasty in people with arthritis. Cochrane Database Syst Rev. 2014;(2):CD004260.

Read the review →

Systematic review

11Review of exercise after knee replacement

Who and when. Artz, Elvers, Lowe, Sackley, Jepson and Beswick, published in BMC Musculoskeletal Disorders in 2015.

What they did. They pooled 18 randomised trials with 1,739 people comparing exercise after knee replacement with minimal physiotherapy, and compared different types of programs.

What they found. Exercise improved function and pain at three to four months, and the benefit lasted up to six months in the higher quality studies. No long term benefit was found. Outpatient sessions were no better than a home program.

What it means. Exercise after knee replacement helps in the first months. The studies were small and the long term benefit is unknown.

Artz N, Elvers KT, Lowe CM, Sackley C, Jepson P, Beswick AD. Effectiveness of physiotherapy exercise following total knee replacement: systematic review and meta-analysis. BMC Musculoskelet Disord. 2015;16:15.

Read the review →

Last reviewed 26 October 2026. Next review due October 2028. General information only. It does not replace advice from your own doctor.

What this page compares

Before the operation

During the operation

After the operation

The bigger picture

Risks and effort

What usually works instead

Questions people ask

What is the fastest way to recover from a knee replacement?

What are the mistakes to avoid after a knee replacement?

Do I need to go to physiotherapy sessions?

Can I ice my knee too much?

Does exercise before surgery make recovery faster?

Sources

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