Joint Replacement Rehab: who to see and what helps

Joint Replacement Rehab · Kitchener, Waterloo & Cambridge

Joint replacement rehab is the exercise, walking and daily-task work around an operation to replace a hip, knee, shoulder or elbow, done alongside your surgeon and hospital team and never in place of them. The UK’s national guideline says it should begin within 24 hours of surgery, with supervised sessions offered afterwards to people who are struggling with daily activities or not reaching their goals alone. At CARESPACE the first visit is with a physiotherapist, before or after the operation, who assesses and treats you that day.

What joint replacement rehab is

It comes in three parts. Before a hip or knee replacement, the guideline says people should get advice on exercises to do before and after the operation, on weight, diet and stopping smoking, and on staying independent. In hospital, a physiotherapist or occupational therapist gets you moving and sends you home with an exercise programme. Then come the weeks at home, on your own programme or with supervised help.

How the operations differ

• Hip. The early concern is the ball coming out of the socket, so some surgeons set movement precautions for the first six weeks: see Hip Replacement Rehab.
• Knee. The work is bending, straightening and rebuilding the thigh muscle, through stiffness and swelling that can last 8 to 12 weeks: see Knee Replacement Rehab.
• Shoulder, conventional and reverse. A conventional replacement fits a plastic cup into the socket and a metal ball on the arm bone. A reverse replacement switches them, so the deltoid muscle powers the arm instead of the rotator cuff; a cuff that is completely torn and cannot be repaired is one of several reasons for choosing it. You leave hospital in a sling. After a reverse replacement, American orthopaedic surgeons advise avoiding extreme arm positions (behind your body, or straight out to the side) and lifting nothing heavier than 5 pounds, or the limit your surgeon sets, for the first six weeks. They also say not to push yourself up out of a chair or bed and not to do repetitive heavy lifting, and give no end date for either, so ask your surgeon.
• Elbow. Hand and wrist exercises come first, then gentle elbow movement as the incision heals. You will most likely not be allowed to put weight on the arm until about six weeks, and most surgeons recommend a permanent lifting limit of no more than 5 to 10 pounds.
• Osteotomy. Not a replacement: the shinbone or thighbone is cut and reshaped to take pressure off the damaged side of the knee, usually for early arthritis on one side of the joint. Expect crutches for several weeks, about six weeks for the bone to heal, and perhaps three to six months before full activities. Once it has healed there are no restrictions on physical activity.

Warning signs after a joint replacement

Call 911 if you develop chest pain, shortness of breath or you are coughing up blood. A blood clot that has travelled to the lungs can show itself this way: as sudden shortness of breath, sudden chest pain, or chest pain in one spot when you cough. The instruction is the one in the guidebooks Waterloo Regional Health Network (WRHN) gives people having a hip or knee replacement.

Call 911 or go to the nearest emergency department immediately if a replaced hip moves out of place: it will be very painful and you will not be able to stand. Do the same after a fall or a blow to any replaced joint if the pain is severe, the joint or limb has changed shape or sits at an odd angle, a bone is showing or a cut is bleeding heavily, you cannot move it, you cannot walk or put weight on the leg, or the limb is numb, tingling, pale, blue or cold. Those signs are drawn from the NHS’s and British Columbia’s advice on injuries, in Ontario terms. After any other fall onto a new joint, contact your surgeon’s office the same day.

If you went home with a nerve block catheter for pain relief (WRHN leaves one in for up to four days after a knee replacement): call 911 for a seizure, and go to the nearest emergency department, or call the anesthesiologist on the number your hospital gave you, for pain or swelling where the catheter enters the skin, ringing in your ears, a metallic taste in your mouth, or a numb mouth or tongue.

Go to the nearest emergency department, too, if you are home from hospital and cannot urinate.

The emergency departments in Waterloo Region are:

• WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
• WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
• Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

Contact your surgeon’s office or hospital care team right away, the same day, for any of the signs below. If you cannot reach them, go to an urgent care clinic or an emergency department that day. Do not save these for a rehabilitation appointment: nobody at CARESPACE can rule out a blood clot or an infection.

• Signs of a blood clot in a leg: redness, swelling, warmth, tenderness or pain anywhere in either leg, including severe pain in the calf
• Signs of infection: a fever above 38°C, or chills; redness, swelling, warmth, tenderness or increasing pain around the incision; any drainage from the wound, above all thick or foul-smelling discharge (green, brown or creamy yellow); an incision that opens; or pain in the joint that keeps increasing, with activity and at rest
• Lots of bleeding, or a dressing that is soaked through
• A sudden increase in pain that is not related to activity, or pain that is not controlled by the medication you were prescribed
• Dizziness
• Nausea or vomiting you cannot control, or severe constipation or diarrhea that does not improve with medication
• Pain, burning, urgency or frequency when you urinate
• A bloody nose, or blood in your urine or stool

The same-day list was written for hip and knee replacements. After a shoulder or elbow replacement or an osteotomy, use it together with the sheet your own surgeon gave you: follow that sheet where it gives its own instruction, and call the surgeon’s office the same day about anything else on either.

What the evidence says about joint replacement rehab

• Start within a day. The UK’s NICE guideline on hip, knee and shoulder replacement (2020) says a physiotherapist or occupational therapist should offer rehabilitation on the day of surgery if possible and no more than 24 hours after it. When NICE says “offer”, its committee was confident; “consider” means the case was less certain.
• Advice for everyone, supervision for those who need it. After a hip or knee replacement, NICE says to give advice on self-directed rehabilitation before the person leaves hospital. It says to offer supervised group or individual sessions to people who have difficulty managing daily activities, have ongoing loss of function with specific rehabilitation needs, or find that working alone is not meeting their goals, and to consider them for people with cognitive impairment. After a shoulder replacement, the advice may be for any of the three.
• Exercise before surgery: some support for the knee. Before a knee replacement, a 2021 review for the United States Agency for Healthcare Research and Quality, covering 83 studies of hip and knee replacement, found that an exercise programme may shorten the hospital stay and increase strength, with similar pain, movement and daily activities afterwards, all on low-strength evidence; before a hip replacement, it found the evidence insufficient. The American physiotherapy guideline for knee replacement says such programmes should be designed.
• Which programme is best is not known. After both hip and knee replacement, the review found that different rehabilitation programmes may lead to comparable pain and daily activities, on low-strength evidence, with too little research to say which components, settings or providers work best, or who benefits most.
• Shoulder, elbow and osteotomy. We found no graded rehabilitation guideline for these beyond NICE’s shoulder advice, so what this page says about them comes from orthopaedic surgeons’ public information, and your surgeon’s protocol overrides it.

What your surgeon and hospital team look after

The wound, blood thinners and pain medication, how much load the joint may take, any sling or movement precautions, and when you may drive all belong to your surgeon and hospital team, with your physician, nurse practitioner or pharmacist for medicines. Later on, new or worsening pain, a limp or loss of function in a replaced joint should be referred back to an orthopaedic service.

How each CARESPACE service helps around a joint replacement

Physiotherapy

Before surgery, a physiotherapist can set up strengthening and flexibility exercises. Afterwards they can pick up where the hospital programme stops: checking how the joint moves and how you walk or reach, progressing the exercises inside your surgeon’s limits, and working on the tasks you are stuck on. Our post-surgical rehabilitation page covers surgery of all kinds.

See our physiotherapy team →

Occupational Therapy

The UK guideline names occupational therapists beside physiotherapists for advice on managing daily activities after a joint replacement. An occupational therapist can work through dressing, bathing and the car with one arm in a sling or a hip under precautions, and the equipment that helps, such as reachers and sock aids.

See our occupational therapy team →

Kinesiology

A kinesiologist can run the exercise programme at either end: strengthening before the operation, and graded strengthening and walking once the surgeon’s early restrictions are lifted and the goal is work, long walks or sport.

See our kinesiology team →

Personal Training

A personal trainer can keep you exercising for the long term within the limits that stay with a replaced joint: no repetitive heavy lifting after a shoulder replacement, a low permanent lifting limit after most elbow replacements, and low-impact activity in place of running and jumping after a hip or knee.

See our personal training team →

Other services people ask about

Massage therapy has been studied after knee replacement only, in the reviews we read; Knee Replacement Rehab reports what was found. Pain, redness, warmth or swelling in a leg after surgery is a warning sign for your surgeon’s team, not something to have massaged.

Where most people start

With a physiotherapist. Before surgery, bring your operation date; afterwards, bring the exercise sheet and restrictions the hospital gave you.

How your team works together

Your surgeon’s protocol sets the limits and your physiotherapist plans inside it. An occupational therapist can be added where daily tasks are the sticking point, and a kinesiologist or personal trainer once the early restrictions end.

Browse by service: physiotherapists, occupational therapists, kinesiologists and personal trainers.

What to expect at your first visit

1. The operation. Which joint, the date (planned or done), and the restrictions your surgeon has set.
2. Where you are now. How the joint moves, your strength, and how you are walking, reaching or using the arm.
3. What you need to get back to.
4. Treatment that day and a home programme that fits inside your surgeon’s rules.

What you can do at home

• Before a hip or knee replacement, exercise every day: start with about ten minutes of walking, or swim or cycle if walking hurts.
• After surgery, do the exercises the hospital gave you, and keep your follow-up appointments.
• With a new shoulder, do not push yourself up from a chair or bed with that arm until your surgeon says you may.
• With a new hip or knee, keep to the lifting limit you were given. In a Waterloo Region winter that means someone else shovels, and icy steps and driveways are best avoided.

How long recovery takes

It depends on the joint, and no source we read gives one figure. A hip replacement may take several months, and a knee several months or longer. For the shoulder, the elbow and osteotomy, the time limits that surgeons publish are in the list near the top of this page; some shoulder rules have no end date. Ask your surgeon what to expect for your operation.

Joint replacement rehab in Kitchener, Waterloo and Cambridge

Kitchener. Physiotherapy in Kitchener, Kinesiology in Kitchener and Personal Training in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Physiotherapy in Waterloo, Kinesiology in Waterloo and Personal Training in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Physiotherapy in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

Does Ontario pay for physiotherapy after a joint replacement?

Ontario covers physiotherapy at government-funded clinics for people with a valid Ontario health card who meet its criteria. One is having been discharged from hospital after an overnight stay, or having had outpatient or day surgery within the last 12 months, and needing physiotherapy for the condition you were in hospital for. Being 65 or older is another. Those clinics assess whether you qualify, so ask your hospital team about it before you pay for care. CARESPACE is pay-per-visit: you pay at each visit and are given a receipt for your extended health plan.

Can I do the exercises on my own, or do I need supervised sessions?

After a hip or knee replacement the starting point is your own programme, with someone to contact. Supervised sessions are for people who find daily activities difficult, have ongoing loss of function, or are not meeting their goals alone.

Should I have physiotherapy before a joint replacement?

It is optional. What the local hospital asks for before surgery is mainly daily exercise, and the research support is for the knee, as the evidence list above sets out.

How much can I lift after a joint replacement?

Follow your surgeon’s figure. WRHN’s guidebooks set 5 to 10 pounds for six weeks after a hip or knee replacement; the shoulder and elbow limits are in the list near the top of this page.

Can I do joint replacement rehab in Cambridge?

Yes, through Physiotherapy in Cambridge, before or after your operation. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• National Institute for Health and Care Excellence. Joint replacement (primary): hip, knee and shoulder (NG157). 2020.
• Konnyu KJ, Thoma LM, Bhuma MR, et al. Prehabilitation and Rehabilitation for Major Joint Replacement. Comparative Effectiveness Review No. 248, Agency for Healthcare Research and Quality, 2021.
• Jette DU, Hunter SJ, Burkett L, et al., for the American Physical Therapy Association. Physical Therapist Management of Total Knee Arthroplasty. Clinical practice guideline, Physical Therapy, 2020.
• Waterloo Regional Health Network. Hip Replacement Guidebook and Knee Replacement Guidebook. Hospital guidebooks, WRHN @ Midtown; files posted June 2026.
• American Academy of Orthopaedic Surgeons. Reverse Total Shoulder Replacement, Total Elbow Replacement, Osteotomy of the Knee, Total Hip Replacement and Total Knee Replacement. OrthoInfo.
• NHS. Hip replacement: recovery (reviewed March 2024) and Knee replacement: recovery (reviewed September 2026).
• NHS. Hip pain in adults (reviewed November 2025) and Broken arm or wrist (reviewed October 2026), for the signs after a fall.
• HealthLink BC. Anterior Cruciate Ligament (ACL) Injuries (when to call a doctor after a knee injury). Current as of November 2022.
• Government of Ontario. Get physiotherapy. Updated November 9, 2026.

Related conditions

Hip Replacement Rehab
Knee Replacement Rehab
Hip Osteoarthritis
Knee Osteoarthritis
Shoulder Osteoarthritis

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