Advanced Exercises To Prepare For Knee Replacement (My Routine)

(I may earn a small commission from the products mentioned in this post.)

Your knee replacement surgery is fast approaching. You’ve met with your doctors, organized your home and cleared your schedule for the next 2 months so you can focus on preparation and recovery.

Your doctor has given you information to read and prepare for surgery and you’ve learned that your legs and body should be in shape. If you’ve been exercising and want to take your workout to the next level, I’ll share my advanced exercises for pre-knee replacement surgery.

Keep in mind that this article outlines my exercises and may not be applicable in your situation. The reasons for knee replacement differ from person to person. Activities and movements that cause pain for me may not cause you pain and vice versa.

I talked with my doctor before starting these knee replacement workouts and it’s important you do the same. If you decide to try my workout, start slow and gradually work your way up to more weight and resistance.

These exercises may not be for you if:

  • You have trouble extending your leg to a straight position
  • Have damage to ligaments, tendons, and muscles
  • Have severe inflammation or pain in your leg
  • Have difficulty standing or sitting down

Difference Between Beginner and Advanced Knee Replacement Exercises

If you haven’t read my beginner knee replacement exercises article I recommend doing-so before this article.

The beginner exercises were the first step for me as I developed strength around my knee. As I’ve improved my strength I’ve looked for ways to adapt the exercises and make them more challenging.

I want my quadriceps, hamstrings, ligaments, and tendons to not only be strong for recovery but also be flexible during surgery. I can feel the progress I’ve made and I’m confident going into surgery that I’ve done everything to ensure success and a speedy recovery.

You’ll notice that many of the advanced knee replacement exercises in this article are similar to the beginner. The main difference is that I’m now using a band and ankle weight to create resistance.

The reason for the band and ankle weight is to focus on muscle strength. I’ve been doing high repetition exercises without resistance and my muscle endurance is fantastic.

When I first started doing the exercises I would become tired at about 10 repetitions however now I can do 20-30 repetitions and still remain strong the rest of the day.

The band and ankle weights will add resistance and allow me to do fewer repetitions, which in theory, should help with building muscle strength over endurance. Remember, I don’t stop my activity with these exercises. I also get exercise with my routine of long distance swimming, hiking, biking, walking, and pickleball.

Let’s get started!

Related: Best Shoes to Wear After Knee Replacement Surgery

Section 1: Resistance Band Exercises Before TKR

Exercise bands, also known as resistance bands, have been used in physical therapy for decades. More recently they’ve gained popularity for individual workouts as a way to increase strength, range of motion, and flexibility.

Exercise bands come in different sizes, colors, and strengths. For serious workouts the bands are thick, but for people recuperating from injury, such as a sprained ankle, the bands are lightweight and thin.

The following exercises utilize lightweight thin bands, perfect for adding a small amount of resistance to exercises. I purchased the Gold’s Gym bands for under $10 and they come with 3 bands, each with a different strength.

Currently I’m using the 1st band (thinnest) and after a few weeks I plan to work my way up to the 3rd band. I like the gradual increase in band strength because I can make sure I’m progressively gaining strength.

Exercise 1: Standing Straight Leg Extensions – (Forward and Backward)

I hook one end of the band to the leg of a table or a fixed object and insert my foot in the other end. I stand upright, far enough away from the chair so the band is taut and I face away from the support.

I keep my leg straight in a locked position (no bending) and slowly bring my leg forward 5-6 inches. The band will stretch and I can return my leg back to the starting position.

The muscles of the front quadriceps and front hip should be engaged. After a few repetitions the thigh muscles should burn (good burn).

If I bend the knee during this exercise it puts additional pressure on the joint and causes me pain.

Once I’ve completed the exercise for the front of the thigh, I turn and face the chair, table, or stationary object the band is hooked onto. This exercise is just like the first exercise, however the difference is in the direction the leg moves. Instead of moving forward a few inches I move my heel back, away from the chair or table.

I feel the hamstring muscle (back of thigh) flexing as I do this exercise. Once again, I keep a straight leg to avoid pressure on your knee joint. I move the heel backward 5-6 inches and slowly return to starting position while concentrating on the muscles of the upper leg.

My routine: 2 sets of 10 repetitions (4 total – forward and backward)

Exercise 2 Standing Straight Leg Extensions – (Lateral and Medial)

best exercise for tkr surgeryOnce you’ve got the hang of Exercise 1, it will be easy to adapt a similar technique for Exercise 2.

Exercise 2 utilizes the same standing position using the resistance band, a chair, table, or stationary object, but the difference is I face the side. Facing to the side, I’m able to extend the straight leg outward (lateral) or inward (medial) and work the outer thigh and inner thigh.

I concentrate on keeping the leg straight, locked at the knee. I feel the muscles of the upper thigh and hips engage. With the resistance band tight, there’s no need to extend my leg more than a few inches with each movement back and forth.

After completing the exercise on one side of the leg, I turn and face the other direction and repeat the exercise to work the inside and outside of the thigh.

My routine: 2 sets of 10 repetitions (4 total – lateral and medial)

Alternative Position for Resistance Bands

resistance band for knee replacement exerciseExercises 1 and 2 can also be done lying down. I’ve tried both methods and they have a similar impact.  It’s really a matter of what’s more comfortable.

When I choose to use resistance bands lying down, I attach the band to a the opposite leg. I use a yoga mat or sit on the carpet to add extra padding for my body.

After attaching one side of the resistance band to the other leg, I slip my foot in the other side and lay down in a way where the band is taut on the foot. I then position myself in a way so I can do both forward and backward leg extensions and medial and lateral extensions.

To do-so I have to adjust my position (front, back, side or other side). Keeping my leg straight and in a locked position reduces pressure on the knee.

Section 2: Ankle Weight Exercises

ankle weights knee replacement exercises Ankle weights have been around for a long time as a way to add weight to the legs while exercising.

Years ago I saw people walking and running with ankle weights. People thought adding weight to the legs while training would help them run faster or jump higher. Their intentions were good – they wanted to workout harder and become stronger.

But ask most medical professionals and they’ll tell you that walking and running with ankle weights can actually be dangerous. The added weight increases pressure on the lower limbs, especially around the joints (ankles, knees and hips) where ligaments and tendons can be stretched or torn.

I mention the hazards of ankle weights because if used improperly they can negatively affect knee replacement preparation. I use ankle weights only while sitting down and only to isolate specific muscles during a workout.

My exercise movements are very short and controlled (only a few inches at a time). The following exercises are somewhat similar to the band exercises, however unlike the band, the ankle weight only needs to be connected to a leg – not anchored to a stationary object.

Another benefit of ankle weights is the weight can be adjusted. I take out a portion of the weight to start and work my way up to higher weight over time.

I used the ankle weights pictured above.  Weight can be removed to start and as the weeks go by you can add weight to make the exercise more challenging.  These Golds Gym ankle weights are good quality and worked well for me.

Exercise 1: Lying Straight Leg Raises (Forward and Backward)

straight leg raises knee replacement surgeryUsing the carpet or a yoga mat I sit down and attach the ankle weight. Most ankle weights come in packs of 2 so sometimes I attach them to both ankles.

After attaching the weight I straighten one leg to a locked position (workout leg) and bend my opposite leg at the knee so it rests on the floor.

I lie down on my back and begin doing leg lifts from a resting position on the floor to about 20 degrees off the floor – there’s no need to bring the leg high off the floor. I try to keep my quadriceps flexed so the muscles are carrying the weight. I also feel flexion in the muscles around my hips.

To engage the back of my leg (hamstrings and glutes) I turn on my stomach.  Keeping my leg straight, I bring my leg off the mat a few inches with each repetition.

My routine: 2 sets of 10 repetitions (4 total – front and back)

Exercise 2: Lying Straight Leg Raises (Medial and Lateral)

Similar to the exercises with the bands, I’ll also turn and lay on each side for leg raises. This works the same muscles (quadriceps, hamstrings, hips, and glutes) but will work them from a different angle.

I make sure my leg is straight and only lift the leg a few inches off the mat. I stop immediately if I feel any pain or discomfort.

My routine: 2 sets of 10 repetitions (4 total – medial and lateral)

Exercise 3: Straight Leg Raises Variation – (Alphabet and Circles)

If I become bored raising my leg up and down, I’ll do variations of the exercises. Variations with ankle weights are slightly easier than resistance bands because I’m not connected to an anchor.  There’s more freedom to my movements.

My variations usually consist of holding the leg raised at 15-20 degrees and:

  • Making the letter “V” in the air
  • Writing the alphabet in the air (A-Z or as many letters as I can write)
  • Doing “Figure 8’s”
  • Making circles (clockwise and counterclockwise)

These variations keep my straight leg in the air for a longer period of time rather than back to the resting position. It also keeps my muscles flexed for a longer period of time.

If I want to really work my thigh muscles I’ll include a few sets of these at the end of my workout.

My routine: 1-2 sets of these per exercise session

Muscle Balance Is Important

Even though you might only have knee replacement on one knee, it’s wise to exercise both legs. More important than appearance, having one leg that is much stronger than the other could result in injury.

There’s even a case for giving more attention to your “good” knee. After surgery you’ll be dependent on your other leg for a few weeks (if not months).

It’s not uncommon to see someone overcompensate on their good leg and wind up injuring it as well. Professional athletes frequently experience this problem.

They rehabilitate one leg and return to work early, only to injure their strong leg because it’s working harder.  It is best to exercise both legs for overall body strength and a speedy recovery.

Related: Best Shoes to Wear After Knee Replacement

Additional Exercises (Beginner)

Even though I’m doing advanced exercises now, I still focus on my balance – a beginner exercise. I stand on each leg for a minute or two closing one eye or both and I walk with one foot in front of the other on a line.

I also continue to walk, swim, and ride my bike. These activities keep my muscle endurance up and provide a cardiovascular workout as well.


In this article we looked at advanced exercises to prepare for knee replacement surgery. The exercises I mention may not be for everyone, depending on your injury, mobility, and pain tolerance. Make sure you consult your doctor before attempting these exercises.

I’ve gained strength in my legs by adding resistance bands and ankle weights. I’m very careful not to bend my knee and add pressure to my joints and I also minimize my movements for these exercises (just a few inches for each movement).

Using these exercises, balance exercises, as well as walking, swimming, biking and pickleball, I’ve developed enough strength in my knee in preparation for surgery and for my recovery.

If you have any comments feel free to let me know in the comment space below.  Maybe you have an exercise routine pre-surgery or post-surgery that can help others.

Thanks for reading another one of my articles. Visit again for more information on my knee replacement preparation, surgery, and recovery.