The Fitness Pilates Blog

Total Knee Replacement (TKR) – A Complete Guide for Fitness Pilates Teachers

I hope you all have had a great week. I have been using the Deep Work 2 from Pure Energy in my FP classes and this morning I am teaching FP Barre and Balance and going to revist the Fitness Pilates album also on The Pure Energy App – What have you been using this week?

I am continuing on with our Health Conditions in FP classes as the feedback has been so positive… let me know what you think.

Here is a comprehensive overview of a knee replacement

Total Knee Replacement (TKR) – A Complete Guide for Fitness Pilates Teachers

What is a Knee Replacement?

A total knee replacement (TKR), or total knee arthroplasty, is a surgical procedure where a damaged or worn-out knee joint is replaced with an artificial joint (prosthesis). The prosthesis is usually made from metal and plastic components and mimics the movement of a natural knee.

In some cases, a partial knee replacement may be done if only one part of the knee is affected.

Why Do People Have a Knee Replacement?

Most commonly due to severe osteoarthritis, but also:

Rheumatoid arthritis
Post-traumatic arthritis
Severe joint damage from injury
Loss of cartilage or bone deformity
Chronic pain and stiffness that limit daily life and mobility

TKR is often considered when:

Pain persists despite conservative treatment (exercise, physio, medication)
The individual has difficulty walking, climbing stairs, or standing from a seated position

The Rehabilitation Process

Rehab typically follows phases:

Phase 1: Initial Recovery

Focus: Pain management, swelling control, wound healing
Exercises: Gentle ankle pumps, quadriceps sets, glute squeezes, heel slides

Phase 2: Early Mobility

Regain range of motion (ROM), improve gait and leg strength
Walking with crutches or walker, then transitioning to stick
Progression to seated knee bends, straight leg raises, and standing weight shifts

Phase 3: Functional Strength & Mobility

Balance, proprioception, and functional movements
Step-ups, supported squats, leg press, hamstring curls
Return to daily activities and light exercise

Phase 4: Long-Term Maintenance

Full return to fitness activities.
Focus on long-term strength, mobility, and prevention of compensatory movement patterns

Fitness Pilates: Safe & Effective Programming After TKR

Fitness Pilates Exercises to Include (with modifications as needed):

These support joint stability, ROM, and control without overloading the knee.

Seated or Supine Work:

Seated pelvic tilts and posture alignment
Seated or supine leg slides (heel or toe)
Ankle circles and pumps
Core activation: supine ab preps, toe taps (with caution)
Bridge (progress slowly from supported to single leg over time)

Standing & Balance Work (when cleared by physio):

Sit to stand (from a high surface)
Supported squats (small range at first)
Heel raises
Standing hip abduction/adduction
Wall slides (partial ROM)
Balance on one leg (initially with support)

Mobility & Flow:

Seated spinal mobility (twists, cat/cow)
Gentle thoracic extension and rotation
Arm flows with breathing patterns

Exercises to Avoid (especially early stages):

Deep squats or lunges (especially loaded or unsupported)
Kneeling positions (unless explicitly cleared by physio)
High-resistance leg work (banded knee extensions, heavy load)
Double leg raises or strong hip flexor moves that could strain knee
Unstable balance moves (e.g. BOSU work, balance pods too early)
High-impact or plyometric work (jumping, bounding)
Prone knee flexion (can stress the joint early on)

Teaching Tips for Fitness Pilates Instructors:

Always ask if they’ve had unilateral or bilateral replacement, and when
Clarify how long since surgery and if they’ve been discharged from physio
Focus on alignment, stability, breath, and control
Prioritise hip and core strength to support the knee
Offer props for support (chair, block, wall)
Include rest breaks and alternatives
Avoid prolonged static standing or any move that causes discomfort

Annual Numbers & Trends

Across the UK, there are over 100,000 knee replacement procedures carried out each year sciencedirect.com+12nice.org.uk+12pmc.ncbi.nlm.nih.gov+12. NHS data from 2018–19 shows about 93,900 procedures in a single year, with nearly all patients aged 50 and above digital.nhs.uk.
The National Joint Registry indicates around 85,000 primary total knee replacements (TKRs) annually digital.nhs.uk+15orthopaedicsandtraumajournal.co.uk+15nice.org.uk+15.
Historical trends show a roughly 100% increase in knee replacement incidence in England from the 1990s to the early 2000s pmc.ncbi.nlm.nih.gov+1ft.com+1.

That’s a LOT of knee replacements

Is this helpful….email me and let me know and please feel free to share with your class members.

Ill post this in the Fitness Pilates Facebook group so we can continue the discussion there.

Have a lovely weekend.

Rachel x

JUNE PILATES COURSES

June Training Opportunities – Don’t Miss Out!

Reformer Pilates Course – LIVE in Derby at a stunning Reformer studio called BLOOM
Spaces are very limited as this is an in-person training, so if you’ve been thinking about upskilling – now is the time to jump in

Fitness Pilates Reformer – Online Training
Our next online training for qualified Fitness Pilates teachers is happening on
Wednesday 24th June – perfect for expanding your skills and adding Reformer-based concepts to your repertoire.

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