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Physiotherapy · Joint replacement

Knee and hip replacement rehab in Phuket

The new joint replaces the worn surface. Your strength needs its own plan: ready before surgery, guided through the first weeks home, then rebuilt and tested.

Surgery here, in Bangkok or overseas, or months out and still weak.

Book a free physio assessment

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Rated 5.0 from 57 Google reviews

What the research says

Surgery does not return your strength

Your thigh muscles lose much of their strength in the month after a knee replacement.1 In one small study, people were already weaker than healthy adults before surgery, and the gap was still there six months later.2

  • 62%

    drop in thigh strength about a month after knee replacement in one study of 20 people, mostly because the muscle stops switching on fully.1

  • 41%

    below healthy adults: thigh strength six months after knee replacement, in one small study.2

  • 19%

    of people were unsure or unhappy with their new knee one year on, in a Scottish study of 1,217 people.3

The operation is one step. Strength, before surgery and after it, is the part you control.

How we work

Prepare, load, test, keep training

Our pathway follows the latest physio guideline for knee replacement and the UK national guideline for hip and knee replacement.4,5 Your physio signs off each stage before your coach takes over.

  • Get stronger before surgery

    Exercise before a knee replacement improves strength and function in the first weeks to months after it, and the latest guideline recommends it.4,6 For hips, it prepares you but has not changed results after surgery.7,8

  • Build strength progressively

    The latest knee replacement guideline strongly recommends progressive strength training.4 Loads rise as pain and swelling allow.

  • Supervision when you need it

    In a UK trial of 334 slow recoverers, 18 therapist-led sessions did no better than a physio review and home program.9 We add sessions when you need them, not by default.

  • No bending machine

    A machine that bends the knee for you added about 2 degrees of bend across 24 trials, which is not worthwhile. The latest guideline advises against it.10,4

Your recovery

Five phases, booking to a year

Times are typical, not promises, and your surgeon’s plan always comes first.

  1. 01

    Weeks before surgery

    Get ready

    Build leg strength two to three times a week, walk or ride a static bike most days, practise crutches, stairs and car transfers, and set up your home. Your physio records a baseline.

    Ready for surgery whenBaseline tests are done, you are training twice a week, you are safe on stairs with your aid, and your surgeon’s written plan is on file.

  2. 02

    0 to 2 weeks after surgery

    First weeks home

    Walk short distances often, calm the swelling, start bending and straightening, and wake up the thigh muscle. Follow your surgeon’s hip limits and blood thinner plan exactly.

    Move on whenAt least 10 days since surgery, walking indoors safely, managing bed, chair and toilet alone, and a dry, healing wound.

  3. 03

    2 to 12 weeks after surgery

    Build strength

    The main strength block: sit to stands, knee extensions, step-ups, step-downs, bridges and hip work, adding load each week, plus balance, walking drills and the bike.1,4

    Move on whenWalking 20 minutes without an aid or a limp, chair stands and walking test at or above your pre-surgery score, and 10 controlled step-ups each side.

  4. 04

    3 to 6 months after surgery

    Back to life

    Stairs, longer walks, slopes and sand, travel and sport, with heavier strength work. Golf starts with putting and chipping. Your physio leads and ends this phase with a sign-off check.

    The handover checkAt least 12 weeks since surgery, the operated leg at least 80% as strong as the other, and stairs step over step. Your physio signs it off.

  5. 05

    6 months onward

    Stay strong

    Your coach runs your training two to three times a week, with walking, cycling or swimming most days, and a physio retest at 12 months.

    On track whenTraining at least twice a week most weeks, 12-month tests at or above your 6-month results, and the strength gap closing.

In one small study, walking was back to its pre-surgery level by three months, but strength only by six.2 Thigh strength before knee replacement predicted stair climbing a year later.11

Between sessions

A simple traffic light after every session

Your new joint needs load, but the right amount. Pain up to 5 out of 10 was acceptable in prehab research, settling overnight.12

Check three things: pain during and after exercise, any extra swelling or heat the next morning, and your bend and walking.

  • Green: progress

    Pain 0 to 2, settled by morning, no extra swelling, range steady. Keep going and add a little load next session.

  • Amber: hold

    Pain 3 to 5, or a little more swelling that settles within a day. Repeat the same load and tell your physio.

  • Red: step back

    Pain above 5, still worse next morning, more swelling or heat, or bend lost. Drop back a step and call your physio within 24 hours.

Go to hospital now if

Call 1669 in Thailand.

  • Sudden breathlessness, or pain in your chest
  • Coughing blood, fainting or a racing heart
  • New swelling, pain or redness in your calf or leg
  • Fever above 37.8°C, or shaking chills
  • Wound redness spreading, or pus or fluid leaking
  • New hip: sudden severe pain, or you cannot take weight

Even with blood thinners, about 2 to 3.5 in 100 people had a clot with symptoms within 90 days in one large trial.13 Ask your surgeon before long flights.

Surgery booked?

Use the weeks before to get ready

Pooled trials of strength training before hip or knee replacement found better movement and thigh strength three months after surgery, with smaller effects at a year.6 The latest knee replacement guideline recommends exercise before surgery.4

For hips, pooled trials found no clear benefit after surgery.7 Prehab still gives us your baseline, rehearses crutches, stairs and transfers, and starts the strength habit you will need afterwards. Flying to Bangkok or overseas for surgery? Start before you go.

3 mo

after surgery, when strength prehab gains were clearest in pooled trials6

1 yr

by then, the extra effect was smaller6

Patient reviews

What our patients say

Rated 5.0 from 57 Google reviews

  • “I started seeing Khun Maew last August for a knee issue and within 15 minutes she had identified a multitude of issues I’d been dealing with for more than 20 years … I have been pain free for 6 months and am now in the gym working to rebuild my mobility and strength.”

    Michelle LawlorGoogle review

  • “Great Physiotherapy. Khun Meaw helped me very professionally with my the post-op rehab of my knee after ACL and Meniscus repair. She is very kind, knowledgeable and helpful. Really recommend her and Optimize!”

    ELIH HectorGoogle review

  • “I have been working with Khun Meaw on some strengthening exercises for my shoulders, hips and knees. … Her goal has been to give me the tools I need to work on my specific areas of need and not to keep me in an endless cycle of needing help……so professional and a joy to work with.”

    Catlin McCrackenGoogle review

  • “I honestly can’t thank Karim at Optimisefit enough … I’ve lived in five different countries and, unfortunately, had to deal with many injuries, so I’ve seen quite a few physios over the years. But no one has ever come close to the level of knowledge, care, and clarity that he brings.”

    Unfiltered OpinionsGoogle review

  • “Optimise is a fantastic set up, I have been working with Khun Meaw on a physio front, and she is awesome and really gets to the root of the problem and starts from there – could not recommend highly enough. Having seen a couple of different physios on the island, Khun Meaw is certainly number 1.”

    Jamie AllworkGoogle review

  • “Meaw has been incredible. She helped me recover from long term neck and lower back pain and gave me personalized exercises that I now do daily. These have made a huge difference in my strength, mobility, and overall well-being. I’m so grateful for her expertise and highly recommend her to anyone looking for real, lasting results!”

    Jeff CraigGoogle review

  • “I came to Optimize with chronic back pain and absolutely no ability to train. I was first matched with Khun Meaw, a highly skilled rehabilitation trainer who helped me eliminate my back pain completely. … After that, I continued training with Kate for a full year.”

    nesterzhzhotGoogle review

Read all 57 reviews on Google

Questions

Joint replacement questions

Do I need physio three times a week for months?

Not usually. In a UK trial of 334 people recovering slowly, 18 therapist-led sessions were no better than a physio review plus a home program.9 We add supervised sessions when you need them.5

Will the bending machine get my knee moving?

Across 24 trials, the machine added about 2 degrees of bend, which is not worthwhile.10 Bending and straightening the knee yourself, plus strength work, is what the guideline recommends.4

Once the pain goes, is my leg strong again?

Not necessarily. In one small study, thigh strength six months after knee replacement was 41% below healthy adults.2 Pain relief and strength recovery run on different clocks, so we test strength directly.

Does harder training straight after surgery speed things up?

In a trial of 162 people, high-intensity training from day 4 was safe but gave the same results as lower-intensity training at three and twelve months.14 Steady progression is our aim.

Are hip precautions always needed?

Pooled studies have not shown that routine movement limits reduce dislocation, though the evidence is limited.15,16 Some surgeons still set them for good reasons, so always follow your surgeon’s plan.

Can you help if I had surgery elsewhere?

Yes. Bring your surgeon’s written plan. Your physio tests where you are and starts you at the right phase.

Physio team

Your physio team

Karim has a background in post-operative knee rehab. Meaw leads our clinical standards.

How physiotherapy works here
  • Meaw, Head Physiotherapist at Optimise

    Meaw

    Head Physiotherapist

  • Karim, Physiotherapist at Optimise

    Karim

    Physiotherapist

Also on the team Sukanya, Physiotherapist

Next step

Find out where your strength stands

Message us on WhatsApp to book your free physio assessment. Weeks before surgery or months after, you leave with a clear plan.

Book a free physio assessment

Opens WhatsApp with a message ready to send.

Questions first? WhatsApp +66 65 914 1604

Low back painSciaticaShoulder painKnee arthritisRunner’s kneeACL rehabAnkle sprainNeck painTendon painHamstring strainMeniscus tearsHeel painHip arthritisFrozen shoulderRotator cuff tears
Sources (16)
  1. Mizner RL, et al. Early quadriceps strength loss after total knee arthroplasty. The contributions of muscle atrophy and failure of voluntary muscle activation. J Bone Joint Surg Am. 2005;87(5):1047-1053.
  2. Bade MJ, et al. Outcomes before and after total knee arthroplasty compared to healthy adults. J Orthop Sports Phys Ther. 2010;40(9):559-567.
  3. Scott CEH, et al. Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br. 2010;92(9):1253-1258.
  4. Bove AM, et al. Clinical practice guideline for physical therapist management of total knee arthroplasty: revision 2026. Phys Ther. 2026;106(7):pzag058.
  5. National Institute for Health and Care Excellence. Joint replacement (primary): hip, knee and shoulder. NICE guideline NG157. 2020.
  6. Jørgensen SL, et al. Effects of resistance training prior to total hip or knee replacement on post-operative recovery in functional performance: a systematic review and meta-analysis. Front Sports Act Living. 2022;4:924307.
  7. De Klerk TC, et al. Effects of home-based prehabilitation on pre- and postoperative outcomes following total hip and knee arthroplasty. Bone Jt Open. 2023;4(5):315-328.
  8. Svinøy OE, et al. The effect of prehabilitation for older patients awaiting total hip replacement. A randomized controlled trial with long-term follow up. BMC Musculoskelet Disord. 2025;26(1):227.
  9. Hamilton DF, et al. Targeting rehabilitation to improve outcomes after total knee arthroplasty in patients at risk of poor outcomes: randomised controlled trial. BMJ. 2020;371:m3576.
  10. Harvey LA, Brosseau L, Herbert RD. Continuous passive motion following total knee arthroplasty in people with arthritis. Cochrane Database Syst Rev. 2014;(2):CD004260.
  11. Mizner RL, et al. Preoperative quadriceps strength predicts functional ability one year after total knee arthroplasty. J Rheumatol. 2005;32(8):1533-1539.
  12. Ageberg E, Link A, Roos EM. Feasibility of neuromuscular training in patients with severe hip or knee OA: the individualized goal-based NEMEX-TJR training program. BMC Musculoskelet Disord. 2010;11:126.
  13. CRISTAL Study Group; Sidhu VS, 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.
  14. Bade MJ, et al. Early high-intensity versus low-intensity rehabilitation after total knee arthroplasty: a randomized controlled trial. Arthritis Care Res (Hoboken). 2017;69(9):1360-1368.
  15. Korfitsen CB, et al. Hip precautions after posterior-approach total hip arthroplasty among patients with primary hip osteoarthritis do not influence early recovery: a systematic review and meta-analysis. Acta Orthop. 2023;94:141-151.
  16. Crompton J, Osagie-Clouard L, Patel A. Do hip precautions after posterior-approach total hip arthroplasty affect dislocation rates? A systematic review of 7 studies with 6,900 patients. Acta Orthop. 2020;91(6):687-692.

This page is general information based on the research listed here. It is not a diagnosis. Your physio will tailor the plan to you, and your surgeon’s or doctor’s instructions come first. Clinically reviewed by Meaw, Head Physiotherapist at Optimise, November 2026.