A patient who recently had a right total knee replacement (14 days ago) presents with high pain and fear of full weight bearing. What is the BEST exercise to initiate today?

• A. Supine straight leg raise with 1 lb ankle weight
• B. Standing single-leg squat with body weight
• C. Treadmill walking at a moderate pace without support
• D. Deep squat with resistance

Answer: (A)

After total knee replacement, the goal early on is to protect the healing structures while reactivating the quadriceps without placing the knee in weight-bearing stress. Isolating the quadriceps with a supine straight leg raise lets the patient work the muscle while keeping the knee straight and the joint unloaded, which reduces strain on the incision and prosthesis. Adding a small ankle weight provides gentle, progressive resistance as tolerated, helping to build strength and combat extensor lag without pushing weight through the knee. This approach supports pain control and confidence, making it feasible to advance to more challenging activities later.

The other options require greater knee loading or deep knee flexion. Standing single-leg squats or deep squats with resistance place substantial force through the operated knee and demand more control, which can aggravate pain or fear and risk compromising the surgical site. Treadmill walking without support also involves weight bearing and gait demands that may be too much early after surgery. Starting with a controlled, non–weight-bearing quad exercise sets a safe foundation for rehabilitation.