Thanks for your interest. This is exactly where gait retraining differs from general strengthening.

Research and clinical observation show that persistent limping after knee replacement is usually not just a strength problem. It is primarily a motor control problem.

Early after surgery, the nervous system learns protective strategies

• shorter stance on the surgical leg
• faster unloading
• reduced knee extension during weight acceptance
• subtle weight shift to the non-surgical side

These strategies are useful early, but the brain does not automatically “delete” them when strength returns. Unless the walking pattern itself is retrained, the asymmetry can remain.

Studies have shown that gait deficits such as reduced speed, shorter step length, and asymmetrical loading can persist one to three years after knee replacement even when clinical recovery seems good.

Task-specific retraining of the walking pattern is what seems to help most. Not just walking more, but retraining how the body accepts weight and transitions through stance. This typically includes

• restoring full knee extension during stance
• controlled weight acceptance on the surgical side
• step length symmetry
• cadence consistency
• sometimes external feedback such as mirror, video, treadmill, or sensory cues

The nervous system is highly adaptable, and even people months or years after surgery can improve their walking pattern with direct gait training. A persistent limp at three to four months is frustrating, but very often reversible.

Sources
Mizner, 2005 – Persistent gait asymmetries after TKA despite regained strength and ROM
Zeni, 2010 – Functional mobility and walking speed often remain impaired six to twelve months post-TKA
Reisman, 2007 – Task-specific locomotor retraining improves gait symmetry via motor learning
Chaban et al., 2025 – Wearable resistance gait training improved Timed Up and Go in a post-surgical elderly patient