Abstract: Objective To explore the effect of functional exercise under the guidance of fast-track surgery on the recovery of patients with total knee arthroplasty. Methods A total of 49 patients (66 knees) who underwent total knee arthroplasty from April 1, 2015 to July 1, 2016 were selected. Patients were randomly divided into two groups, fast-track surgery group (group F, n=25, 33knees) and traditional rehabilitation group (group T, n=24, 33 knees). The differences of baseline data between two groups were not significant (P> 0.05) before total knee arthroplasty. After surgery, patients in group F did functional exercise under the guidance of fast-track surgery. Functional exercise in group F was commenced earlier than group T. The frequency and intensity were specified; Patients in group T underwent functional exercise according to traditional rehabilitation theory. Active range of motion of the knee joint and hospital for special surgery(HSS) score were recorded and compared at 1 month and 3 months after operation between 2 groups. Results At 1 month after operation, the difference of active range of motion of knee joint between group F (105.6±8.1)° and group T (94.1±8.5)° was significant (P< 0.05). The difference of HSS score between group F (69.4±4.1) and group T (59.2±6.4) was significant (P< 0.05). At 3 months after operation, active range of motion of knee joint in group F (116.3±7.2)° was greater than that of group T(98.5±6.9)° (P< 0.05). The HSS score of group F (80.6±3.0) was higher than that of group T(68.3±4.2) (P< 0.05). Conclusion Functional exercise after total knee arthroplasty based on fast-track surgery concept is worthy of clinical application due to the ability to promote recovery after operation.