Timeline For Knee Replacement Recovery
Almost 800,000 total knee replacements are performed in the United States each year making it one of the most common orthopedic procedures. Below is a general timeline of what to expect after undergoing a total knee replacement. It is important to keep in mind that everyone’s postoperative course will vary; and the most important thing is to keep an open dialogue with your surgeon and healthcare team and follow their advice and instruction.
Day of Surgery: Expectations For A Total Knee Replacement
On the day of your total knee replacement, you will meet with your surgeon in the preoperative area where you will have the opportunity to ask any last minute questions. You will also be meeting with the anesthesia team at this time to discuss a possible nerve block, what type of anesthesia will be used (typically general or spinal anesthesia) and be given any further preoperative medications and instructions. After the surgery you will be taken to the recovery area, or Post-Anesthesia Care Unit (PACU), to recover from the anesthesia. When appropriate, you will be allowed to have family come back to visit you and you will do some walking with therapy. These days many total knee replacements are done outpatient. If you do stay in the hospital it is typically just overnight. In the hours and days following surgery it will be important to control your pain and swelling. This is typically done through a multimodal approach including cryotherapy (cold therapy), rest, elevation, intraoperative pain injections and, of course, oral medications. Your surgeon may place you on a combination of medications post-operatively including anti-inflammatories, Tylenol, opioid and non-opioid pain medications, nerve medications such as Gabapentin, etc.
Total Knee Replacement Recovery: The First Week
In the first week after your knee replacement you will continue to walk short distances with the help of an assistive device. You will also likely start formal physical therapy and begin working on knee range of motion, quadriceps strengthening and swelling control. Typically in the first day or two after your surgery your surgeon will have you start some type of blood thinning medication to help decrease the risk of blood clots. This could be as simple as a daily aspirin but will depend upon your medical history as well as your surgeon’s discretion. During this phase it will be important to monitor your incision/bandage site for redness, drainage etc. There are many ways to close the incision following a knee replacement such as staples, sutures, and glue. You will need to follow your surgeon’s instructions regarding bathing/showering and management of bandages. It is not unusual to experience increasing swelling and bruising of the knee and leg during this time. If you happen to notice significant calf pain, fevers, chills, illness, or non- bloody drainage at any time you should notify your surgeon immediately.
Postoperative Physical Therapy For Total Knee Replacement: Weeks 2 Through 6
Typically you will have your first postoperative visit with your surgeon within the first 2-3 weeks after surgery. At this visit, x-rays of your new knee will be taken. Your wound and knee will be evaluated to be sure things are progressing appropriately. During this stage it will be important to continue with diligent wound care for your incision per your surgeon’s instructions. Physical therapy will become more intense during this stage as it is important to achieve full extension and at least 120 degrees of flexion in the first 6 weeks before too much scar tissue has a chance to form and possibly limit motion long term. In the first six weeks you will likely start to wean off of your walker/cane and begin gait training with physical therapy. You will also progress your strengthening from open chain (foot off the floor) exercises to closed chain (foot on the floor) exercises. Typically it is safe to start driving after the first 3 or 4 weeks provided that you aren’t taking any narcotic pain medications at that time.
Full Knee Range of Motion by Weeks 6-12
Congratulations! You have made it through the toughest part of your recovery. At this point your incision should be fully healed. You should have full range of motion of your knee and your pain and swelling should be markedly improved. During this time you will continue to build strength around the knee and start to reintroduce activities such as longer distance walking, swinging a golf club, hitting tennis balls, light cycling etc. During this time you may also have another post-operative visit with your surgeon to ensure you are progressing appropriately.
Postoperative Care After Total Knee Replacement: 3-6 months
Return to full activity including higher level activities such as tennis, golf, pickle ball etc. It's not unusual to still have some occasional stiffness or slight swelling during this phase as it can take a full year to fully recover and heal from the surgery. It is wise at this point to discuss antibiotic dental prophylaxis and ongoing annual follow ups with your surgeon.
Physical therapy is crucial after total knee replacement surgery. NeeHab’s Flexion Device helps improve flexion and extension of the knee and inhibits the formation of scar tissue with early motion. Learn more about our rehabilitation device for knee replacement surgery and its effectiveness!
About The Author
Kevin Brown, Certified Physician Assistant
Kevin Brown is a certified physician assistant who has been practicing in general orthopedics and orthopedic surgery for the past twelve years. Prior to his physician assistant career, Kevin was an orthopedic physical therapist for 4 years. He resides in Charlotte, NC with his wife and two sons.
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