Knee Replacement Recovery: Discharge to 21 days

After being discharged from the hospital, a patient will go home or to a rehabilitation center with on-site nursing and physical therapy. Whether the patient is home or at a rehabilitation center, the priorities will be the same:

• Do physical therapy
• Maintain adequate pain control
• Get enough sleep
• Keep the incision clean (and covered if instructed to do so by your surgeon)
• Avoid activities that could endanger the patient or the incision
• Watch out for signs of complications, such as deep vein thrombosis (DVT)

Most patients have a follow-up visit with their surgeon 10 to 21 days after surgery. At that time stitches may be removed and the recovery guidelines may be adjusted.

See “When Can I…?” Answers for Knee Replacement Patients

Physical Therapy After Knee Replacement Surgery

Every patient will be given physical therapy exercises to do at home. The patient may also receive in-home physical therapy or go to a physical therapist’s clinic. Initially, recovery and physical therapy typically prioritize:

• Reducing swelling and pain. The leg must be elevated above the heart. It is important to realize that most reclining chairs do not elevate the knee above the heart. Instead, lie on a bed or couch with the foot propped up on pillows.

  When possible, elevate the foot without support behind the knee. Gravity will force the knee into a straighter position. This position can be uncomfortable but will help prevent scar tissue from forming.

• Walking regularly. Walking can be done with a walker, crutches, or other assistive device. Walking encourages the healing process and helps lower the risk of complications.
• Stretching and strengthening exercises. Most stretches and exercises will target the quadriceps, hamstring, and calf muscles. The patient will be given a list of recommended exercises and stretches with descriptions on when and how to do them.

See Knee Replacement Surgery Rehabilitation Exercises

The goal is to eventually bend the knee at least 120°, allowing the person to get in and out of most car seats, low chairs, and sofas.

Pain Medications After Knee Replacement Surgery

If a nerve block was used during knee replacement surgery, it may wear off shortly after being discharged. This means patients may have more pain at home than they did in the hospital. To decrease and avoid pain, patients will need to take oral medications.

The oral pain medications used may include:

• Opioid medications, such as oxycodone
• Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and COX-2 inhibitors
• Aspirin, a pain reliever as well as a blood thinner (use only if approved by the surgeon)
• Gabapentin, a medication developed to treat seizures but sometimes prescribed to treat nerve pain

People should not wait until their pain becomes severe before taking medications. Oral pain medications do not take effect immediately. In addition, pain is easier to stop before it starts.

See Pain Medications for Arthritis Pain Relief

Getting Sleep After Knee Replacement Surgery

Knee pain and stiffness can make getting sleep challenging. Higher doses of pain medication, or stronger pain medications, may be needed at night in order to sleep.

It can be dangerous, even life-threatening, to take sleep medications and pain medications together. Only take sleep medications if approved by the overseeing surgeon.

Initially, getting in and out of bed can be awkward and painful. Over the first two weeks, it will get easier and less painful.

Activity Restrictions After Knee Replacement Surgery

Patients are typically given a list of activities they should not do, also called precautions. Common restrictions during this phase of recovery include:

• No driving. Pain medications, pain, stiffness, and other factors will affect a person’s ability to operate a motor vehicle.
• No swimming or taking baths. Immersing the wound in water increases the risk of infection.
• No carrying heavy loads. The extra weight will put added stress on the new knee.

Patients should adhere to the all activity restrictions assigned by their surgeon’s office.

See Post-Surgical Knee Replacement Precautions and Tips

Caring for a Knee Replacement Surgery Incision

Traditional total knee replacement surgery often entails an 8” to 10” incision. It is typically recommended that the incision remain covered by a bandage from several days up to 2 to 3 weeks.

A surgeon’s office will provide detailed instructions about how often to change the bandages and how to do so. In general:

• The wound should be cleaned and bandages changed daily.
• Immersing the leg in a bath tub, hot tub, or pool must be avoided until the wound is adequately healed—typically for a minimum of 4 weeks. These activities can increase the risk of infection.
• Showers are usually OK beginning 2 to 3 days after the surgery. The incision should not be scrubbed or sprayed with water. Instead, people are advised to let soapy water run over the incision, rinse it with clean water, and gently pat it dry.

A hospital may use a specially designed bandage that can stay in place for a week or longer. These bandages are able to absorb blood and moisture to keep the skin clean and dry (similar to a baby diaper); the bandages are also antimicrobial and waterproof. They can be worn in the shower.

When to Seek Immediate Medical Care

People who have recently had knee replacement surgery should call their doctors or seek medical treatment if they experience signs of:

• Infection, including oozing of fluid from the wound; redness of skin around the wound; notably increased swelling or pain; and/or a high fever, particularly one accompanied by chills or shaking. A mild fever is normal. A surgeon’s office may tell patients in advance to seek medical care only if a fever reaches over a certain temperature.
• Deep vein thrombosis, including severe pain in the calf or thigh (not necessarily near the incision); swelling in the calf, ankle or foot; shortness of breath; chest pain; and/or bluish skin color. Deep vein thrombosis can be life-threatening and should be treated immediately.
• Peroneal nerve damage in the leg, including numbness or a feeling of prickling or pins and needles in the leg and/or foot drop, in which the foot suddenly and uncontrollably drops to the floor mid-step.

If the patient is unsure if their symptoms are normal, a call to a health care provider is recommended. Most people who have knee replacement surgery do not experience medical complications.

See Total Knee Replacement Risks and Complications