Recovering from Knee Replacement Surgery

Proper rehabilitation and a well-carried out recovery give you the chance to get back on your feet and continue an active lifestyle after knee replacement surgery. Setting and working toward goals will hasten healing and improve your chances for long-term success. It is important to commit to a plan that will enable you to do as much as you can every day to keep yourself moving toward complete recovery. 
There is much to expect and strive for in the first twelve weeks after your knee replacement. With your commitment and appropriate actions, you will feel good as new after this recovery period. 

What Will Recovery Be Like?

Day 1

On day 1 after knee replacement surgery, rehabilitation begins. In the first 24 hours after surgery, you will begin to stand and walk with the use of an assistive device that your physiotherapist will give you. It is very important to wake up and start using your new artificial knee as soon as possible before complications can set in.

Your physiotherapist (PT) will instruct you on exercises you should perform to help strengthen your bones and muscles. The PT will guide you every day. Your PT will also guide you on how to get in and out of the bed and walk around using a mobility aid such as a walker, crutches, or a cane. You will be asked to sit at your bedside and walk a few steps and then transfer yourself to a bedside commode. A nurse will assist you in daily personal tasks such as dressing, bathing, bandaging, and using the toilet.

Your PT will also discuss your home environment with you and teach you how to use a continuous passive motion (CPM) machine. Some people will leave the hospital with a CPM machine on their legs. This machine will help you keep your knee in motion to prevent scar tissue buildup and stiffness due to immobility.

Day 2

On day 2, your PT will ask you to walk periodically, aided by a walking device. You may also be required to use the toilet in the bathroom instead of a bedpan. You may also be requested to continue using the CPM machine. As you continue to recover from knee replacement surgery, your activities will continue to increase.

Discharge

By day 2, your knee will have become better and strong enough to allow you to go home. Before your discharge, the doctor will prescribe you strong painkillers to help reduce the dosage of pain medication. Your PT will ask you to go for longer walks outside the hospital room, walk up and down stairs, and also move onto a chair or toilet with no assistance.

Before you are discharged, you should be able to:

• Bathe and dress on your own
• Bend your knees perfectly, preferably at an angle of 90 degrees
• Rely little on assistive devices for standing and getting in and out of bed

The goals before your discharge include:

• You should have understood all the suggested exercises and can do them well.
• Your knee can achieve 90-degree motion, meaning you can sit and stand well.
• You can walk at least 25 feet and also go up and down stairs using crutches or a walker.
• You can get in and out of your bed comfortably with little or no help from assistive devices.

Weeks 4 to 6

If you have done your exercises and taken to rehabilitation well, then you will notice a dramatic improvement in your knee. Your knee at week 4 should display improved bending and more strength. Your physiotherapist will make you go for longer walks and wean you from assistive devices. Toward the end of week 6, you should be able to go for long walks, i.e. half a mile. You will feel that you have regained independence. At this point you will be able to do normal chores such as cleaning, cooking, and dusting among other household chores.

You should seek assistance from your PT to know when you can return to work or resume certain other activities. Some patients who had a total knee replacement (TKR) can resume driving on the fourth week after surgery. You should talk with your doctor before getting behind the wheel. It is wise to take longer and allow full healing and recovery.

Goals set for weeks 4 to 6 include:

• Return to normal activities
• Significant reduction of inflammation and swelling 
• Have the strength of your knee increased by continued exercises such as walking
• Achieve a motion of 90 degrees angle flexion on your knee (This is required for normal walking and stair climbing.)

Weeks 7 to 11

At weeks 7 to 11 you should be well on the road to recovery. You may be able to walk a couple of miles with no assistance of assistive devices. You should also be able to do some activities such as shopping, housekeeping, and driving. Your PT will monitor your exercises and adjust them as necessary. These exercises include:

• Hip abductions
• Raising your heel and toes
• Partial knee bending
• Bicycle riding
• Step-ups
• Balancing the legs by standing on one leg at a time

This period is very crucial for your long-term success after knee replacement surgery. Your commitment to rehabilitation and exercises will play a key role in how quickly you return to your normal lifestyle and how well you can use your knee in the future.

Week 11 goals:

• You should have much-improved knee motion of more than 115 degrees.
• You can walk with less pain and stiffness.
• You have a strong knee.
• You should try to begin or return to activities such as walking, riding a bike, and swimming.

Week 12

At week 12, you should be up and really ready for activities such as swimming, dancing, bike riding, and walking long distances. You should continue with all the exercises prescribed by your PT. However, you should still avoid activities that could damage your implants such as skiing, aerobics, football, running, and too much cycling. At week 12, you will have no pain in your knee.

Week 12 goals:

• There should be no flexion loss.
• You should have ongoing contact with your doctor.
• You have less pain or no pain when doing normal activities.

Bottom Line

Your recovery after knee replacement surgery requires your commitment. If you have followed your PT's instructions well, then you will have seen a wonderful improvement by the end of week 12. By that time, your knee should no longer be feeling any pain, and you should be performing your day-to-day activities without any problem. You will feel almost 100 percent recovered after one year. While every person is different and recovery periods may vary, it doesn't hurt to aim and work for a swift return to normal.