Recommendations for Patients After Total Knee Replacement Surgery

If your knee joint is severely affected by arthritis or an injury, it may limit your physical activity, such as walking or climbing stairs. You may even feel pain at rest.

If medications, reduced physical activity, and the use of walking aids no longer help, total knee replacement surgery (arthroplasty) may be considered. This procedure can relieve pain, correct limb deformity, and restore normal physical activity.

One of the most significant achievements in 20th-century orthopedics, total knee replacement was first performed in 1968. Advances in surgical materials and techniques have greatly improved the effectiveness of this procedure. In the United States, approximately 300,000 of these surgeries are performed annually.

What Changes After Total Knee Replacement?

Understanding what to expect without surgery—and what surgery can provide—is important in making your decision.

More than 90% of people who undergo this procedure experience complete pain relief and improved mobility, allowing them to return to a normal, active lifestyle. However, total knee replacement cannot restore more function than what was possible before arthritis developed.

After surgery, you should avoid certain movements and sports, including running and contact sports.

Even with normal use, the components of the prosthesis—especially the polyethylene liner—will wear down. Excessive load on the joint or excess weight may accelerate wear, leading to instability and pain. With proper use, the prosthesis can last for many years.

Activities After Surgery:

Dangerous activities: running, jumping, contact sports, high-impact aerobics.
Excessive activity: long or exhausting walks, playing tennis, lifting more than 25 kg.
Allowed activities: light walking, swimming, golf, driving, light hiking, ballroom dancing, climbing short flights of stairs.

HOME RECOMMENDATIONS

Some tips to make returning home and rehabilitation easier:

Secure grab bars in the bathroom and shower.
Handrails along stairs.
A stable chair with a firm, high seat, strong backrest, armrests, and footrest.
A raised toilet seat.
A stable shower bench or chair.
Remove loose rugs and electrical cords from walkways.

THE SURGERY

You will be admitted to the clinic before surgery and examined by an anesthesiologist. Common types of anesthesia for total knee replacement include:

General anesthesia (you will be asleep and on a ventilator)
Spinal or epidural anesthesia (you will be awake but numb from the waist down)

The anesthesiologist will discuss the pros and cons with you.

The surgery takes about two hours. The damaged cartilage and part of the bone are removed, and metal and plastic components are inserted to restore joint alignment and function.

The prosthesis usually includes three parts:

Femoral component (polished durable metal)
Tibial component (strong plastic on a metal base)
Patellar component (also plastic)

After surgery, once fully awake, you’ll be moved to your room. You’ll stay in the clinic for several days.

You will feel pain initially—painkillers will be provided. Walking and gentle exercises will begin soon after surgery to support recovery. You will also be encouraged to breathe deeply and cough often to prevent lung complications.

To prevent blood clots and swelling, your surgeon may recommend elastic bandages, compression stockings, and anticoagulants.

Foot and ankle exercises will help improve circulation and reduce swelling and clot risk. Many patients begin knee exercises the day after surgery. A physical therapist will teach you special exercises to help strengthen your knee and restore movement.

POSSIBLE POST-OPERATIVE COMPLICATIONS

The risk of complications is low.

Serious complications, such as joint infection, occur in less than 2% of cases. Heart attack or stroke is even rarer. However, chronic conditions can increase the risk. Although rare, complications can delay your recovery.

Deep vein thrombosis (DVT) in the thigh or pelvis is the most common complication. Your surgeon will take preventive measures, including elastic stockings, exercises, and anticoagulants.

Despite advancements, prosthesis components may wear out over time, or fixation may loosen. In rare cases, major blood vessels or nerves around the knee may be damaged during surgery.

RETURNING HOME

Success largely depends on how carefully you follow post-op instructions in the first few weeks.

Wound care: Your incision may have staples, sutures, or internal stitches. Staples or stitches will be removed about two weeks post-op; internal stitches do not require removal.
Avoid getting the wound wet until fully sealed. You may use a special bandage to prevent irritation from clothing or compression stockings.

Diet: Appetite may decrease for a few weeks. A balanced, iron-rich diet and adequate fluid intake aid healing.

Activity: Exercise is key in your home rehab. You should return to normal activity within 3–6 weeks. Expect some discomfort with movement and at night.

Your rehab program should include:

Gradual increase in walking distance (indoors then outdoors)
Practicing key movements like sitting, standing, and climbing stairs
Returning to basic household chores
Daily exercises for mobility and strength
Possible in-home physical therapy

Driving is possible once the leg is strong and flexible enough to operate pedals—usually 4–6 weeks after surgery.

PREVENTING COMPLICATIONS

Blood clot prevention: Follow medical instructions closely.

Signs of clots:

Pain in the calf not related to the incision
Tenderness, swelling, or redness at the back of the leg
Swelling in the thigh, calf, ankle, or foot

Signs of embolism:

Sudden shortness of breath
Sharp chest pain, especially with deep breathing or coughing

Contact your doctor immediately if these occur!

Infection prevention:

Bacteria can enter the bloodstream during dental work, urinary or skin infections, and infect the joint space.

For two years after surgery, you may need preventive antibiotics before dental or surgical procedures.

Watch for:

Persistent fever over 37°C (98.6°F)
Chills or sweating
Increasing redness, swelling, or pain around the wound
Drainage from the incision
Increased pain at rest or during activity

Preventing falls:

Falls can damage the implant and require additional surgery. Be especially cautious on stairs. Use crutches, walkers, canes, handrails, or other supports until the joint regains strength and mobility.

Your surgeon or therapist will advise when and how to stop using assistive devices.

ABOUT YOUR NEW KNEE

You may feel numbness around the scar. Flexion might be limited. Full range of motion isn’t always restored.

Metal detectors at airports or other facilities may react to your implant. Inform security that you have a metal implant. Ask your surgeon for a note confirming your knee replacement.

After surgery, you should:

Participate in rehab programs to maintain joint mobility and stability
Follow fall-prevention and injury guidelines
Inform your dentist about the surgery—antibiotics may be needed before dental work for two years or more
See your surgeon periodically for exams and X-rays—even if the knee feels fine

EXERCISES

Consistent exercise is vital for recovery. Orthopedists and physical therapists usually recommend:

20–30 minutes of exercises, 2–3 times a day
30-minute walks, 2–3 times a day

Examples of early post-op exercises:

Quadriceps contraction: Tighten thigh muscles, try to straighten the knee and lift the leg. Hold for 5–10 seconds, repeat 10 times every 2 minutes. Rest and repeat.
Leg raises while sitting: Keep knee straight. Do until fully extended.
Ankle pumps: Slowly flex and extend the ankle every 5–10 minutes. Start immediately post-op and continue until full recovery.
Knee straightening: Place a small roll under the ankle so the heel is elevated. Contract the thigh muscle. Hold knee straight for 5–10 seconds, then relax.
Knee bending (bed-supported): Slide your heel toward the buttock to bend the knee as much as possible. Hold 5–10 seconds, then straighten.

EARLY WALKING

You’ll begin walking short distances and caring for yourself soon after surgery. This helps strengthen muscles and restore motion.

With walker or full weight-bearing: Stand upright, place weight on walker/crutches. Move walker forward, step with operated leg touching the floor. Rest it on the floor, then lift it slightly. Step forward again.
With cane/crutches: Use for a few weeks. Hold cane in the hand opposite the operated knee. Transition to a cane when you can balance and bear weight equally.

Stairs:

Climbing stairs requires flexibility and strength. Use handrails. Step up with the healthy leg first. When going down, lead with the operated leg.