Author: Prof. N. Reha Tandoğan, MD
Total Knee Replacement is a very successful operation if performed properly. However, you should remember that the recovery period is long and the progress is gradual. Here are a few things you should know about your recovery.
Pain and stiffness
Your knee will feel slightly warm and stiff, especially in the mornings up to 6 months. Cold packs are helpful for the pain in the first 3 weeks. Your surgeon will prescribe a set of different painkillers (called multi-modal analgesia) to control your pain. A moderate amount of pain, especially at night is expected in the first month, but will get better gradually. Depending on your pain threshold, you might need regular pain medications up to 2 months after surgery. A small amount of swelling in the operated leg is expected in the first few days, this should resolve with placing a pillow under your leg and using anti-embolic stockings.
Walking and stair climbing
Walking on an even surface is possible after your discharge from hospital, however you should not overdo it. Remember you just had an operation and your knee needs to recover. Limit your walking distance to 20 minutes in the first 1-2 months then increase this as you progress without pain and swelling. Stair climbing will get better every month; however you should use rails to prevent falls. Start stair climbing one step at a time and move on to normal stair climbing once your operated leg feels stable. You might need a walking aid such as a cane or walker in the first few weeks, especially if you have a bilateral (both knees replaced during the same operation) knee replacement.
Your knee range of motion will improve in time. The most important gains in knee motion are in the first 3 weeks, however your motion will improve up to one year while the soft tissues adapt to your new knee. It is essential that you perform your prescribed exercises, even when you have slight pain in the early weeks after surgery. This is important, since it is difficult correct limited motion of the knee after six weeks. If your surgeon is not satisfied with your knee motion at 6 weeks, he might advise a procedure called “manipulation under anesthesia” in which your doctor overcomes the adhesions and restores your knee motion under general anesthesia. Although your knee can bend to almost normal, squatting is not advised after knee replacement, since this might cause undue stress on the implant and shorten its life.
You should not worry if you cannot actively lift your leg in the first few weeks after surgery, your muscle strength will recover gradually. Physiotherapy with electrical stimulation and assisted exercises will be helpful to regain your muscle strength and balance.
Showering and wound care
Your surgeon will not discharge you until your surgical wound is dry and there is no bleeding or discharge. Small spots of blood in the wound dressing are normal in the first few days and usually no dressing changes are needed. Your surgeon might advise you to protect your dressing with a clingfilm during showering in the first few days. Usually, you can remove the dressing after 3 days and leave the wound open. Showering without protection is possible once the surgical wound is dry and clean. A slight redness and warmth around your scar and front of the knee is expected in the first few weeks, this should fade when you lift your leg above heart level. Bruising in the back of your leg than extends down to the ankle is normal and will resolve in a few weeks.
Swimming is possible after the first 3 weeks. Cycling and hiking are encouraged after total knee replacement once the knee has recovered in a few months. Running, impact sports such as soccer, volleyball, singles tennis and basketball may negatively impact the lifetime of your knee by increasing wear and are not advised. You should consult with your surgeon if you want to ski and play doubles tennis, this might be possible under certain conditions.
Contact your surgeon as soon as possible if..
There are several situations when you should contact your surgeon as soon as possible before your scheduled appointment:
- If you have a fever over 37.5 degrees Celsius (100 degrees Fahrenheit)
- If you have drainage of blood or pus from your wound
- If you have continuous pain even when taking full dose pain medication
- If you have shortness of breath and abnormal heart rhythm
- If you have blood in your urine or stool
- If you have severe swelling in your whole leg that does not resolve with elevating the leg.