Knee Replacement FAQs
Everyone heals from their surgery at a different pace. In most cases, however, you will be restricted to using a walker or crutches for 1 month after your operation. You will then be allowed to advance to a cane outdoors and no support around the house for several weeks. You will gradually return to normal function without any assistive devices. You will use an assistive device until you can walk without a limp. This usually takes about 3 months, but may take longer. There may be continued improvement in strength and endurance for 6 to 12 months after surgery.
Approximately 10 to 14 days post-operatively. This may be done by a visiting nurse (if you are at home) or rehabilitation staff (if you are at a rehabilitation facility).
Approximately 1 week or until there is no drainage from the incision. This should be changed daily to a new dry, sterile gauze. If desired, you may continue to wear a bandage to protect the incision from irritation (clothing, compression stockings, etc.).
If your surgeon orders a knee immobilizer, it should be worn when sleeping and walking, until you are able to independently perform a straight leg raise. Most patients only use this for about 1 week post-operatively. However, if you wish to wear it for comfort, you may also use it a night for several weeks.
3 days after you operation, if no drainage is present at the incision. Initially, try to keep the incision dry with a plastic wrap. If it gets wet, pat it dry.
You should not submerge your knee under water before the staples are removed. Check with your surgeon before swimming in a pool or ocean.
You will likely require some form of pain medication for about 3 months. Initially you will be on a strong oral pain medication (such as a narcotic). Most people are able to wean off of their strong pain medication after 1 month and are able to switch to an over-the-counter pain medication (such as Tylenol or ibuprofen). If you are on Coumadin (warfarin) or Lovenox, avoid taking any NSAIDs (e.g. aspirin, ibuprofen, Advil, Motrin, Aleve, Naprosyn).
Yes! The physical therapist plays a very important role in your recovery. You will see a physical therapist soon after your operation and throughout your stay at the hospital. If you go home, you will likely have a therapist come to visit you (usually 2-3 times a week). Sometimes, you will be referred to an outpatient physical therapist. If you go to a rehabilitation hospital, you will receive therapy there. Your therapist will help you walk, regain motion, build strength and help you reach you post-operative goals. Your therapist will keep your surgeon informed of your progress.
If you have been given a CPM, you will use it about 6 hours per day. This may be divided any way you wish. For example, you can use it 3 times a day for 2 hours. The setting for flexion (bending the knee) can be increased daily as tolerated. Generally you can discontinue the CPM when you can bend your knee greater than 90°. Usually that is 2 weeks after surgery.
You should spend some time each day working on straightening your knee (extension) as well as bending your knee (flexion). A good way to work on extension is to place a towel roll underneath your ankle when you are lying down. A good way to work on flexion is to sit on a chair or stationary bicycle and bend your knee. Avoid using a pillow or towel roll behind the knee for any length of time.
Generally not for the first 2 months. However, as everyone’s strength varies, consult with your physical therapist before using weights. Use light weights to begin with, and focus on good technique and repetition.
Typically, you will be on a “blood thinner” to help prevent blood clots. You might stay on “blood thinner” for 4 to 6 weeks or switch over to aspirin. This will be decided prior to your discharge from the hospital. If you are on aspirin, you will be on this for 12 weeks. You may consider talking to your internist about the benefits of continuing aspirin after 12 weeks.
4 weeks is usually sufficient. These supplements help your body replenish its iron stores which may be depleted postoperatively.
It is very common to have constipation postoperatively. This may be due to a variety of factors, but is especially common when taking narcotic pain medication. A simple over-the-counter stool softener (such as Colace) is the best prevention for this problem. In rare instances, you may require a suppository or enema.
If you had surgery on your right knee, you should not drive for at least 1 month. After 1 month, you may return to driving as you feel comfortable. If you had surgery on your left knee, you may return to driving as you feel comfortable as long as you have an automatic transmission. DO NOT DRIVE IF TAKING NARCOTICS! Some surgeons do not allow their patients to drive until after they have been seen in the office at 4-6 weeks after surgery. Check with your surgeon.
This depends on your profession. Typically, if your work is primarily sedentary, you may return after approximately 1 to 2 months. If your work is more rigorous, you may require up to 3 or 4 months before you can return to full duty. In some cases, more time may be necessary.
You may travel as soon as you feel comfortable. It is recommended that you get up to stretch or walk at least once an hour when taking long trips. This is important to help prevent blood clots. During the first 2 months after surgery, you should not travel for extended periods as that would interfere with your physical therapy.
You may set off the machines at airport security depending on the type of knee implant you have and the sensitivity of the security checkpoint equipment. At your follow-up visit you may ask to have a wallet card to carry with you for travel.
You may return to most activities as tolerated. Some of the best activities to help with motion and strengthening are swimming and a stationary bicycle. Check with your surgeon before returning to any strenuous activity.
You should avoid impact activities such as running, downhill skiing, and vigorous racquet sports such as singles tennis or squash. Some surgeons allow more vigorous activities. Check with your surgeon.
Yes, as soon as you are comfortable.
If you are on Coumadin, avoid alcohol intake. Otherwise use in moderation at your own discretion. You should also avoid alcohol if you are taking narcotics or other medications.
These should be used for the first few weeks in order to help reduce swelling and improve circulation. You may wear them longer, especially if you find that your ankles swell without them. They should be worn while out of bed and removed for sleeping.
Ice should be used for the first several weeks, particularly if you have a lot of swelling or discomfort. Some surgeons allow the use of heat once the initial swelling has decreased. Check with your surgeon.
After 2 months, you may try to kneel. Although this may be uncomfortable initially, you will not injure your knee replacement by kneeling. Most people find the more you kneel, the easier it gets. You may find it more comfortable to use a kneeling pad.
Yes. Initially, you will lead with your non-operated leg when going up stairs and lead with your operated leg when going down stairs. As your leg gets stronger, you will be able to perform stairs in a more regular pattern (about 1 month).
Most people require 70° of flexion (bending the knee) to walk on level ground, 90° to ascend stairs, 100° to descend stairs, and 105° to get out of a low chair. Your knee should also come to within 10° of being fully straight to function well.
Everyone’s range of motion (ROM) varies and depends on individual factors. Your potential will be determined at the time of your surgery. In most cases, you will have at least 90° of flexion and full extension by 6 weeks. At 1 year, you may have up to 125° of flexion, but 105 to 110° is usually satisfactory. The more you are restricted in range of motion prior to surgery, the greater the chance for continued knee stiffness after surgery.
For the large majority of cases, your leg length will be essentially unchanged. In rare cases, however, you may notice a change in leg length. This is more common when a severe deformity of the knee exists before surgery. At first, this may feel awkward. However, you will gradually become accustomed to your new knee and leg length. Occasionally, a shoe lift may be prescribed for you.
Yes. You will be given a letter explaining this in detail at your first follow-up visit. Avoid any dental cleaning or non-urgent procedures for 6 weeks postoperatively.
It is not uncommon to have feelings of depression after your knee replacement. This may be due to a variety of factors such as limited mobility, discomfort, increased dependency on others, and/or medication side effects. Feelings of depression will typically fade as you begin to return to your regular activities. If your feelings of depression persist, consult your internist.
This is a very common complaint following knee replacement surgery. Non-prescription remedies such as Benadryl or melatonin may be effective. If this continues to be a problem, medication may be prescribed for you.
This varies from patient to patient. For each year following your knee replacement, you have a 1% chance of requiring additional surgery. For example, at 10 years postoperatively, there is a 90% success rate.
Follow-up appointments should be made postoperatively at 4-6 weeks, 1 year, 2 years, 5 years, 7 years, and 10 years.
- Clicking noise with knee motion
- Skin numbness on the outer (lateral) part of your knee
- Swelling around the knee and/or lower leg
- Warmth around the knee
- “Pins and needles” feeling at or near the incision
- Dark or red incision line
- Bumps under the skin along the incision. Occasionally, the sutures used to close the wound can be felt
- Increased bruising if on Coumadin
(Call the office immediately if you experience any of these)
- Increasing redness, particularly spreading from the incision
- Increasing pain and swelling
- Fevers (>101° F)
- Persistent drainage from your wound
- Calf swelling or pain, particularly associated with ankle motion
- Ankle swelling that does not decrease or resolve overnight
- Bleeding gums or blood in urine/stool
You will be instructed by your physical therapist on appropriate exercises and given a list to follow. In general, swimming and a stationary bicycle are good exercise options. These exercises should be continued indefinitely even after your recovery is complete.
It depends. Many people are able to go home after their operation. However, you may go to a rehabilitation facility in order to gain the skills you need to safely return home. Many factors will be considered in this decision. These include: availability of family or friends to assist with daily activities, home environment, safety considerations, post-operative functional status as evaluated by a physical therapist in the hospital, and overall evaluation by your hospital team.