Knee pain and function greatly improve during the first few weeks after knee replacement surgery. Significant improvements continue during weeks 4 through 6. By week 6, the majority of patients are off pain medications and have resumed their day-to-day routines.
To achieve this post-surgical success, knee replacement patients continue physical therapy, pain management, and avoidance of risky behaviors.
The ability to walk independently, straighten the knee, and adequately bend the knee will be physical therapy priorities during this time.
- Walking independently. Gradually, the patient will make the transition to walking independently, without a walker or assistive device. For example, a physical therapist may first encourage the patient to make short trips around the house without a walker. A patient may be advised to use a cane instead of a walker before transitioning to walking independently.
- Straightening and bending the knee. The physical therapy exercises assigned to the patient will gradually become more challenging. These exercises will continue to stretch and strengthen the quadriceps, hamstring, and calf muscles.
Special effort will be made to bend the knee to at least 120°. This degree of flexion allows a person to get in and out of car seats, low chairs, and sofas. (For reference, a full squat typically requires bending the knee to 140°. Deep squatting may not always be possible after knee replacement.)
Physical therapy appointments typically become less frequent after 2 weeks and generally stop 2 to 3 months after surgery.
In general, pain medications will be needed in lower doses and less often than they were in the first 2 or 3 weeks after knee replacement surgery. A doctor or pharmacist may recommend tapering opioid or other pain medications to avoid side effects.
Many people will be able to stop taking all pain medications before week 6. People who continue to need pain medications several weeks after surgery are advised to talk to their doctor about potential risks and side effects. For example, taking NSAIDs every day for an extended period of time may lead to gastrointestinal problems and increase the risk of stroke and heart problems. Medication alternatives may be available.
Returning to Everyday Activities
Surgeons may lift activity restrictions that were assigned during the first 4 weeks after knee replacement surgery. For example, patients may be given permission to use pools, baths, or hot tubs. A person should not do so until the surgeon tells them it is OK.
Similarly, a surgeon may give a patient permission to drive and ease back into activities that involve limited knee twisting, such as golf, gentle yoga, and dancing. This typically happens at the 6- to 8-week mark. For example, 8 weeks after surgery, a person used to playing 18 holes of golf may be given permission to start to work toward playing 9 holes.
Returning to work
The ability to return to work will depend on factors such as pain levels, medications being taken, stamina, and job requirements. If the employer allows, a person may return to work part-time before committing to a full-time schedule.