Dr. Tony Moya
Fellow of the American Academy of Orthopaedic Surgeons
http://orthodoc.aaos.org/TonyMoyaMD
South Florida Institute of Sports Medicine
Tony Moya, MD 17842 NW 2nd Street
Pembroke Pines , FL 33029 USA
Phone: 954-430-9901  | Fax: 954-430-0608
Copyright 2014 American Academy of Orthopaedic Surgeons
Activities After Knee Replacement

After undergoing knee replacement, you may expect your lifestyle to be a lot like it was before surgery—but without the pain. In many ways, you are right, but returning to your everyday activities takes time. Being an active participant in the healing process can help you get there sooner and ensure a more successful outcome.

Even though you will be able to resume most activities, you may have to avoid doing things that place excessive stress on your "new" knee, such as kneeling or participating in high-impact sports like jogging. The suggestions here will help you enjoy your new knee while you safely resume your daily activities.

Your Hospital Stay

Returning to your daily activities is a process that begins during the first few days you spend in the hospital after your procedure. Knee replacement is major surgery and, at first, you will want to just take it easy. It is important, however, that you start some activities immediately to help prevent complications and begin healing.

Pain Management

Proper pain management is important in early recovery. When you feel less pain, you can start moving sooner and get your strength back more quickly.

Pain after surgery varies from person to person. While you can expect to feel some discomfort, it can be managed with medication. During your stay in the hospital, your pain medication may be provided in different forms:

  • Oral (pill form);
  • Intravenous (IV) tube;
  • Patient-controlled anesthesia (PCA), which allows you to press a button to release a small amount of medicine through an IV tube when you begin to feel pain.

Remember that it is easier to control pain if you address it before it gets too severe. After a day or two, oral medication will completely replace intravenous medication.

Decreased appetite, nausea, and constipation are common side effects from pain medication and anesthesia. You may experience these symptoms for several days after surgery, but they will generally improve with time. If needed, your doctor will provide stool softeners and anti-nausea medication. Moving and walking will also help decrease these symptoms.

Additional Postoperative Care

In addition to pain management, there will be other medical interventions in the hospital that affect your early recovery.

  • During the operation, a urinary catheter may be placed to help empty your bladder after surgery. The catheter is usually removed within 24 hours.
  • Initially, you may have a dressing on the incision and a drain to remove any fluid build-up around the knee. The drain will be removed in a day or two.
  • You will be given breathing exercises to prevent congestion from developing in your chest and lungs.

Preventing Complications

Although the complication rate after knee replacement surgery is low, when complications occur they can prolong or limit full recovery. The complications most likely to occur include infection and blood clots. Your doctor and healthcare team will take several measures to prevent these complications.

  • Infection. An infection may occur in the wound or deep around the implant. Because of this risk, antibiotics are given within one hour of the start of surgery (usually once in the operating room) and continued for 24 hours following the procedure.
  • Blood clots. Surgery and postoperative immobility increase the risk of blood clots forming in your legs. These blood clots can cause pain and swelling, and may be life threatening if they travel to your lungs. There are several measures your doctor may prescribe to prevent blood clots, including:
    • Blood-thinners;
    • Early movement—Even while in bed, you can pedal your feet and pump your ankles regularly to keep blood flowing in your legs;
    • Elastic hose support stockings and/or pneumatic compression sleeves (a pneumatic compression sleeve inflates and deflates in order to help keep the blood flowing in your legs).

Physical Therapy

A physical therapist will visit you shortly after your surgery and begin teaching you how to use your new knee. If you had considerable pain in your knee before surgery, you may have cut back on your activities and your leg muscles may have become weak. Physical therapy will help you build up strength in your quadriceps (thigh muscles) to develop control of your new joint.

You may be fitted with a continuous passive motion (CPM) exercise machine that will slowly and smoothly straighten and bend your knee. This will prevent stiffness in the joint and increase range of motion.

Hospital Discharge

Your hospital stay will typically last from 1 to 4 days, depending on the speed of your recovery. Before you are discharged from the hospital, you will need to accomplish several goals, such as:

  • Getting in and out of bed by yourself.
  • Having acceptable pain control.
  • Being able to eat, drink, and use the bathroom.
  • Walking with an assistive device (a cane, walker, or crutches) on a level surface and being able to climb up and down two or three stairs
  • Being able to perform the prescribed home exercises.
  • Understanding any knee precautions you may have been given to prevent injury and ensure proper healing.

If you are not able to accomplish these goals, it may be unsafe for you to go directly home after discharge. If this is the case, you may be temporarily transferred to a rehabilitation or skilled nursing center.

When you are discharged, your healthcare team will provide you with information to support your recovery at home. They will discuss possible complications, and review with you the warning signs of an infection or a blood clot.

Warning Signs of Infection

  • Persistent fever (higher than 100 degrees)
  • Shaking chills
  • Increasing redness, tenderness or swelling of your wound
  • Drainage of your wound
  • Increasing pain with both activity and rest

Warning Signs of a Blood Clot

  • Pain in your leg or calf unrelated to your incision
  • Tenderness or redness above or below your knee
  • Increasing swelling of your calf, ankle or foot

Signs that a blood clot has traveled to your lungs include:

  • Shortness of breath
  • Sudden onset of chest pain
  • Localized chest pain with coughing

Notify your doctor if you develop any of the above signs.

Recovery at Home

You will need some help at home for several days to several weeks after discharge. Before your surgery, arrange for a friend, family member or caregiver to provide help at home.

Preparing Your Home

The following tips can make your homecoming more comfortable, and can be addressed before your surgery:

  • Rearrange furniture so you can maneuver with a cane, walker, or crutches. You may temporarily change rooms (make the living room your bedroom, for example) to avoid using the stairs.
  • Remove any throw rugs or area rugs that could cause you to slip. Securely fasten electrical cords around the perimeter of the room.
  • Get a good chair—one that is firm with a higher-than-average seat and has a footstool for intermittent leg elevation.
  • Install a shower chair, gripping bar, and raised toilet seat in the bathroom.
  • Use assistive devices such as a long-handled shoehorn, a long-handled sponge, and a grabbing tool or reacher to avoid bending over too far.

Wound Care

During your recovery at home, follow these guidelines to take care of your wound and prevent infection:

  • Keep the wound area clean and dry. A dressing will be applied in the hospital and should be changed as necessary. Ask for instructions on how to change the dressing before you leave the hospital.
  • Follow your doctor's instructions on how long to wait before you shower or bathe.
  • Notify your doctor immediately if the wound appears red or begins to drain. This could be a sign of infection.

Swelling

Mild to moderate swelling is normal for the first 3 to 6 months after surgery. To reduce swelling, elevate your leg slightly and apply ice. Wearing compression stockings may also help reduce swelling. Notify your doctor if you experience new or severe swelling, since this may be the warning sign of a blood clot.

Medication

Take all medications as directed by your doctor. Home medications may include narcotic and non-narcotic pain pills, oral or injectable blood thinners, stool softeners, and anti-nausea medications.

Be sure to talk to your doctor about all your medications—even over-the-counter drugs, supplements and vitamins. Your doctor will tell you which over-the-counter medicines are safe to take while using prescription pain medication.

It is especially important to prevent any bacterial infections from developing in your artificial joint. Your doctor may advise you to take antibiotics whenever there is the increased possibility of a bacterial infection, such as when you have dental work performed. Be sure to talk to your doctor before you have any dental work done and notify your dentist that you have had a knee replacement. You may also wish to carry a medical alert card so that, if an emergency arises, medical personnel will know that you have an artificial joint.

Diet

By the time you go home from the hospital, you should be eating a normal diet. Your doctor may recommend that you take iron and vitamin C supplements. You may also be advised to avoid supplements that include vitamin K and foods rich in vitamin K if you taking certain blood thinner medications, such as warfarin (Coumadin). Foods rich in vitamin K include broccoli, cauliflower, brussel sprouts, liver, green beans, garbanzo beans, lentils, soybeans, soybean oil, spinach, kale, lettuce, turnip greens, cabbage, and onions.

Continue to drink plenty of fluids, but try to limit coffee intake and avoid alcohol. You should continue to watch your weight to avoid putting more stress on the joint.

Resuming Normal Activities

Once you get home, you should stay active. The key is to not do too much, too soon. While you can expect some good days and some bad days, you should notice a gradual improvement over time. Generally, the following guidelines will apply:

Driving

In most cases, it is safe to resume driving when you are no longer taking narcotic pain medication, and when your strength and reflexes have returned to a more normal state. Your doctor will help you determine when it is safe to resume driving.

Sexual Activity

Please consult your doctor about how soon you can safely resume sexual activity. Depending on your condition, you may be able to resume sexual activity within several weeks after surgery.

Sleeping Positions

You can safely sleep on your back, on either side, or on your stomach.

Return to Work

Depending on the type of activities you do on the job and the speed of your recovery, it may be several weeks before you are able to return to work. Your doctor will advise you when it is safe to resume your normal work activities.

Sports and Exercise

Continue to do the exercises prescribed by your physical therapist for at least 2 months after surgery. In some cases, your doctor may recommend riding a stationary bicycle to help maintain muscle tone and keep your knee flexible. When riding, try to achieve the maximum degree of bending and straightening possible.

As soon as your doctor gives you the go-ahead, you can return to many of the sports activities you enjoyed before your knee replacement.

  • Walk as much as you would like, but remember that walking is no substitute for the exercises prescribed by your doctor and physical therapist.
  • Swimming is an excellent low-impact activity after a total knee replacement; you can begin as soon as the sutures have been removed and the wound is healed.
  • In general, lower impact fitness activities such as golfing, bicycling, and light tennis will help increase the longevity of your knee and are preferable over high-impact activities such as jogging, racquetball and skiing.

Air Travel

Pressure changes and immobility may cause your knee joint to swell, especially if it is just healing. Ask your doctor before you travel on an airplane. When going through security, be aware that the sensitivity of metal detectors varies and your artificial joint may cause an alarm. Tell the screener about your artificial joint before going through the metal detector. You may also wish to carry a medical alert card to show to the airport screener.

Last reviewed: June 2014
AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS "Find an Orthopaedist" program on this website.
Copyright 2014 American Academy of Orthopaedic Surgeons
Related Articles
Arthritis of the Knee (http://orthoinfo.aaos.org/topic.cfm?topic=A00212)
Beyond Surgery Day: The Full Impact of Knee Replacement (http://anationinmotion.org/value/knee/)
Infections (http://orthoinfo.aaos.org/topic.cfm?topic=A00197)
Knee Replacement Exercise Guide (http://orthoinfo.aaos.org/topic.cfm?topic=A00301)
Total Knee Replacement (http://orthoinfo.aaos.org/topic.cfm?topic=A00389)
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