What to expect from total knee replacement surgery

A knee replacement is a big, but life-changing surgery. It is completely normal to feel overwhelmed and nervous about the operation and what’s to follow. Here we outline what you can expect during your hospital stay, the rehabilitation stages and how long recovery will take.

Remember, everyone is different, and your experience and recovery won’t necessarily be the same as someone else who has also had a knee replacement. If at any stage during this process you are worried about your recovery or have additional questions, please don’t hesitate to contact us so that we can help you or put your mind at ease.

Before the operation

We will explain everything you need to know to you, in detail, before your operation. We will ask you to stop taking your blood thinners about five days before the surgery. You will also need to stop taking supplements like Omegas and St John’s Wort, as these can cause bleeding.

Day 0: The operation

This is the day of your knee replacement operation and it’s completely normal to feel nervous. The total time that you will spend in theatre is typically between 2 – 2,5 hours long.

The anaesthetist will discuss the type of anaesthetic you will have before the surgery. Most patients will receive a spinal anaesthetic with a light general anaesthetic.

You will receive a catheter which is normally removed relatively soon after the operation.

We will contact your relatives to let them know how the surgery went as soon as you’re out of theatre and on your way to the recovery room.

When you wake up, you will have thick bandages on your knee that will remain in place for the first 24 hours.

If your surgery was in the morning, a physiotherapist will get you up on your feet that same afternoon. If the surgery took place in the afternoon, this will be done the following morning. The physio will teach you to walk with crutches, provided that your pain is under control.

We provide medication to prevent significant pain, so you should only feel discomfort and not pain. It’s important that you take the medication offered to you in hospital to prevent breakthrough pain, as that takes time to get under control and will limit the speed at which you’re able to mobilise.

Day 1

The day after surgery, we will remove the thick bandages. As we’ve already mentioned, you should not have pain after the operation. You will have discomfort, and this will be at its worst during the first 24 – 48 hours after the surgery. You will be offered pain medication regularly, which we encourage you to take.

The physiotherapist will see you twice in the morning. If you are a candidate for rapid discharge, you will be discharged on this day. If not, the physio will see you again in the afternoon and you will be discharged the following morning (on day 3). Most of our patients are discharged on day 2 or 3.

Before we can discharge you, you need to be able to move around safely on crutches, be able to straighten your leg (have full extension) and be able to do a straight lift raise off the bed. The physio will also make sure you know how to walk safely up and down stairs. There is no reason not to climb stairs immediately after your surgery.

Back at home

You will have a lot of medication at the beginning. It’s vital that you maintain a strict schedule for taking your medication once you are home. We will give you a tick sheet to help you keep track of which medicines you take, when. This will help you (and us) to manage your pain. We recommend that you do not wean yourself off the pain medication until after the first 3 – 4 days.

We avoid prescribing opioid medication to our patients. However, some of the medication that we prescribe can be addictive. Because you’ll be using them for a short period, it’s unlikely that they will remain addictive. Please speak to us before your surgery if you have any concerns about certain types of medication.

We often give patients a light sleeping tablet to take for the first few days after the operation to make sure they rest well to aid in recovery.

You will have a waterproof dressing placed on your knee before you’re discharged. You will be able to shower at home, with this dressing on, but you won’t be able to bath. The dressing should remain dry and white. If you notice blood soaking the white cotton pad, please contact us.

Your operated knee and even your leg might swell. This is normal, provided you don’t experience significant discomfort. The swelling can last for anything from 2 – 12 weeks. You may also have bruising, which will settle.

It is normal for your operated knee to feel warm for up to 6 – 8 weeks. If the warmth is bothering you, you can put ice on the wound (above the dressing). A bag of frozen peas works well because it moulds to the knee.

Some people have a numb area on the inside of their leg or around the knee after the operations. This is because of damage to the superficial nerves. It’s nothing to be concerned about and those nerves will either regenerate with time or you will get used to the numbness.

The length of time that you will have to use crutches for varies from person to person. You will have to use crutches for 2 – 4 weeks, or until you are confident to walk without them.

Please contact us if you are worried about anything related to your recovery.

Two weeks post-operation: check up

Two weeks after your surgery, we will see you for a check up consultation.

During this appointment, we will make sure that your wound looks good. If the wound has healed well by 2 weeks, your chance of getting an infection drastically decreases. We may put some micropore adhesive tape over the wound to stabilise the scar and help to make it smaller and neater.

By this time your pain should be under control, and you should have stopped taking the strongest pain medication. You could possibly still have some discomfort and may take a simple analgesia and an occasional anti-inflammatory. You will have to continue taking blood thinners.

It is crucial that by two weeks post-operation you have good extension, that your leg can bend to around 90 degrees and that you are able to walk comfortably without crutches. However, if you walk with a limp without crutches, we would prefer for you to continue using the crutches for a while.

Your outpatient physiotherapy can start at two weeks to aid with confidence and ensure that your gait pattern is normal. The physio will give you exercises that you must do regularly to help your recovery.

Weeks 2 – 6

Between weeks 2 and 6 your confidence in your ability to move around should improve drastically. You should be able to move more efficiently, too. For example, you don’t necessarily have to be able to walk 5km, but you should be able to walk a short distance in a quicker time than before.

During this time, you need to focus on getting the leg straight and bending the leg more. You should be able to bend the operated knee more than 115 – 120 degrees by 6 weeks.

You can sleep on either side, but most people find it more comfortable to sleep on their back.

Most people should be able to return to work at 4 – 6 weeks post-surgery.

You can start driving again when you can walk around your vehicle without any assistance, including without crutches. You also need to be able to perform an emergency brake.

If you drive an automatic car and surgery was on your left knee, you should be able to drive after 2 – 4 weeks, provided you are walking comfortably and have minimal discomfort. Unfortunately, if you have a right-sided knee replacement, you need to wait until 6 weeks to drive an automatic or manual vehicle.

Six weeks post operation: check up

You will have another appointment with us 6 weeks post-operatively. At this check up, we will see how you are progressing and whether you need any additional help with your recovery.

If you are unable to walk well or to bend and straighten your knee as well as we expect you to, we will step up your physiotherapy programme and ask to see you for another check-up after an additional 6 weeks.

If we are happy with you progress, we will only see you again 6-months post-operatively.

Weeks 6 – 10

At around 6 weeks post-operatively, your wound may become red and a little bit swollen and irritable. This is usually because of the stitches that are dissolving. If you are concerned though, please contact us.

During this time, you should be able to walk more freely and your swelling should be settling – which means your chance of developing a clot decreases. You should also be able to walk up and down stairs confidently.

Once again, it’s important to continue doing the strengthening exercises from the physio. These exercises won’t only focus on the knee and muscles around the knee, but also on your glutes and muscles around your hips. If you don’t do these exercises, you may begin to experience weakness, knee imbalances, pain and discomfort.

Set yourself walking goals so that you gradually do more each day. For example, you may want to increase your step count by a certain amount each day or achieve a fixed distance in a shorter amount of time. From 6 weeks, you can also cycle on a stationary bike to aid with knee flexion.

Remember that your knee and the muscles around your knee need to get fit again after being inactive for a while. It’s normal for the knee to feel stiff, a bit swollen, or uncomfortable if you did a lot the previous day. Having regular goals can help prevent you from overexerting yourself.

Weeks 10 – 12

Most people can return to hiking, walking, and playing golf and bowls between weeks 10 – 12. You may still experience some discomfort in your operated knee the day after doing these activities.

If, at 3 months (12 weeks) post-operation, you have been relatively problem-free, there’s an 80 – 85% chance that your knee replacement will last for 20 years or more.

Months 3 – 12

Many people are able to return to their usual activities anytime from about 8 weeks onwards, but it’s important to start off slowly.

A full recovery takes anything between 6 – 12 months. This will be when the knee is strong, functioning well, and there are days when you completely forget about it. Please remember that different people recover at different speeds, and you cannot compare your recovery to someone else.

We will see you for another check-up 6 months after your surgery. If you are doing well, then we won’t need to see you again unless you have any concerns.

Other things to take note of

Kneeling

There’s no reason not to kneel after your knee replacement. However, some people do find it difficult to kneel after their surgery. To overcome this, you can use a high-density kneeling cushion, such as a Knee Pal. You can also gradually increase the duration of your kneeling to build an exercise tolerance.

Medication and side-effects

You may experience side-effects from the medication you are prescribed after your surgery. The most prominent of these is constipation.

Getting in and out of bed

In the initial period after your operation, you may find it easier to get in and out of bed by leaning towards the unoperated side.

Dental work

If you are going to have dental work done, you will need to take antibiotics before and after the procedure to decrease your risk of developing an infection. You will need to do this for the rest of your life.

Flying

You won’t be able to take short haul flights of less than 2 hours for at least the first 4 weeks. Long flights should be avoided for 3 – 6 months post-operatively.

Should you take a flight, we will put you on an anti-coagulant for a short period before and after the flight to decrease your risk of developing deep vein thrombosis or a clot.

High impact activities

We recommend avoiding high-impact activities until at least 4 – 6 months post-operatively and until you feel confident. Many people will struggle with high impact activities such as running and playing soccer, after their knee replacement.

While there’s no evidence to suggest you shouldn’t do them, it’s important to remember that the implant is made from metal and plastic. Higher impact activities could potentially damage and knee and surrounding structures, affecting the longevity of the implant.

Knee versus hip replacements

Remember, everyone is different, and your experience and recovery won’t necessarily be the same as someone else who has also had a knee replacement. Also note that knee and hip replacements are two very different procedures and cannot be compared. Hip replacements are more stable, the patients experience less pain, and they recover much quicker than those with a knee replacement.

Please remember, that if you are concerned about anything at all, phone us or come and see us. You are not alone on this journey!