People who have knee replacement surgery will experience varying degrees of pain afterward. A person can take measures to help manage their pain after surgery.
This article discusses knee replacement surgery basics, including general postoperative expectations, how to manage swelling, pain, and bruising, realistic recovery timelines, rehabilitation exercises, and when to see a doctor.
After knee replacement surgery, most people stay in the recovery room for several hours for monitoring as the anesthesia wears off, and they wake up.
Once the person is fully conscious and stable for transfer, healthcare professionals will move them to a hospital room or, in some instances, discharge them.
How long someone stays in the hospital depends on several factors, including:
- overall health before the surgery
- additional medical conditions that may affect rehabilitation
However, most people spend 1–3 days in the hospital following knee replacement surgery.
Knee replacement surgery is not without pain, but the team of doctors and nurses uses a host of methods and medications to ensure that people are as comfortable as possible.
According to a 2019 article, healthcare professionals use a combination of treatments before, during, and after knee replacement surgery to control pain. They may refer to this approach, which includes various types of nerve blocks, local anesthetic injections, and pain medications, as multimodal analgesia. This treatment provides pain relief and helps reduce the length of a person’s stay in the hospital.
A team of orthopedic surgeons, nurses, physical therapists, case managers, and other healthcare professionals determines each person’s specific recovery plan and will explain it to them before they leave the hospital.
The healthcare team will provide a combination of medications that work together to reduce pain and limit swelling.
According to the American Academy of Orthopaedic Surgeons (AAOS), common management medications or procedures include:
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- acetaminophen (Tylenol)
- injections of local anesthetics directly into the joint during surgery
Healthcare providers may also prescribe opioids (narcotics) for short-term pain relief.
It is crucial to take opioids only as the doctor prescribed them and to stop taking them as soon as the pain is manageable with other medications.
Opioid addiction is a critical public health crisis in the United States that can cause serious health complications, including overdose and death.
The AAOS state that a person may experience swelling in the first few days or weeks after the surgery. A person can expect mild-to-moderate swelling for 3–6 months afterward.
Ice and elevation of the leg will help reduce swelling. People should apply a cloth-wrapped ice pack to the swollen area for 20 minutes every 3–4 hours when possible.
Gentle ankle and foot exercises after surgery may also help reduce swelling and the risk of blood clots.
To lower the risk of blood clots and swelling, doctors usually prescribe a blood thinner for a fixed period after surgery. Other devices that help reduce the likelihood of a blood clot after knee replacement surgery include compression boots (inflatable foot or leg coverings) and support (compression) stockings.
The AAOS state that performing knee exercises can speed recovery and help reduce postoperative pain.
Most people can begin to exercise the knee within hours of the surgery.
A physical therapist will go through specific exercises to help strengthen the knee and restore its movement. They may suggest performing exercises for 20–30 minutes at a time, two to three times a day, as well as walking for 30 minutes two or three times a day.
Physical therapy may be necessary for up to 3 months.
Examples of early postoperative exercises include:
Tighten the thigh muscle and try to straighten the knee. Hold this position for 5–10 seconds.
Straight leg raises
Tighten the thigh muscle with the knee fully straightened on the bed. Lift the leg a few inches off the bed and hold for 5–10 seconds. Lower the leg slowly.
Move the foot up and down using the calf and shin muscles.
Knee straightening exercises
Place a small rolled-up towel just above the heel, tighten the thigh, and attempt to straighten the knee fully so that the back of the knee touches the bed.
The AAOS state that most people can start doing some normal daily activities 3–6 weeks after surgery and start driving 4–6 weeks after surgery.
According to the American Association of Hip and Knee Surgeons (AAHKS), it can take 3 months to return to normal daily activities and 6 months to 1 year to recover fully.
After surgery, a person will need to focus on proper wound care and be careful to avoid falls and prevent infections.
A person should aim to keep the wound clean and dry and change any dressings as their surgeon has directed.
Although the advice of different surgeons may vary, the AAHKS recommend avoiding soaking the incision in water for 3–4 weeks after surgery or until it has properly healed.
People with waterproof dressings may be able to shower as soon as the day after surgery. People with standard (non-waterproof) dressings usually need to wait 5–7 days after surgery to shower.
However, it is important to follow the surgeon’s instructions on how long to wait before showering or bathing.
According to the AAOS, a common cause of infection is bacteria that enter the bloodstream during dental procedures or through a break in the skin. These bacteria can gather around the knee replacement, causing an infection.
To help prevent infection during the operation, people receive intravenous antibiotics within 1 hour of the skin incision and, often, for 24 hours after surgery.
Some surgeons also recommend using a preoperative chlorhexidine wash at home the day before the operation.
People should use crutches, a cane, a walker, and handrails to get around postoperatively until their strength, balance, and flexibility have improved.
The surgeon will discuss assistive aid options with the individual before they leave the hospital.
Most people can walk without assistance 2–4 weeks after surgery.
People who have had total knee replacements or other knee surgery should avoid activities or motions that impact the knee joint, especially running, jumping, or jogging.
People should speak with a doctor as soon as possible if they think that they have developed a blood clot or infection.
Signs of blood clots include new or worsening pain or swelling in the calf, ankle, or foot and redness, swelling, or tenderness above or below the knee.
Part of a blood clot can break loose and travel to the lungs, where it can get stuck and cause a blockage. This condition is called pulmonary embolism, and it is a very serious and sometimes life threatening emergency.
Signs of pulmonary embolism include:
- shortness of breath
- sudden chest pain
- coughing with chest pain
Blood, or systemic, infections require immediate treatment to prevent further serious complications. Signs of infection may include:
- high fever, typically higher than 100.4ºF orally
- worsening pain, swelling, flushing, or tenderness of the knee or the area around the surgical incision
- leakage from the surgical incision
- worsening pain during rest and activity
People may experience some pain and swelling around the surgical site after knee replacement surgery.
Most people need to take pain medications and perform gentle knee exercises after the procedure to help manage the pain.
A person should call their surgeon immediately if they are concerned about any signs of infection, blood clots, or pulmonary embolism.