Recovery after Total Knee Replacement

After total knee replacement (TKR), recovery and rehabilitation is an active process. To improve your chances for long-term success, it’s important to push yourself and commit to a plan over the 12-week recovery phase.

Day 1. There’s no rest for the weary! Rehabilitation will start almost immediately after surgery. Within the first four hours, a physical therapist (PT) will have you begin standing and walking using an assistive device. Expect to learn how to get in and out of your bed and learn exercises that strengthen your muscles. You will probably be set up with a continuous passive motion (CPM) machine to keep the knee in motion to prevent scar tissue and stiffness.

Day 2 until discharge. Exercises and activities will be slowly increased, including walking up and down stairs, transferring to a chair and toilet without assistance. Pain meds will be slowly tapered.

Goals at discharge include: Bend your knee well, at least to 90 degrees; dress and bathe on your own; get in and out of bed with the least use of an assistive device; and walk at least 25 feet and go up and down stairs using a walker or crutches.

Discharge through week 3. You may be discharged to a rehabilitation facility or directly home. Your PT will prescribe a daily exercise regimen for you. If you are unable to perform the exercises, it’s important that you inform your doctor. Outpatient or home PT can be arranged to help assist you. It’s helpful to have a family member learn the exercises, so they can act as your coach. Bathing and dressing should be easier. You may be asked to continue using a CPM machine.

Weeks 4-6. Increase the knee strength by continuing your exercises, including walking. Return to everyday activities and speak with your surgeon about when you can drive and return to work. Expect improved range of motion of the knee.

Weeks 7-11. This period is crucial for long-term success. Commitment to exercise and your rehabilitation plan will help you succeed. Pain should be significantly reduced.

Engage in basic activities such as driving, housekeeping and shopping, recreational walking, swimming, stationary bike, etc. Range of motion and strength training exercises might be modified as you can move the knee more freely. The goal is to be able to bend your knee 115 degrees.

Week 12. You should have less pain or no pain with normal activities and experience and full flexion and extension. Continue your ongoing exercise routine, but avoid highimpact activities (running, aerobics, skiing, basketball, etc.). Stay in contact with your medical team.

Week 13 and beyond. While full recovery times can vary, the typical recovery time is 3-12 months. Keep in touch with your medical team and don’t wait if you feel pain, stiffness, swelling or decreased motion of the knee. At this point, you should be almost entirely pain free and able to engage in a wide range of activities.

Remember, while you are rehabbing from a TKR, the harder you work, the more likely it is that you will achieve a fuller recovery in a shorter period of time.

SUSAN LOCKE,MD, is Healthnetwork Foundation’s medical director.

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