Total Knee Replacement – Expectations & Advice

Congratulations on your new knee! The first two weeks are the most important while also usually being the most difficult. You want to ensure your new knee is progressing as expected, while also watching for any negative signs or symptoms. Here are some tips to help you through. Please note, every surgeon is different and may have different protocols and procedures. Please refer to your surgeon’s plan of care, as this is a general guideline.

Visual Expectations

the knee joint is usually swollen, bruised and possibly a little warmer to the touch. There will be a large incision down the front of your knee and is usually either glued or stapled shut. The method of closure is dependent on the surgeon’s preference. Each surgeon has their own standard wound care procedures following a TKR, so please refer to your surgeon if you are unsure what to do.

Pain Expectations

Every person experiences pain differently. This means that there is no way to determine what level of pain you will be in following your TKR. If your surgeon prescribed you pain medication, use as directed. The best thing to manage pain in the first few days is to use the pain medications (if applicable) as directed in combination with ice for 15-20 minutes every 1-2 hours. During the time you ice, it is most beneficial to elevate your leg above your heart to limit swelling and therefore limit pain. Some surgeons provide compression stockings to be worn for several weeks, or a compression sleeve. This is to help decrease the amount of swelling in the knee and lower leg.

The first 2 weeks are typically the most painful following a TKR. Each week should improve after that. A good piece of advice is to judge your progress week by week, instead of day by day. You will notice larger improvements weekly instead of daily and feel more confident that you are headed in the right direction.

Wound Care

Most commonly staples are used, this means a waterproof bandage will most likely need to be applied for showers. You can find Tagaderm and non-adhesive gauze at any local pharmacy. If you know your surgeon will use staples, and you haven’t had your TKR yet, we recommend getting these before hand to avoid having to go afterward. Following a shower, you will need to remove the waterproof bandages and replace with dry, breathable ones. Once the staples are removed (typically 7-10 days post operatively) steri-strips will likely be used for 7-10 days more. These do not have to be covered even for a shower and should fall off on their own.

If the incision is glued, they may have applied a bandage that will remain for several days or even a few weeks. In this case, please discuss proper dressing care with your surgeon’s staff. Please note that this is common practice, however your surgeon or physical therapist should tell you exactly what needs to be done in your particular case. Please refer to your specific medical staff if you are unsure what to do for wound care. In any case, your incision should never be left it moist bandages as this can increase your risk for infection.

Should I be walking?

During the first 2 weeks you should be getting up to walk frequently throughout the day. Walking helps to improve your quad strength, knee range of motion, and decrease your risk of getting a blood clot (DVT). Some general guidelines are to get up and walk 5-10 minutes every hour or 15-20 minutes every 2 hours. This should also be balanced with rest. Even though you need to walk, it is important to remember to allow your knee to heal. As you improve, you can increase your walking time as tolerated. It is common for you to feel really well one day, then have increased pain again the next. This is typically due to doing too much on days you feel better, so be cautious of how much you do on a daily basis!

Physical Therapy

If you are receiving physical therapy, your Physical Therapist should be working closely with you and your surgeon to help guide you through the upcoming weeks. Please note: it is VERY important that you get your knee as straight as you can as quickly as you can. This will help improve your gait and decrease complications later. It can be painful at first, but the better you are at getting your knee extension (knee straight) back, the faster you will walk without a limp. All other physical therapy exercises should be performed under the guidelines of a Physical Therapist.

Assistive Devices

Most commonly you will be on a walker or crutches. Prior to having the TKR, be sure you understand how to use whichever device you will receive if possible.

Please reference this site for how to use bilateral crutches:https://myhealth.alberta.ca/alberta/pages/use-crutches.aspx 

Please reference this site for how to use a walker: https://myhealth.alberta.ca/Alberta/Pages/use-a-walker.aspx

When to seek medical advice

If you experience any combination of increased warmth, redness, swelling, tenderness in your calf, fever, shortness of breath, or other abnormal symptoms seek attention immediately. Your biggest risk of a blood clot (DVT) is 2-10 days following surgery. For more information about DVT please reference here: https://orthoinfo.aaos.org/en/diseases–conditions/deep-vein-thrombosis

You should also contact your surgeon if you are having sudden increase in pain that is not alleviated by pain medication, rest and ice.

When will I return to normal?

This is different for everyone, so keep in mind the timeline may be faster or slower depending on your strength, activity level prior, and how well you adapt to your new knee. A general guideline given by many Physical Therapists is as follows:

• Performing normal, light activity within the home by 1 month.
• Able to get out and about, walking longer distances, going to the gym by 3 months.
• Normal activity level with occasional discomfort or notable differences by 6 months.
• It isn’t until roughly 1 year that you are expected to feel 100% back to normal.