Do’s and Don’ts after Knee Replacement

Knee replacement surgeries are life-changing surgeries as they allow the patients to get back to the activities they enjoy without the fear of pain or disability. Thousands of knee replacement surgeries are performed each year and with the advancement in techniques and implants, the knee replacements today last for 20 years and more.

Rehabilitation following knee replacement surgery forms a critical part of recovery. The majority of the patients are able to go home three days after the surgery or even earlier depending upon their recovery and the type of surgery. Once the patients are home, there are certain precautions they need to take and exercises they need to do to maximize the benefits of the surgery and prevent any potential complications.

X-ray showing total knee replacement.

Do’s after knee replacement

• Elevate the involved limb when lying down to relieve swelling after the surgery. Elevation just above the heart level helps in improving circulation.
• Exercises such as ankle pumps and quadriceps exercises are linked with decreased risk of deep vein thrombosis and potential stiffness of the knee.
• Use icing to reduce swelling and inflammation after the surgery. Icing helps in the reduction of pain and swelling, as cold temperature leads to narrowing of the blood vessels of the leg. This in turn leads to a reduction in edema.
• Walking is encouraged the next day of the surgery and in some cases, the same day of the surgery. Regular walking with support helps in the reduction of edema and stiffness. Walking also improves circulation and prevents deep vein thrombosis.
• Using adequate support while walking and performing exercise is important to prevent any inadvertent injury. Proper use of a walker or a cane is necessary to prevent any falls.
• A healthy diet rich in fibers and liquids is important to prevent any constipation after the surgery. Constipation may occur as a result of general anesthesia used for surgery. Obese and overweight patients should try to follow a diet plan under the supervision of their primary physician to reduce their weight.
• Follow the instructions of the surgeon for care of the operative wound. Report promptly any signs of surgical site infection such as redness, excessive swelling, discharge from incision, and fever.

Intraoperative image showing cementing of the tibial component.

• Patients are advised not to ignore knee pain after the surgery. While some pain is normal following the surgery and usually decreases in intensity in the following weeks, excessive pain may be associated with knee replacement complications such as deep vein thrombosis, implant breakage, fracture, tendon rupture, ligaments rupture, prosthetic infection, etc. While muscle soreness is common after exercises, any exercise pain associated with the exercises should be brought to the physician’s notice.
• Make your home environment safer by removing any potential objects/furniture that may cause you to trip while at home. Patients are advised to make extra space for movement at home by removing unwanted stuff. Patients are also advised to remove any loose wires or any small items that may cause them to trip and fall.
• Patients are also advised to install equipment to prevent any inadvertent accidents. Equipment may include bath mats, handrails in the bathtub and toilet seat, nightlights, texture to slippery floors, etc.
• To ease the rehabilitation process at home, patients are advised to move their sleeping quarters to the first floor to avoid stairs during the initial recovery period.
• Patients are advised to keep their essential items within reach in case they live alone and also have quick access to phones in case they need help.

Don’ts after a knee replacement

• Don’t perform any activity that involves twisting or significant force during the initial postoperative period.
• Follow the advice of the physician regarding wound care and don’t allow the incision area to be constantly wet or soiled. Report any discharge or redness to your physician.
• While exercise is important, don’t push yourself to bend or straighten that is accompanied by pain. Rather increase your exercise capacity gradually under the supervision of your therapist.
• Even after weeks/months of knee replacement surgery, don’t engage in high-impact activities/sports. Surgeons generally advise against running/jogging activity.
• Patients may require narcotic medications to control the initial postoperative pain. Patients are advised to avoid driving while on narcotic medications.
• Don’t ignore the pain and swelling out of proportion to the usual postoperative symptoms. These may be signs of serious complications such as deep vein thrombosis.

Knee replacement surgeries are highly successful surgeries and a coordinated rehabilitation with the surgeon and the therapist ensures an early return to baseline activity. Speak with your physician before and after the surgery to clear any questions and concerns.