Get moving again with this 12-week guide to active recovery following knee replacement surgery.
If you just joined the new-knee club, welcome! You’re part of an increasingly popular group here in the United States, with more than 600,000 new members coming aboard every year, according to the Agency for Healthcare Research and Quality.
First performed in 1968, knee replacement surgery has come a very long way in the past five decades in terms of surgical technique. The American Academy of Orthopaedic Surgeons calls it “one of the most successful procedures in all of medicine.” But people still get nervous about what will be involved when it comes to recovery.
“There continues to be a perception that you’ll be out of commission for weeks, if not months,” says Carol Mack, D.P.T., C.S.C.S., a physical therapist in Cleveland. “In fact, because you need to get moving right away, you may find you’re more active sooner than you thought, especially compared to when your knee was affected by pain and inflammation.”
The majority of people who get knee replacements are over 65, she adds, and the importance of activity for recovery can be a true booster for strength and balance.
Here’s what you can expect once you’re out of surgery and the key lifestyle changes to make so you bounce back stronger.
Day 1 to 6 Weeks After Surgery: Start Moving, Minimize Pain, and Stay Steady
Whether you’ve had one knee done or both, the recovery goals are similar for the first few weeks: Increase activity, reduce pain, and don’t fall.
“Most people will go home from the hospital the day after surgery, using a walker,” says Timothy Gibson, M.D., an orthopedic surgeon and medical director at MemorialCare Joint Replacement Center in Fountain Valley, California.
“In the past, you’d be in the hospital for up to five days, with a device that moved your knee,” Dr. Gibson says. “But we’ve learned that a more active recovery at home helps reduce risk of complications like blood clot or pneumonia.”
When you walk frequently, you take deeper breaths than when you’re lying down, which allows your lungs to expand better, he explains. That cuts down on potential pneumonia risk. Similarly, regular movement—even little trips, like getting up from the couch to get a glass of water—helps your circulation, so clots are much less likely to form.
Outpatient physical therapy will help with exercises geared toward lowering inflammation, increasing mobility, and strengthening your supporting leg muscles so your knee can start to bend to a greater degree.
Aim to do five to 10 reps of each of these exercises two times a day, or as your doctor or physical therapist recommends.
Lie down, and try to push your knee down while tightening your thigh muscle for five to 10 seconds at a time.
Straight Leg Lift
Lie down, and straighten your knee as much as possible. Lift your leg a few inches off the floor, holding for a count of five.
Lie down, and flex your toes toward you and then point your feet away from you.
Seated Knee Bend
Sit in a chair, and gently draw your foot under the chair until you feel a stretch in your knee. Release and repeat, this time holding the stretch for a count of 10 to 15. Over time, work up to 30 seconds.
You’ll also be encouraged to walk as much as you can comfortably. In the first few weeks, that will likely involve a walker or cane, Mack says. The goal is usually to walk independently by about three weeks after surgery.
Another major part of your recovery during this time will be pain management. There’s no sugarcoating it. Knee surgery can be notoriously painful, and many people are surprised by the amount of swelling and bruising that occurs in the days after surgery, says William Macaulay, M.D., chief of adult reconstructive surgery at NYU Langone Health in New York.
That can lead to concerns about overtreating the pain with narcotics, he says, but there are numerous options that can be used instead.
“Narcotics are actually not very good at treating pain, compared to the spectrum of pain medications available,” he explains. “You can expect a more multimodal pain control program instead.”
For example, many patients are discharged with a nerve block device that deadens pain in the first week after surgery, making medication less necessary.
Another major consideration to keep in mind during the first few weeks is preventing falls, Dr. Macaulay says. People over 65 are at higher risk of falling in the post-op period than those who are younger, he says, especially if pain is managed to the degree that you start to feel more ambitious in your movement.
“A fall in the wrong way can be one of the rare things that may mess up a well-done knee replacement,” he says. “Caution and vigilance for safe, yet frequent, mobilization is paramount.”
In other words: Ask for help! The upside to being more reliant upon others? You’ll have people nearby to keep your spirits up. Now’s a great time to take your mind off your knee by playing cards with some pals or joining a book discussion at the library.
Another great way to reduce your fall risk is to move more. As long as you get the go-ahead from your doctor and physical therapist, you can try water-based fitness classes, which help strengthen the legs with minimal impact on the joints. SilverSneakers Splash classes are a fun and safe option for all skill levels, including non-swimmers.
6 to 12 Weeks After Surgery: Build Strength and Balance
As your knee or knees heal, you’ll likely find much more stability and a normal degree of bend. But that doesn’t mean your recovery is at its endpoint. In fact, this second phase is equally important for the long-term success of your knee replacement.
“This is the period of time where you begin to build strength and focus on balance, as well as do movement that’s specific to your goals,” says Mack.
For instance, if you love to play pickleball, your physical therapist will likely have you doing lateral movements so you can shift from side to side more easily. If bike riding is your passion, you can start to focus on interval training—which means alternating between an easy pace and a modified sprint on your bike—to build endurance.
Most of all, it’s important to do strength training at least three days per week to build your major muscle groups. These moves may include bodyweight squats, clamshells, core work, and exercises done on one leg to improve balance.
Follow any instructions from your doctor or physical therapist, plus check out our beginner’s guide to strength training.
12+ Weeks After Surgery: Focus on Whole-Body Health
Good news: You’ve made it through the toughest part of your recovery. Now’s the time to establish or continue healthy lifestyle habits to help you get back to everyday activities without pain.
“See recovery and knee health as long-term commitments to yourself,” Mack says. “Set new goals, try different activities, focus on strength and balance, and you’ll likely discover that having a knee replacement is one of the best things to happen to you.”
Mack suggests focusing on these four strategies.
Reach and Maintain a Healthy Weight
Extra weight—even as little as five or 10 pounds—can put extra strain on the knees and slow down recovery. Work with your medical team to come up with a weight loss plan that works for you, and check out these strategies to lose weight after 60.
Get Quality Sleep
Good sleep helps lower inflammation and improves recovery, Mack says. Set a schedule, create a bedtime routine, and talk to your doctor about any sleep concerns you might have. Plus, try these tips to sleep better.
Eat More Vegetables
Nutrient-rich vegetables help with blood flow and fight inflammation, which is crucial for a healthy rebound. Eating well can also help you lose weight in a safe, sustainable way. Here’s a shortcut: Stock up on frozen vegetables.
Make a Plan to Stay Active
This is the most important change of all, Mack says. Focus on activities that can expand your range of movement. Maybe that means taking a new SilverSneakers class, trying yoga or tai chi, or picking up golf or other low-impact hobbies.
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