In the first six weeks after a knee replacement, the work is to keep the swelling down, get the knee straightening and bending, walk with less help and wake the thigh muscles back up. Your surgeon's protocol sets the rules, and physical therapy works through them in stages, with a written home program that changes as the knee heals.
Your surgeon sets the rules
Bring your surgeon's post-op protocol and your discharge paperwork to the first visit. Dr. Ed works from your protocol, not from a generic plan.
Physical therapy starts when your surgeon says so. On Dr. Ed's pre and post-op physical therapy page, that is within the first one to two weeks for most joint replacements. The timing points below come from the American Academy of Orthopaedic Surgeons (AAOS). They are general ranges, and where your surgeon says something different, your surgeon wins.
The first days at home
Before you leave the hospital, AAOS says you need to meet several goals, including walking with an assistive device (a cane, walker or crutches) on a level surface, climbing up and down two or three stairs, and doing the prescribed home exercises (Activities After Knee Replacement, AAOS).
If you go straight home, AAOS says you will need some help at home for several days to several weeks, so arrange help before surgery. It says swelling can be moderate to severe in the first few days or weeks and mild to moderate for about 3 to 6 months, and that you reduce it by raising your leg and applying ice.
Driving and work have their own timing. AAOS says that in most cases it is safe to drive again once you are no longer taking opioid pain medication and your strength and reflexes have returned to a more normal state, and that your doctor will help you decide when. Going back to work can take several days to several weeks, depending on your job and your recovery.
AAOS also lists warning signs of infection and of a blood clot, such as persistent fever, drainage from the wound, pain in the leg or calf unrelated to your incision, increasing swelling of the calf, ankle or foot, and shortness of breath or sudden chest pain. It says to tell your doctor right away if you develop any of them. The CDC lists difficulty breathing and chest pain among the signs of a blood clot in the lungs and says to seek medical help immediately if you have them (CDC).
From walker to cane to light weights
The AAOS Total Knee Replacement Exercise Guide covers the exercises and gives some of the timing. It says to start the exercises as soon as you are able. Its early exercises are thigh tightening, straight leg raises, ankle pumps, knee straightening and knee bends.
- At first.AAOS says you will walk with a walker or crutches.
- Often about 2 to 3 weeks.AAOS says you can begin using a single crutch or cane when you can walk and stand for more than 10 minutes and your knee is strong enough that you are not carrying any weight on the walker or crutches.
- Usually 4 to 6 weeks.AAOS says you can repeat the exercises with light weights around your ankle.
The exercises also outlast the six weeks: AAOS says to keep doing the ones your physical therapist prescribes for at least 2 months after surgery (Activities After Knee Replacement, AAOS). It says walking is not a substitute for them, and the exercise guide adds that a full recovery will take several months.
How Dr. Ed works through the stages
Dr. Ed treats you himself, one-on-one, in the stages your surgery needs.
- Early.Controlling swelling and pain, protecting the repair, gentle range of motion, and getting you safe on stairs and in the car.
- Middle.Restoring full range of motion with hands-on work, waking the muscles back up, and rebuilding walking so it looks normal again.
- Late.Strength, balance and the specific things you want back, such as gardening, hiking or lifting a grandchild.
Dr. Ed's targets, not tied to a week: about 110 degrees of bend for everyday function, and a knee that straightens to 0 degrees, or as close as possible.
You leave every visit with a written home program, adjusted as the repair heals. A family member is welcome at every session and can learn the home exercises to help. What patients say about their own recoveries is on the Reviews page.
What to do next
If your surgery date is set, book the evaluation before it if you can, so there is no gap. If you are already home, book once your surgeon says physical therapy can start. Evening and Saturday appointments mean a working family member can drive you. The knee replacement recovery page covers how Dr. Ed treats it.