Knee joint replacement - discharge

You had knee replacement surgery to replace all or part of the bones that make up your knee joint. Your surgeon removed and reshaped your damaged bones, then put your new artificial knee joint in place. You should have received pain medicine and learned how to take care of your new knee joint.

By the time you go home, you should be able to walk with a walker or crutches without needing much help. You may need to use these walking aids for up to 3 months. You should also be able to dress yourself with only a little help and get into and out of your bed or a chair by yourself. You should also be able to use the toilet without much help.

Over time, you should be able to return to your former level of activity. You will need to avoid some sports, such as downhill skiing or contact sports like football and soccer. But, you should be able to do low impact activities, such as hiking, gardening, swimming, playing tennis, and golfing.

A physical therapist may visit you at home to make sure your home is set up safely for you as you recover.

Your bed should be low enough for your feet to touch the floor when you sit on the edge of the bed. Keep tripping hazards out of your home.

• Learn how to prevent falls. Remove loose wires or cords from areas you walk through to get from one room to another. Remove loose throw rugs. Do not keep small pets in your home. Fix any uneven flooring in doorways. Use good lighting.
• Make your bathroom safe. Put hand rails in the bathtub or shower and next to the toilet. Place a slip-proof mat in the bathtub or shower.
• Do not carry anything when you are walking around. You may need your hands to help you balance. You can attach a pocket or holder to your walker or crutches to hold things instead.

Put things where they are easy to reach.

Place a chair with a firm back in the kitchen, bedroom, bathroom, and other rooms you will use. This way, you can sit when you do your daily tasks.

Set up your home so that you do not have to climb steps. Some tips are:

• Set up a bed or use bedroom on the same floor.
• Have a bathroom or a portable commode on the same floor where you spend most of your day.

You may need help with bathing, using the toilet, cooking, running errands and shopping, going to your medical appointments, and exercising. If you do not have a caregiver to help you at home for the first 1 or 2 weeks, ask your health care provider about having a trained caregiver come to your home.

Use your walker or crutches as your provider told you to use them. Take short walks often. Wear shoes that fit well and have nonskid soles. Do not wear high heels or slippers while you are recovering from surgery.

Do the exercises your physical therapist taught you on your own each day. Your provider and physical therapist will help you decide when you no longer need crutches, a cane, or a walker.

Ask your provider or physical therapist about using a stationary bicycle and swimming as extra exercises to build your muscles and bones.

Try not to sit for more than 45 minutes at a time. Get up and move around after 45 minutes if you will be sitting some more.

Wear a small fanny pack or backpack, or attach a basket or strong bag to your walker, so that you can keep small household items like a phone and notepad with you.

To prevent injury to your new knee:

• Do not twist or pivot your body when you are using a walker.
• Do not climb up on a ladder or stepstool.
• Do not kneel down to pick up anything.
• When lying in bed, keep a pillow under your heel or ankle, not your knee. It is important to keep your knee straight. Try to stay in positions that do not bend your knee.

Your provider or physical therapist will tell you when you can start putting weight on your leg and how much weight is OK. When you can start bearing weight will depend on what kind of knee joint you have. It is important not to start bearing weight until your doctor tells you it is safe to.

Do not carry anything over 5 to 10 pounds (2.25 to 4.5 kilograms).

Ice your knee 30 minutes before and 30 minutes after activity or exercises. Icing will decrease swelling.

Keep the dressing (bandage) on your incision clean and dry. Change the dressing only if your surgeon told you to. If you do change it, follow these steps:

• Wash your hands well with soap and water.
• Remove the dressing carefully. Do not pull hard. If you need to, soak some of the dressing with sterile water or saline to help loosen it.
• Soak some clean gauze with saline and wipe from one end of the incision to the other. Do not wipe back and forth over the same area.
• Dry the incision the same way with clean, dry gauze. Wipe or pat in just 1 direction.
• Check your wound for signs of infection. These include severe swelling and redness and drainage that has a bad odor.
• Apply a new dressing the way your doctor or nurse showed you.

Sutures (stitches) or staples will be removed about 10 to 14 days after surgery. You may shower 5 to 6 days after surgery, as long as your surgeon says you can. When you can shower, let the water run over the incision but do not scrub your incision or let the water beat down on it. Do not soak in a bathtub, hot tub, or swimming pool.

You may have bruising around your wound. This is normal, and it will go away on its own. The skin around your incision may be a little red. This is normal too.

Your provider will give you a prescription for pain medicines. Get it filled when you go home so you have it when you need it. Take your pain medicine when you start having pain. Waiting too long to take it will allow your pain to get more severe than it should.

In the early part of your recovery, taking pain medicine about 30 minutes before you increase your activity or do your physical therapy can help control pain.

You may be asked to wear special compression stockings on your legs for about 6 weeks. These will help prevent blood clots from forming. You may also need to take blood thinners for 2 to 4 weeks to lower your risk for blood clots.

Take all your medicines the way you have been told.

• Do not double up on your pain medicine if you miss a dose.
• If you are taking blood thinners, ask your provider whether you can also take ibuprofen (Advil, Motrin) or other anti-inflammatory drugs.

You may need to avoid sexual activity for a while. Your provider will tell you when it is OK to start again.

People who have a prosthesis, such as an artificial joint, need to carefully protect themselves against infection. It used to be recommended that you need to take antibiotics before any dental work or invasive medical procedures, however, the recommendation has been changed except for high risk patients. Make sure to check with your provider, and tell your dentist or other surgeons about your knee replacement.

Contact your provider if you have:

• Blood that is soaking through your dressing and the bleeding does not stop when you put pressure on the area
• Pain that does not go away after you take your pain medicine
• Swelling or pain in your calf muscle
• Darker than normal foot or toes or they are cool to touch
• Yellowish discharge from your incision
• A temperature higher than 101°F (38.3°C)
• Swelling around your incision
• Redness around your incision
• Chest pain
• Chest congestion
• Breathing problems or shortness of breath

Total knee replacement - discharge; Knee arthroplasty - discharge; Knee replacement - total - discharge; Tricompartmental knee replacement - discharge; Osteoarthritis - knee replacement discharge

Ellen MI, Forbush DR, Groomes TE. Total knee arthroplasty. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 80.

Rachala SR, Sierra RJ. Unicompartmental, bicompartmental, or tricompartmental arthritis of the knee: algorithm for surgical management. In: Scott WN, ed. Insall & Scott Surgery of the Knee. 6th ed. Philadelphia, PA: Elsevier; 2018:chap 125.

Willimon SC, Perkins CA. Postoperative management. In: LaPrade RF, Chahla J, eds. Evidence-based Management of Complex Knee Injuries. Philadelphia, PA: Elsevier; 2021:chap 40.

Updated by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.