One week after knee replacement surgery, you’re past the hardest days but still in the thick of early recovery. Pain is decreasing from its peak but still noticeable, especially when you move the joint. Swelling, bruising, and stiffness are all normal at this stage. Most people are walking short distances with a walker or crutches and starting basic physical therapy exercises at home.
Pain Levels at One Week
The most intense pain typically happens in the first two to three days after surgery, when you’ll rely on strong pain medication. By the end of the first week, pain should be noticeably better than those initial days, but it won’t be gone. Moving the knee, getting up from a chair, and walking will still hurt. Many people describe it as a deep ache with sharper pain during movement.
Your surgical team will likely transition you from stronger medications to milder ones during this window. Ice packs applied for 15 to 20 minutes at a time can help manage both pain and swelling. Expect the discomfort to be worse at the end of the day, especially after physical therapy sessions or periods of activity.
What Your Knee Looks and Feels Like
At one week, your knee will look significantly swollen and bruised. Black-and-blue discoloration spreading around the knee and even down the shin is completely normal and part of the healing process. The area around your incision will likely feel warm, numb, or tingly. Some people notice the bruising actually looks worse during the first week before it starts to fade, which can be alarming but is expected.
Your incision may still have some spotty drainage that’s red or clear in color, though this typically settles within the first five days. The skin around the incision will be red and swollen. Follow whatever instructions your surgeon gave you about dressing changes. Some surgeons use dressings that stay on until your first follow-up appointment, while others ask you to check the incision daily and keep it clean and dry.
How Much You Should Be Moving
By one week, you should be walking short distances around your home using a walker, crutches, or a cane. Your very first walk happened within hours of surgery, likely just from the bed to the bathroom with help. Now you’re building on that, taking multiple short walks throughout the day. Most surgeons and physical therapists recommend aiming for 20 to 30 minutes of total activity daily, broken into smaller chunks rather than done all at once.
Start with small, manageable distances and increase gradually. Walking to the kitchen, the bathroom, and around your living space counts. Between walks, rest with your leg elevated above heart level to help control swelling and pain. Most people won’t ditch their assistive device for about six weeks, so don’t rush it.
Range of Motion Targets
Your physical therapist will be watching two measurements closely: how straight you can make your leg (extension) and how far you can bend it (flexion). By the end of the first week, the goal is to get your knee nearly fully straight and to bend it past 70 degrees. For reference, 70 degrees is roughly enough to sit in a chair with your foot somewhat pulled back underneath you.
This might sound modest, but achieving it takes real effort when your knee is swollen and sore. Don’t be discouraged if you’re not quite there yet. Consistent daily exercise is what gets you to these benchmarks.
Exercises You’ll Be Doing
Physical therapy starts almost immediately, and by one week you’ll have a small routine of exercises to do multiple times a day. The core exercises at this stage are simple but important.
- Ankle pumps: Move your foot up and down rhythmically, pumping the calf and shin muscles. Do this for two to three minutes, two to three times per hour. This keeps blood circulating and helps prevent clots.
- Quad sets: While lying down, tighten the thigh muscle on your surgical leg and try to press the back of your knee flat. Hold for 5 to 10 seconds, repeat about 10 times, rest for a minute, then repeat until your thigh feels fatigued.
- Bed-supported knee bends (heel slides): Lying on your back, slide your heel toward your buttocks, bending the knee as far as you can. Hold for 5 to 10 seconds, then straighten. Repeat until fatigued or until you can fully bend the knee.
These exercises feel tedious, but they’re the foundation of your recovery. The quad sets in particular help “wake up” the thigh muscle, which tends to shut down after surgery and is essential for knee stability.
Sleeping During the First Week
Sleep is one of the biggest challenges in early recovery. Pain, swelling, and the inability to find a comfortable position make restful nights rare at first. The best sleeping position is on your back with a pillow under your calf and knee to keep the leg straight and slightly elevated. A wedge pillow works well for this. Avoid placing the pillow only under your foot, as this can hyperextend the knee and increase pain.
If you’re a side sleeper, you can lie on your non-surgical side with a pillow between your legs to cushion the knee. Do not sleep on the side that was operated on. Stomach sleeping is off the table entirely, since it puts direct pressure on the surgical site. Many people find that sleeping in a recliner is actually more comfortable than a bed during the first week or two.
Warning Signs to Watch For
While swelling, bruising, warmth, and moderate pain are all expected, certain changes signal a problem. Contact your surgical team if you notice redness that is spreading or getting worse around the wound, swelling that keeps increasing instead of gradually settling, new or worsening pain in the joint, or fluid leaking from the incision that is thick, yellow, or has an odor. A wound that looks like it’s opening up or not healing also warrants a call.
Get emergency care if you develop a fever over 100.4°F (38°C), shivering or chills, a rapid heart rate, confusion or drowsiness, or severe pain that’s worse than what you experienced right after surgery. These can indicate infection or other serious complications. Also be alert for signs of a blood clot in your leg: sudden calf pain or swelling that’s significantly worse on one side, especially if it comes on quickly. Your care team will likely have you on a blood thinner during this period to reduce that risk.
Daily Life at One Week
Expect to need help. Getting dressed, bathing, preparing meals, and managing stairs are all harder than you’d think with a swollen, stiff knee and an assistive device in one hand. A raised toilet seat, a shower chair, and a long-handled grabber for picking things up make a real difference. If you live in a multi-story home, set up a recovery station on the main floor so you can minimize trips up and down stairs.
Most people are not driving at one week, especially if the surgery was on the right knee. You won’t be able to return to work yet unless your job can be done entirely from a seated position at home. The first week is really about three things: managing pain, doing your exercises, and walking a little more each day. Recovery from knee replacement is a slow build, and the first week is just the starting line.