Total knee replacement (TKR) resurfaces a damaged knee joint with artificial components. The first week following surgery is the most intense period of recovery, setting the foundation for long-term mobility and function. Understanding expectations for these initial seven days is important for managing discomfort and actively participating in the recovery plan. This immediate post-operative phase is designed to maximize the success of the new joint.
The Initial Hospital Stay and Acute Pain Control
The first two to four days are typically spent in the hospital, focused on stabilizing the patient and managing acute pain. Modern pain management begins immediately, often utilizing a multimodal approach, including nerve blocks or spinal anesthesia administered during the procedure. These techniques help control the most severe pain in the immediate hours after surgery.
As the initial local anesthetic wears off, the care team transitions to systemic pain control, which may involve intravenous medications or a patient-controlled analgesia (PCA) pump. The goal is to reduce pain to a manageable level where physical therapy can begin, not its complete elimination. Careful monitoring of vital signs and blood oxygen levels is continuous during this time.
Early mobilization is an immediate goal to prevent complications like deep vein thrombosis (DVT). Patients are often assisted out of bed to a chair within 24 hours of surgery and encouraged to begin walking short distances with a walker. Sequential Compression Devices (SCDs) are placed on the legs to promote circulation. Before discharge, the care team confirms the patient can safely manage basic mobility and has a comprehensive pain control and rehabilitation plan for the transition home.
Essential Mobility Goals and Physical Therapy
Physical rehabilitation begins on the day of surgery, focusing on recovering the knee’s range of motion (ROM). The primary goal for the first week is to achieve at least 90 degrees of knee flexion, the angle needed for sitting comfortably. Achieving full knee extension is equally important and must be prioritized early in the recovery process.
Therapists introduce specific exercises designed to increase mobility and strengthen the quadriceps muscle, which is often weakened by the surgery. These exercises must be performed multiple times daily, often hourly while awake, to prevent the formation of stiff scar tissue. Walking with an assistive device, such as a walker or crutches, is practiced daily to ensure safe navigation and proper weight-bearing on the new joint.
Movement is encouraged to reduce stiffness and swelling, but patients must learn the distinction between therapeutic activity and overexertion. While some soreness is normal, intense, sharp pain signals the need to stop and rest. Some surgeons may recommend a Continuous Passive Motion (CPM) machine at home, which gently bends and straightens the knee to assist with ROM goals.
Navigating Medications and Common Post-Surgical Symptoms
Managing pain effectively at home involves adhering to a scheduled oral medication regimen, often combining prescription opioid pain relievers with nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen. Taking pain medication before therapy sessions is a common strategy to maximize participation in exercises. Since constipation is a common side effect of opioid medication, stool softeners or laxatives are necessary.
Patients should expect significant swelling (edema) in the knee and surrounding leg, which can persist for several weeks. Bruising (ecchymosis) may also extend down the leg toward the ankle as the body reabsorbs blood. Post-operative fatigue and a mild mental fogginess are common systemic symptoms, reflecting the body’s energy expenditure on healing.
These common symptoms are best managed using the R.I.C.E. principles: Rest, Ice, Compression, and Elevation. The leg should be elevated above the level of the heart for 20-minute intervals several times a day to help fluid drain away from the surgical site. Applying cold packs for 15 to 20 minutes every few hours reduces pain and inflammation. Compression stockings are often recommended to control swelling and reduce the risk of blood clots.
Home Care for the Incision Site and Safety Signals
Proper care of the surgical incision is important to prevent infection during the first week. The dressing applied by the surgeon should be kept clean and dry; patients are typically instructed to avoid showering or getting the incision wet until the surgeon approves it. Sutures or staples remain in place throughout this first week, requiring the patient or a caregiver to inspect the wound daily for signs of complications.
While some mild redness along the incision line and small amounts of clear or pinkish drainage are sometimes expected in the first few days, specific “red flag” symptoms require an immediate call to the surgeon’s office. These signs indicate a potential infection or a blood clot. Concerning signs of infection include increasing redness that spreads away from the incision, excessive warmth, or the presence of thick, pus-like drainage.
A persistent fever above 101 degrees Fahrenheit is a serious warning sign. Severe, unexplained pain or tenderness in the calf muscle, accompanied by swelling, may signal a deep vein thrombosis (DVT), which is a medical emergency. Reporting any of these changes promptly ensures that immediate and appropriate medical intervention can be taken.