Total Knee Arthroplasty (TKA), commonly known as knee replacement surgery, is a highly successful procedure designed to alleviate pain and restore mobility. Achieving the best outcome and ensuring the longevity of the artificial joint depends heavily on strict adherence to post-operative instructions. Ignoring these restrictions can lead to complications such as joint dislocation, infection, or premature implant wear, which may require further surgery. The immediate and long-term success of the procedure relies on avoiding specific actions that place undue stress on the healing tissues and the new mechanical components.
Movements That Compromise the New Joint
The first few weeks following a total knee replacement require extreme care to protect the surgical site and surrounding soft tissues. Patients must avoid deep knee bending, which means flexing the knee past 90 degrees. Forcing the joint into a deep bend places excessive strain on the incision and surrounding muscles, potentially delaying healing. Patients should also avoid low seating, such as soft couches or low chairs, which forces the knee into a restricted position.
Twisting or pivoting on the operated leg is highly restricted, especially when the foot is planted. This action creates torsional stress on the new joint, straining the ligaments and tendons that stabilize the knee. Such twisting can risk loosening the implant or damaging the joint capsule while it is still healing. Patients should also refrain from crossing the legs at the knee or ankle, as this puts uneven pressure on the joint and surrounding structures.
Kneeling is strongly discouraged, particularly in the initial months after TKA. Direct pressure on the front of the knee can be painful and potentially harmful to the surgical incision and underlying components. While some patients may eventually return to modified kneeling, it requires specific clearance from the surgeon or physical therapist. Avoiding these movements prevents mechanical failure and allows the tissues to heal securely around the implant.
High-Impact Activities and Heavy Lifting
Once the initial healing phase is complete, attention shifts to avoiding activities that cause chronic wear or acute damage to the artificial joint. High-impact activities are restricted long-term because they transmit excessive force through the knee. Running, jogging, and jumping can place forces equivalent to three times the body weight onto the knee joint, dramatically increasing the risk of premature implant wear or loosening.
Contact sports, such as football, basketball, and skiing, are typically off-limits due to the high risk of falls and uncontrolled twisting movements. These activities can result in acute traumatic injury, potentially fracturing the bone around the implant or causing component damage. Patients should instead focus on low-impact alternatives like walking, stationary cycling, or swimming, which build strength without stressing the joint.
Heavy lifting, especially involving the lower body, puts significant pressure on the knee and should be avoided. While the specific weight limit varies by surgeon and recovery progress, lifting objects heavier than 20 to 30 pounds is typically restricted during early recovery. Prolonged, repetitive activities involving deep squatting or excessive bending, such as intense gardening or manual labor, should be moderated or avoided entirely. This caution is necessary to preserve the integrity of the implant’s bearing surfaces and prolong its functional lifespan.
Ignoring Wound Care and Medication Schedules
Failure to maintain proper wound care poses a significant risk of infection, one of the most serious complications after TKA. Patients must immediately contact the surgical team if they notice signs of infection, which include increased redness, warmth, swelling, persistent drainage from the incision, or a fever. Any of these symptoms warrant immediate contact with the surgical team, as a joint infection often requires aggressive medical or surgical intervention.
The incision site must be kept clean and dry according to the surgeon’s instructions. Patients must not soak the wound in water—meaning no baths, hot tubs, or swimming pools—until they have specific clearance, which is often around six weeks post-surgery. Avoid applying unauthorized creams, lotions, or powders directly to the incision, as these can introduce bacteria or interfere with healing. Only approved dressings and topical agents should be used to protect the wound.
Following the prescribed medication schedule is equally important for both pain management and complication prevention. It is dangerous to abruptly stop taking prescribed blood thinners, which prevent Deep Vein Thrombosis (DVT) and pulmonary embolism. Blood clots are a serious risk following major surgery, and stopping this prophylactic medication without medical guidance can be life-threatening.
Pain medication, particularly opioids, should be taken as directed to manage discomfort and allow participation in physical therapy. Driving is prohibited while taking narcotic pain relievers. Patients must never skip or delay physical therapy sessions, as this is the primary mechanism for restoring strength and range of motion. Neglecting the prescribed exercises can lead to a stiff joint and a significantly compromised long-term outcome.
Environmental Hazards and Home Safety
Ignoring the need to modify the home environment is a common mistake that can lead to a devastating fall, risking serious injury or damage to the new knee. Patients must remove all potential trip hazards from their walking paths, including loose rugs, electrical cords, and excess clutter. Clear, unobstructed walkways are essential, especially when navigating with an assistive device like a walker or crutches.
The use of inadequate assistive devices should also be avoided. Patients must use the walker or crutches as prescribed until cleared to progress. Walking unassisted or using a cane prematurely can lead to a loss of balance and subsequent falls. In the bathroom, patients must use grab bars in the shower and near the toilet to maintain stability and prevent slips on wet surfaces.
Stairs present a significant challenge in early recovery and should not be attempted unsupervised or improperly. Patients are taught a specific technique for stability: leading with the unoperated leg when going up and the operated leg when going down. Carrying heavy items while navigating stairs is hazardous and must be avoided entirely. Modifying the home to create a safe recovery area minimizes the risk of a fall during the most vulnerable period.