A total knee replacement (TKR) is a major surgical procedure that resurfaces a damaged knee joint with an artificial implant. The immediate period following the operation is a time of swift, focused recovery. The first few days are structured around achieving specific mobility and pain control benchmarks. By Day 3, a patient is expected to have made significant progress, demonstrating the functional ability required for the next phase of rehabilitation.
Immediate Post-Operative Focus (Days 1 and 2)
The first 48 hours after a total knee replacement concentrate on stabilizing the patient and initiating movement. Rehabilitation begins almost immediately, often on the day of surgery, with a physical therapist guiding the patient to sit up and dangle their legs. This initial mobilization stimulates circulation and helps prevent complications like blood clots.
A primary focus is ensuring the new joint achieves full extension, or complete straightening, by keeping the leg flat and supported. Medical staff closely monitor incision sites for signs of infection and manage initial swelling with ice and elevation. Pain management is also a high priority during this time, often utilizing nerve blocks and multimodal medication to make early movement tolerable.
Key Mobility Milestones by Day 3
By the end of Day 3, the patient should be able to perform several key actions that confirm readiness for discharge to home or a rehabilitation facility. The ability to safely transfer is a major benchmark, allowing the patient to move from the bed to a chair and back with minimal assistance. This includes safely using the bathroom.
Walking short distances with an assistive device, such as a walker or crutches, is expected. Patients commonly walk 50 to 100 feet, necessary for navigating a hospital hallway or small home environment. A minimum range of motion is targeted, generally aiming for at least 70 to 90 degrees of knee flexion, or bending.
Achieving near-full knee extension is equally important, as straightening the leg is necessary for a normal walking pattern. These milestones demonstrate that the patient has adequate muscle control and pain management to begin the more intensive rehabilitation phase. The ability to perform a straight leg raise, lifting the operated leg a few inches off the bed, indicates sufficient quadriceps strength.
Essential Exercises and Physical Therapy
The mobility achievements by Day 3 are the direct result of consistent physical therapy exercises performed multiple times daily. These exercises are simple, low-impact movements designed to restore initial strength and range of motion while promoting blood flow. Ankle pumps, where the patient rhythmically moves their foot up and down, are performed frequently to help prevent deep vein thrombosis (DVT).
Quadriceps sets involve tightening the thigh muscle to push the back of the knee down against the bed, helping the quadriceps muscle activate. Heel slides are another foundational exercise where the patient bends the knee by sliding the heel toward the buttocks. These early exercises are the method by which the patient works toward the 90-degree flexion goal, with the physical therapist ensuring proper form and safety.
Managing Pain and Medications
Effective pain control is necessary to enable early mobility and exercise, as severe pain prevents full participation in physical therapy. The pain management strategy is typically multimodal, combining several types of medications that target pain through different mechanisms. This often includes scheduled doses of non-opioid medications like acetaminophen and anti-inflammatories, alongside opioids for breakthrough pain.
Many patients receive regional nerve blocks during or immediately after surgery, providing significant pain relief for the first one to three days. As this initial numbness wears off, managing the transitioning pain with oral medications becomes a focus on Day 3. Patients commonly take pain medication 30 to 60 minutes before a physical therapy session to maximize comfort and performance.
Non-pharmacological methods are also a continuous part of the care plan, including the consistent use of ice and elevation. Keeping the surgical leg elevated above the level of the heart helps reduce swelling, which is a major source of pain and stiffness. The goal is not to eliminate all pain, but to keep it at a manageable level that allows for required movement and participation in rehabilitation.