Three weeks after total knee replacement surgery, you transition from the acute post-operative phase into intensive rehabilitation. The early days of managing immediate pain and immobility have passed, and your focus shifts toward regaining functional strength and mobility. This stage marks a significant turning point where consistency in physical therapy yields measurable progress in your day-to-day life. Understanding the specific physical benchmarks and practical expectations for this time frame helps maintain recovery momentum.
Expected Physical Milestones and Range of Motion Goals
By the end of the third week, a primary goal set by physical therapists is achieving 90 to 100 degrees of knee flexion. This range of motion is necessary for performing basic activities, such as sitting down and standing up from a regular chair. Maintaining full knee extension, meaning a completely straight leg, is equally important for developing a normalized walking pattern.
As quadriceps strength improves, reliance on walking aids should decrease. While a walker or crutches were used immediately after surgery, a common milestone at three weeks is transitioning to a single cane or crutch, particularly for short distances. Some individuals may begin walking independently for brief periods, though caution is advised to prevent fatigue and swelling. Physical therapy exercises become more moderate, progressing from gentle range-of-motion work to exercises focusing on weight-bearing and improving gait mechanics.
Your physical therapy program requires performing exercises two to three times daily, in addition to attending scheduled outpatient sessions. These exercises often include heel slides, straight leg raises, and progressing to light resistance on a stationary bike to promote mobility and circulation. Consistent effort in these exercises directly influences the development of scar tissue, helping to prevent stiffness and maximize the long-term function of the new joint.
Managing Residual Pain and Swelling
While intense pain should have lessened since the first week, residual soreness and swelling three weeks post-surgery are normal. Discomfort is often more noticeable after periods of physical activity or in the evening. Most patients are tapering prescription pain medication, shifting toward over-the-counter options like acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), if approved by the surgeon.
Effective management of swelling is necessary to facilitate continued progress in range of motion. Consistent elevation of the leg above the level of the heart helps clear excess fluid from the surgical area. Applying ice packs for 15 to 20 minutes several times daily reduces local inflammation and provides temporary pain relief. Compression stockings, if prescribed, should still be worn to support circulation and reduce fluid pooling in the lower leg.
Caring for the Incision Site and Monitoring for Complications
By the three-week mark, the surgical incision site is nearing completion of its healing process. Staples or sutures are often removed between 10 to 21 days post-operation, meaning this procedure may have just occurred or is scheduled soon. Until the skin is fully closed and cleared by your surgical team, the wound must be kept clean and dry to prevent infection. Once the incision is sealed, you may begin gently massaging the scar with a moisturizing lotion, such as Vitamin E cream, to improve skin elasticity and appearance.
Monitoring the incision and the operated leg for signs of complications remains a high priority. Watch for localized signs of infection, including excessive redness that spreads beyond the incision line, increased warmth, or persistent, foul-smelling drainage. Attention must also be paid to symptoms of deep vein thrombosis (DVT), which remains a risk for up to three months post-surgery. Signs of DVT include new or sudden unilateral calf pain, tenderness, excessive warmth, or swelling that does not subside with elevation.
Reintegrating into Daily Activities
The increased mobility and reduced pain at three weeks allow for the cautious resumption of many daily tasks. Returning to driving depends heavily on the operated leg and whether you are still taking narcotic pain medication. If the surgery was on the left knee and you drive an automatic vehicle, some surgeons may clear you to drive as early as two weeks. For a right knee replacement, the wait is typically at least four weeks to ensure sufficient reaction time and strength for the brake pedal.
Individuals with sedentary or light-duty occupations may be able to return to work at this point. This is provided they can comfortably manage the commute and have opportunities to elevate their leg and move periodically. Simple household activities, like cooking and light cleaning, can be performed, but it is important to pace yourself. Avoid tasks that require heavy lifting, twisting, or prolonged standing.
To improve sleep quality, which is crucial for healing, try sleeping on your back with your leg elevated on pillows placed under the calf and ankle. Avoid placing pillows directly beneath the knee. If you prefer side sleeping, lie on your non-operative side and place a pillow between your knees to maintain proper joint alignment.