The four-week mark after a total knee replacement signifies an important phase in the recovery journey. By this time, many individuals experience notable progress, transitioning from the immediate post-operative period to more active rehabilitation. This stage typically involves a gradual reduction in discomfort and an increase in mobility, allowing for a more engaged participation in the healing process. Understanding the typical expectations at this point can help individuals navigate their recovery with greater clarity.
Expected Physical Sensations
Around four weeks post-surgery, it is normal to experience a continuation of some physical sensations, though they should generally be improving. Pain levels typically decrease, but some discomfort remains, especially with activity or at night. Many individuals may be reducing their reliance on stronger pain medications by this point, with some possibly discontinuing them by six weeks. Swelling is also a common occurrence and can persist for several weeks to months after the procedure, often appearing as mild to moderate. Elevating the leg and applying ice can help manage this swelling, which usually peaks in the first few days and then gradually subsides.
Stiffness in the knee is another expected sensation, resulting from the body’s natural inflammatory response and the formation of scar tissue during healing. This stiffness typically improves with consistent physical therapy and movement. The surgical incision should show good healing by four weeks, with decreasing redness, bruising, and soreness. Avoid immersing the incision in baths, hot tubs, or pools until fully healed (typically four weeks) to reduce infection risk.
A significant focus at this stage is on regaining range of motion (ROM) in the knee. The goal for knee flexion, or bending, between four and six weeks post-surgery is often around 110 to 120 degrees. Achieving this level of flexion is beneficial for performing many daily activities, such as sitting comfortably in a chair or getting in and out of a car. Consistent engagement in prescribed exercises is important for improving both knee extension (straightening) and flexion.
Rehabilitation and Activity Milestones
The active recovery process is a central component of healing at four weeks post-total knee replacement. Physical therapy exercises are crucial for strengthening the muscles around the knee, including quadriceps, hamstrings, and calves, while also improving the knee’s range of motion. Common exercises at this stage may include heel slides, mini-squats, step-ups, and various stretches, all designed to progressively challenge the knee. A stationary bike can also be beneficial for improving knee flexion and engaging in low-impact activity.
Progress in walking is a major milestone observed during this period. Many individuals begin transitioning from assistive devices like walkers to a cane, or may even be able to walk independently for short distances. It is common to walk for 10 minutes or more at a time without significant assistance by four to six weeks post-surgery. Maintaining a proper heel-toe walking pattern is encouraged to promote a natural gait and reduce the risk of developing a limp.
Consistent adherence to the physical therapy program is highly beneficial for optimizing recovery outcomes. Early, regular movement helps to improve circulation, which can reduce swelling and prevent the formation of excessive scar tissue. This active engagement aids physical healing and restores confidence in knee function. A physical therapist’s guidance ensures safe, effective exercises, progressing as the knee gains strength and flexibility.
Resuming Daily Life Activities
At four weeks post-total knee replacement, individuals typically gain more independence in performing daily tasks. Most manage basic self-care, such as showering and dressing, with greater ease. Light household chores may be manageable, but avoid heavy lifting, prolonged standing, or repetitive bending to protect the healing knee. Gradually reintroducing activities helps to rebuild strength and endurance.
Sleeping can be challenging due to lingering stiffness or discomfort. Changing positions or short walks may help alleviate stiffness and promote better sleep. Effective pain management supports restful sleep, aiding overall recovery.
Resuming driving is a common question, with varying timelines. For a left knee replacement in an automatic vehicle, driving may be possible as early as two weeks if not taking narcotic pain medication. For a right knee replacement, driving is generally not recommended for at least four weeks or longer, due to brake pedal use requiring adequate reflexes and muscle strength. Medical clearance from the surgeon is necessary, and most patients are cleared between four to six weeks post-surgery, provided they are off narcotic pain medications.
Recognizing When to Seek Medical Attention
While many sensations are normal, certain signs require prompt medical attention. Seek evaluation for sudden, severe, or worsening pain that doesn’t improve with rest, ice, or elevation. Contact your medical team for new or increasing redness, warmth, or yellow/foul-smelling drainage from the surgical incision.
A fever of 101.6°F (38.7°C) or higher could indicate infection. Report new numbness or tingling around the knee or lower leg. Symptoms of a blood clot, like throbbing pain, leg swelling, chest pain, or difficulty breathing, require urgent medical assessment. Recognizing these signs and seeking timely medical advice addresses potential complications.