Five weeks after a total knee replacement marks a significant shift in recovery, moving the focus from acute post-surgical care toward functional improvement. This intermediate phase allows for more intensive physical rehabilitation as initial soreness and limitations begin to recede. Consistent daily effort is rewarded with noticeable gains in mobility and strength. The goal is to actively retrain the body to use the new joint effectively, often without reliance on walking aids.
Physical Milestones and Healing Status
By five weeks, patients should experience a substantial reduction in pain compared to the first few weeks, often leading to a significant decrease in reliance on prescription medication. Many individuals transition to using over-the-counter pain relievers or stop medication entirely. Discomfort at this stage is usually related to physical therapy and activity rather than the surgery itself, though soreness or a low-grade ache after exercise remains common.
The surgical incision should be well-healed, appearing fully closed and dry, with staples or sutures typically removed around two weeks post-operation. The scar line will likely be pink or slightly red and can be gently massaged to soften the scar tissue and improve flexibility. Generalized swelling in the leg should be much less pronounced. However, localized swelling around the knee is still common and often fluctuates, increasing temporarily after periods of activity.
Mobility capabilities are significantly improved at this stage, with many patients walking without a cane or walker for short distances indoors. The focus shifts from simply bearing weight to normalizing the gait pattern and avoiding a limp. While walking distance increases, it is still advisable to use ice and elevation consistently after activities to manage intermittent swelling.
Targeted Rehabilitation Goals
At five weeks, physical therapy becomes more challenging and prescriptive, focusing on measurable achievements in joint movement. A primary goal is to achieve full knee extension, meaning the leg can straighten completely. Flexion goals are typically 100 to 110 degrees, as achieving at least 100 degrees of knee bend is necessary for basic daily activities like climbing stairs and sitting comfortably.
The nature of the exercises shifts from basic range-of-motion work to targeted strengthening of the muscles surrounding the new joint. Specific attention is given to the quadriceps, which are often weakened by the surgery, as well as the hamstrings and calf muscles. Exercises like straight leg raises, mini-squats with support, and heel slides are progressed by increasing repetitions or introducing light resistance.
Formal therapy sessions are typically maintained two to three times per week, but the home exercise program is of equal importance. Patients must perform prescribed exercises multiple times daily to prevent stiffness, a major complication at this stage. Consistency is paramount for maximizing range of motion gains before scar tissue matures and becomes less pliable.
Resumption of Daily Activities
The intermediate recovery phase allows for the careful reintroduction of many everyday functional tasks, signaling a return to greater independence. Driving is often considered safe to resume around four to six weeks post-surgery. This requires the patient to be completely off prescription opioid pain medication and have the necessary strength and reaction time to quickly move their foot between the gas and brake pedals. Safety is the primary consideration, though patients with left knee surgery and an automatic car may return slightly earlier.
Managing household tasks becomes easier, though heavy lifting, vacuuming, and prolonged standing are still discouraged to prevent increased swelling. Stair navigation should progress to a step-over-step pattern, though using a railing for support remains prudent. Patients with light-duty occupations may consider returning to work around this time, while those requiring manual labor or prolonged standing will need to wait longer.
Low-impact activities, such as using a stationary bicycle, are highly recommended and can often be introduced safely. The cycling motion is excellent for improving range of motion and building quadriceps endurance. For sleeping, patients generally do not need a special position. However, they should continue to avoid placing a pillow directly under the knee, as this encourages a bent position and makes achieving full extension more difficult.