Total knee replacement (TKR) surgery involves resurfacing the damaged ends of the thigh and shin bones with metal and plastic implants to restore joint function. This procedure is effective for alleviating severe, chronic knee pain caused by arthritis or injury. The first week following the operation is the most intense period of recovery and sets the stage for long-term success. Understanding expectations allows for better preparation and a smoother recovery process.
Managing Pain and Medication During the First Week
The initial days after total knee replacement involve significant discomfort as the body begins healing from a major surgical procedure. Pain is typically most acute during the first 48 to 72 hours and then gradually subsides over the remainder of the week. This early pain is a normal response to the bone and soft tissue manipulation required to implant the new joint components.
Modern pain management following TKR employs a multimodal strategy to provide effective relief while minimizing reliance on a single type of medication. This approach may include a continuous epidural or peripheral nerve block that numbs the leg for the first day or two after surgery. Once the nerve block wears off, a combination of medications is used, typically including opioids for severe pain, non-steroidal anti-inflammatory drugs (NSAIDs), and acetaminophen.
Adherence to the prescribed medication schedule is important, even if the pain level feels manageable at a given moment. Taking pain medication before activity or before the pain becomes severe helps to “stay ahead” of the discomfort, which makes physical therapy more productive and reduces overall inflammation. Patients are advised to use ice packs for 15 to 20 minutes every one to two hours, as cryotherapy reduces swelling and pain without medication.
A common side effect of opioid medication is constipation, which can be particularly bothersome during early recovery. To counteract this, patients are advised to proactively take a stool softener or mild laxative alongside the narcotic pain relievers, in addition to maintaining adequate fluid intake. Effective pain control is foundational for engaging in early physical rehabilitation.
Regaining Mobility Through Early Physical Therapy
Physical therapy starts almost immediately, often on the same day as the surgery or the morning after, with the goal of restoring movement and preventing stiffness. Movement is actively encouraged from the outset, starting with small, gentle exercises performed while in bed. The initial post-operative goals focus on achieving functional mobility, such as safely getting out of bed, transferring to a chair, and walking short distances using a walker or crutches.
Specific exercises are mandatory during this first week to promote circulation and begin regaining range of motion. Ankle pumps, where the foot is repeatedly flexed and extended, are performed frequently throughout the day to help prevent deep vein thrombosis (DVT). Quadriceps sets, which involve tightening the thigh muscle to push the knee down, and straight leg raises are introduced early to activate and strengthen the muscles supporting the new joint.
A primary focus is on regaining knee flexion (bending) and extension (straightening). Heel slides, where the heel is slid toward the buttocks to bend the knee while lying down, are a foundational exercise to increase flexion. Physical therapists will guide the patient in passive and active range-of-motion exercises to work toward an initial goal of around 80 to 90 degrees of knee bend by the end of the first week.
While the immediate focus is on gentle movement, walking is a core component of early recovery, and patients are typically weight-bearing as tolerated on the operated leg. Consistency is paramount, and patients are given a structured home exercise program to perform multiple times a day between supervised therapy sessions. Movement and elevation help manage the inevitable swelling that results from the necessary activity.
Caring for the Surgical Site and Preventing Infection
Proper management of the surgical incision is paramount during the first week to ensure healing and prevent the serious complication of infection. The incision is typically closed with staples, sutures, or surgical glue, and covered with a sterile dressing that should remain clean and dry. The dressing type and timeline for removal depend on the surgeon’s preference, but many waterproof dressings are designed to stay in place for the first week.
Patients are advised to keep the incision completely dry until permitted to shower, which may be 24 to 48 hours or up to four days after surgery, depending on the dressing used. When showering is allowed, the site should be gently patted dry afterward, and submerging the knee in a bath, pool, or hot tub is prohibited for several weeks. It is important to inspect the incision daily for any changes, which requires clean hands before and after touching the area.
Normal findings around the incision during the first week include some mild redness, bruising that may extend down the leg, and slight drainage that is clear or light pink. The skin surrounding the incision may also feel slightly warmer than the surrounding tissue due to the localized inflammatory response. These signs are part of the body’s natural healing process and should not cause alarm unless they worsen suddenly.
Signs that may indicate a localized infection require immediate attention from the surgical team. These signs include increased warmth or spreading redness that extends far beyond the incision’s edge, a foul odor, or thick, pus-like yellow or green drainage. Any opening along the incision or a persistent, increasing pain that does not respond to medication should also be reported promptly.
Recognizing Normal Systemic Effects and Warning Signs
The body’s response to major surgery extends beyond the knee itself, leading to several common systemic effects during the first week of recovery. Extreme fatigue is a universal experience, resulting from the physical trauma of the operation, the effects of anesthesia, and the body’s energy expenditure on healing. Disrupted sleep patterns are also common, as the pain and discomfort can become more noticeable when lying down at night.
Appetite and bowel habits frequently change in the immediate post-operative period due to medication side effects and the overall stress on the system. A low-grade fever, generally below 101.5°F, can occur in the first few days as a generalized inflammatory reaction to the surgery. These effects are expected and usually resolve as the body adjusts and the pain subsides.
However, certain symptoms demand immediate medical attention as they may signal serious complications. Deep Vein Thrombosis (DVT), a blood clot forming in the deep veins of the leg, is a risk after TKR. Signs of DVT include new or worsening swelling, persistent pain, cramping, or tenderness in the calf or thigh not related to the surgical incision. The affected area may also feel warm to the touch or show redness.
Systemic infection is indicated by a persistent high fever above 101.5°F that does not respond to acetaminophen, along with shaking chills or confusion. Additionally, symptoms such as sudden shortness of breath, chest pain, or coughing up blood can indicate a pulmonary embolism (PE). A PE occurs when a blood clot travels to the lungs and requires emergency care. Monitoring for these warning signs is a fundamental aspect of safe recovery during the first week.