A total knee replacement is a major surgery that can bring huge improvements to your quality of life. When successful—and they usually are—a TKA can restore function, relieve pain, and help you return to your most loved activities. But how long does it take to recover? Keep reading for my perspective as a Physical Therapist on the general timeline of a typical knee replacement recovery.
Every Recovery Is Different
I see many TKA candidates in the clinic, and within the initial evaluation many of them want to know: “When can I get back to ______?”, followed by whatever activity they are most looking forward to—be it jogging, golfing, gardening, or even simply walking.
My answer always comes with a caveat: it depends. Your recovery will depend on how physically active you were before the surgery and how fit you are currently. Other factors such as age, weight, and existing medical diagnoses also play a part in how long your recovery will be.
Moreover, the way your body responds to the surgery can influence your recovery time. If you experience excessive swelling and pain, it may take you longer to get back on your feet. But a supportive home environment can catalyze a swift recovery, as will consistent adherence to the physical therapy program you’re given after surgery.
In this post I’ll give you a general timeline of a typical knee replacement recovery, but bear in mind that every recovery is different. Your experience may not exactly mirror that of your neighbor, relative, or friend—or even the recovery timeline outlined below. And that’s ok!
Knee Replacement Recovery Milestones
So what can you expect after knee surgery? Below I’ll outline the typical progression I see in many TKA patients within the first six weeks. In physical therapy, we measure progress in terms of a patient’s range of motion (ROM), strength, and mobility. Your doctor may follow different protocols and give you a different timeline for your knee replacement recovery, so use this post for reference only.
Surgery Day and Hospital Stay (Days 1–3)
Immediately after your surgery, you’ll get in and out of your hospital bed with the help of the nursing staff and hospital PT. They may even have you standing and using the bathroom within just a couple hours of your surgery, which will feel like quite an accomplishment!
Most likely, you’ll only need to stay in a hospital for 1 to 2 days after a knee replacement. But it’s not uncommon for a patient to stay longer or be discharged to a short-term skilled nursing facility before going home.
Depending on your condition, you may start outpatient PT right away after discharge. Otherwise, your surgeon will arrange for home health PT for the first 5–10 days. Either way, you’ll likely receive physical therapy 2–3 days a week, starting with ROM and strengthening exercises.
For the first week, you may have to keep your knee bandaged until the incision site can close and fully heal. Meanwhile, your knee will feel very weak, and you’ll need a walker to get around. You may not be able to straighten your knee all the way or bend it past a 70–80º flexion.
Once the incision is closed—usually around the second week—the bandage will be removed. You may feel you have better control of your leg, and despite muscle soreness be able to get around with a walker or even just a cane. If you’ve made good progress in therapy, then by the end of week 2 you may be able to extend your leg straight and achieve 90º flexion in your knee.
In the ensuing weeks, your therapist will focus on helping you transition from a walker to a cane without limping. The goal for your range of motion may be to achieve a 90–100º of knee flexion in week 3, or 100–110º of flexion in week 4.
To desensitize the incision site and help smooth it out, your therapist may incorporate a gentle scar massage into your regular routine. By the third week, you may be able to walk around using only a straight cane. Despite the improved strength, however, you’ll likely still have poor balance and weak stamina.
You’ll need to use a cane until you can achieve a smooth gait or walking pattern—in other words, until you can walk without limping. But by week 4, you should be seeing marked improvements in your gait and feel closer to achieving that goal.
During the final weeks of therapy, you’ll focus primarily on strengthening your leg, achieving a full range of motion, and walking without limping. When you’re ready, your therapist will help you learn to safely navigate stairs.
By week 5, you should be able to walk without a cane most of the time without a limp. Your leg will feel stronger but still experience fatigue and swelling after physical activity. Many patients are able to bend their knee to 110–120º of flexion in the fifth week after surgery.
After a few more visits, you may be able to achieve a normalized walking pattern and no longer need a cane at all. Your therapist will want to make sure you can bend your knee to 120+ degrees of flexion and extend it fully straight. Although your strength and balance will be much better than a few weeks ago, it’ll take longer for both to fully recover.
Depending on your progress, you may be discharged from PT as early as week 6, though many patients continue for a few more visits. And once you’re discharged, you’ll continue your physical therapy exercises at home in order to continue making strides in balance and strength.
When Will I Feel FULLY Recovered?
All in all, six weeks isn’t a lot of time to recover from such a major surgery! You may be able to make all of your PT goals and milestones during the above 6–8 weeks, but it can take up to 12 months for your knee to fully recover.
If that’s disappointing, consider: TKA surgery is a major trauma for your knee. Even in someone who is healthy and fit, it can take months for bones and soft tissue to fully heal. One setback many patients experience is stubborn swelling in response to exercise or physical activity. This swelling can persist for months following knee surgery and up to a year.
The best way to ensure a swift recovery is to prioritize your rehab after surgery. Don’t fall off the wagon! Stick with your exercises and follow your physician’s and PT’s advice to the letter.
You may feel impatient to return to your activities, but the time will go by fast. With the right amount of persistence and optimism, you’ll accomplish a lot during your first 6–8 weeks. And if you’re consistent with your exercises past the 6-week mark, you’ll be able to accelerate your knee’s healing and be closer to achieving normalcy for the long run.