Hospital stays keep getting shorter. A knee replacement that once meant a week in hospital now often means one or two nights, and then you are home, with a walker, a list of exercises, and a body that has been through a significant event. The surgery is the surgeon’s work. The recovery is mostly yours, and it happens in your hallway, your bathroom, your stairs.
The first week: three jobs
Move, in small doses, often. Short walks around the house, ankle pumps to keep blood moving, and the specific exercises your surgical team prescribed. Frequent and gentle beats heroic and rare.
Manage swelling like it is your job. Elevation, the leg up on pillows, above heart level, plus ice as directed. Swelling is the thing that stiffens joints and stalls progress, and the first week is when you have the most influence over it.
Stay ahead of pain, within the plan. Take prescribed medication as directed rather than waiting until pain is severe. You do not win anything by toughing it out; pain that is out of control stops you moving, and moving is the treatment.
What physiotherapy adds
After joint replacement, the research picture is reassuring in one specific way: for most people, a well-run home exercise program gets results comparable to clinic-based programs. A systematic review and meta-analysis of physiotherapy exercise after total knee replacement (18 trials, 1,739 patients) found improved function and less pain at three to four months with structured exercise, and no meaningful difference between home and outpatient delivery. A similar review after hip replacement found physiotherapist-directed home exercise improved strength, walking speed, and step rate just as well as supervised sessions.
That is the model we work in. Our visits focus on the things that need eyes and hands: checking your walking pattern, measuring joint movement, progressing the exercises at the right speed, spotting problems early, and answering the hundred small questions (“is this clicking normal?”) that pile up between surgical follow-ups.
The honest timeline
The first two weeks are the hardest, poor sleep, bruising that looks alarming, energy that disappears by noon. Weeks three to six bring steady, visible gains: walking further, stairs getting easier, the joint loosening up. Most people feel genuinely turned a corner by six weeks, and continue gaining strength and confidence for six months and beyond. Recovery is rarely a straight line. A bad day after two good ones is normal; a week of going backwards is worth a call.
Warning signs: get help the same day
- Fever, or wound redness that is spreading, or any drainage from the incision
- Calf pain or swelling in one leg that is new or getting worse
- Chest pain or sudden breathlessness, call 911
- Pain that escalates sharply instead of gradually improving
- A fall, especially onto the operated side
A note on the home itself
Before surgery, set the house up: a firm chair with arms, a clear path to the bathroom, night lights, loose items off the floor, meals you can reheat. If rehab is booked before the operation, we can help you plan that setup and teach the exercises while you are still moving well, it makes the first post-op week far less overwhelming.
References
- Artz N, Elvers KT, Lowe CM, Sackley C, Jepson P, Beswick AD. Effectiveness of physiotherapy exercise following total knee replacement: systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2015;16:15. Full text (PMC)
- Coulter CL, Scarvell JM, Neeman TM, Smith PN. Physiotherapist-directed rehabilitation exercises in the outpatient or home setting improve strength, gait speed and cadence after elective total hip replacement: a systematic review. Journal of Physiotherapy. 2013;59(4):219–226. PMID 24287215
General information only, not medical advice. Your surgeon’s instructions take priority wherever they differ.