Taking care of your new knee joint

Knee arthroplasty - precautions; Knee replacement - precautions

What to Expect at Home

After you have knee replacement surgery, you will need to be careful about how you move your knee, especially for the first few months after surgery.

In time, you should be able to return to your previous level of activity. But even then, you will need to move carefully so that you do not injure your new knee replacement. Be sure to get your home ready for when you return, so you can move more easily and prevent falls.

Your knee has been hurting for a while, and it hurts bad. You've had trouble sleeping. It may be hard to bathe, to do normal chores like wash the car, or even be comfortable on the job. You may have severe arthritis in your knee, and if so there's a good chance you need a knee replacement. So, what is a knee replacement? Knee replacements are usually done in people age 60 and older. If you need one, you probably have severe arthritis that limits your daily life. During knee joint replacement, your surgeon will remove damaged cartilage and bone from the knee joint. The surgeon then puts man-made pieces, called prostheses, in their place. The lower end of the thigh bone, also called the femur, is usually replaced with a metal part. The part that replaces the upper end of the shin bone, the tibia, is usually made from metal and a strong plastic. The piece that replaces the back side of your kneecap, or patella, is usually made from a strong plastic. You shouldn't feel any pain during surgery because you will have medicine to make you fall asleep. The surgeon will make a cut over your knee to open it up. The cut is usually eight to ten inches long. Your surgeon will move your kneecap out of the way, then cut the ends of your thigh bone and shin bone to fit the replacement part. The surgeon will then cut the underside of your kneecap and prepare it for the new pieces that will attach there. The surgeon then fastens the two parts of the prosthesis to your bones, the upper end of the shin bone and the lower end of the thigh bone. Then the parts are attached to the underside of your kneecap using a special cement. The surgery usually takes a couple hours. After surgery, you will probably stay in the hospital for three to five days. As soon as the first day after surgery, you will be asked to start moving and walking around with a walker, crutches, or a cane. You will likely need physical therapy to strengthen your new joint after your operation. Some people need a short stay in a rehabilitation center after they leave the hospital. At the rehab center, you will learn how to safely do your daily activities on your own. Full recovery can take three months to a year. Your new knee should last for 15 years or maybe even 20. And in the mean time, your new knee should allow you to resume your daily activities once you have learned to move around. Most or all of your pain and stiffness should go away.

Getting Dressed

When you are getting dressed:

Avoid putting your pants on while standing up. Sit on a chair or the edge of your bed, so you are more stable.
Use devices that help you get dressed without bending too much, such as a reacher, a long-handled shoehorn, elastic shoe laces, and an aid for putting on socks.
First put pants, socks, or pantyhose on the leg that you had surgery on.
When you undress, remove clothes from your surgery side last.

Sitting

When you are sitting:

Try not to sit in the same position for more than 45 to 60 minutes at a time.
Keep your feet and knees pointed straight ahead, not turned in or out. Your knees should be either stretched out or bent in the way your therapist instructed.
Sit in a firm chair with a straight back and armrests. After your surgery, avoid stools, sofas, soft chairs, rocking chairs, and chairs that are too low. Sitting on a cushion can help you from sitting too low. It can be difficult to get up from a low chair after knee surgery.
When getting up from a chair, slide toward the edge of the chair, and use the arms of the chair, your walker, or crutches for support to get up.

Bathing and Showering

When you are bathing or showering:

You may stand in the shower if you like. You can also use a special tub seat or a stable plastic chair for sitting in the shower.
Use a rubber mat on the tub or shower floor. Be sure to keep the bathroom floor dry and clean.
Do not bend, squat, or reach for anything while you are showering. You can use a reacher if you need to get something.
Use a shower sponge with a long handle for washing.
Have someone change the shower controls for you if they are hard to reach.
Have someone wash the parts of your body that are hard for you to reach.
Do not sit down in the bottom of a regular bathtub. It will be too hard to get up safely.
If you need one, use an elevated toilet seat to keep your knees lower than your hips when you use the toilet.

Using Stairs

When you are using the stairs:

When you are going up stairs, step first with your leg that did not have surgery.
When you are going down stairs, step first with your leg that did have surgery.
You may need to go up and down one step at a time until your muscles get stronger.
Make sure you hold onto the banister or holders along the stairs for support.
Check to make sure that your banisters are in good condition prior to surgery. It is important to make sure it is safe to use them.
Avoid long flights of stairs for the first 2 months after surgery.

Lying Down

When you are lying down:

Lie flat on your back. This is a good time to do your knee exercises.
Do not place a pad or pillow behind your knee when lying down. It is important to keep your knee straight when resting.
If you need to raise or elevate your leg, keep your knee straight.

Getting Into and Riding in a car

When getting into a car:

Get into the car from street level, not from a curb or doorstep. Have the front seat moved back as far as possible.
Car seats shouldn't be too low. Sit on a pillow if you need to. Before you get into a car, make sure you can slide easily on the seat material.
Turn around so the back of your knee is touching the seat and sit down. As you turn, have someone help lift your legs into the car.

When riding in a car:

Break up long car rides. Stop, get out, and walk around every 45 to 60 minutes.
Do some of the simple exercises, like ankle pumps, while riding in the car. This helps reduce the risks of blood clots.
Take pain medicines before your first ride home.

When getting out of the car:

Turn your body as someone helps you lift your legs out of the car.
Scoot and lean forward.
Standing on both legs, use your crutches or walker to help you stand up.

Ask your surgeon when you can drive. You may need to wait up to 4 weeks after surgery. Do not drive until your surgeon says it is OK.

Walking

When you are walking:

Use your crutches or walker until your health care provider or physical therapist tells you it is OK to stop, which is often around 4 to 6 weeks after surgery. Use a cane only when your provider tells you it is OK.
Put only the amount of weight on your knee that your provider or physical therapist recommends. When standing, stretch your knees as straight as possible.
Take small steps when you are turning. Try not to pivot on the leg that was operated on. Your toes should be pointing straight ahead.
Wear shoes with nonskid soles. Go slowly when you are walking on wet surfaces or uneven ground. Do not wear flip-flops, as they can be slippery and cause you to fall.

Activities you Cannot do After Full Recovery

You shouldn't downhill ski or play contact sports such as football and soccer. In general, avoid sports that require jerking, twisting, pulling, or running. You should be able to do lower-impact activities, such as hiking, gardening, swimming, playing tennis, and golfing.

Other directions you will always need to follow include:

Take small steps when you are turning. Try not to pivot on the leg that was operated on. Your toes should be pointing straight ahead.
Do not jerk the leg that was operated on.
Do not lift too much weight. This will place too much stress on your new knee. This includes grocery bags, laundry, garbage bags, tool boxes, and large pets.

References

Hui C, Thompson SR, Giffin JR. Knee arthritis. In: Miller MD, Thompson SR, eds. DeLee, Drez, & Miller's Orthopaedic Sports Medicine. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 104.

Mihalko WM. Arthroplasty of the knee. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 7.

Version Info

Last reviewed on: 8/12/2023

Reviewed by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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