Knee and hip replacement recovery: exercises, care and warning signs

A knee or hip replacement replaces a worn joint with an artificial one, usually to ease pain and improve movement. The operation is only the start: the weeks and months of rehabilitation, which means the exercises and care that help you regain strength and movement, matter just as much. This article reviews what NHS and MedlinePlus pages say about recovery and warning signs.

1. Introduction

The NHS says it may take several months to recover from a hip replacement and several months or longer from a knee replacement, depending on age and general health ^{[1, 2]}. MedlinePlus says full recovery after knee replacement takes about 4 months to a year ^[5]. Following the aftercare advice from your surgical team is described as key to a good recovery ^[1].

2. In hospital

After the operation you rest in a recovery room, where you may be given pain medicine, and you keep taking pain relief for several days because the joint will be sore ^{[1, 2]}. Nurses and physiotherapists, who are health professionals trained in movement and exercise, help you start walking soon after surgery, at first with crutches or a walking frame ^{[1, 2]}. MedlinePlus says you may be asked to move and walk as soon as the day of surgery after a knee replacement ^[5].

You can usually go home when there are no signs of complications and you can move around safely. The NHS gives typical stays of 1 to 3 days after a hip replacement and 1 to 4 days after a knee replacement ^{[1, 2]}. Compression stockings are usually given to lower the risk of blood clots ^{[2, 3, 4]}. Before you leave, a physiotherapist or occupational therapist, who helps with daily activities, explains how to manage at home and gives you an exercise programme ^{[1, 2]}.

3. Exercises and physiotherapy

Starting the exercises early is linked with better long-term strength and movement ^{[1, 2]}. The NHS advises you to:

• Do the exercises your physiotherapist recommends.
• Walk every day, as far as is comfortable ^[1].
• Move from two crutches to one and then to a stick as your confidence grows after a knee replacement ^[2].
• Raise any problems with your physiotherapist ^[1].

Stitches or clips are usually removed by a nurse at about 10 days ^{[1, 2]}. A follow-up visit is usually planned about 6 weeks after a knee replacement and 6 to 12 weeks after a hip replacement ^{[1, 2]}.

4. Everyday precautions

After a knee replacement, the NHS suggests ^[2]:

• Keep your leg raised as much as possible to reduce swelling.
• Do not cross your legs for the first 6 weeks, and do not sleep with a pillow under the knee.
• Do not kneel on the new knee until your doctor says it is safe.
• Avoid standing for long periods, which can swell the ankle.
• Avoid heavy household tasks, such as vacuuming or carrying shopping, for the first 3 months.

After a hip replacement, the NHS suggests ^[1]:

• Do not cross your legs and do not bend the hip beyond a right angle.
• Do not bend down to touch your feet or ankles.
• Avoid low chairs, low toilet seats and chairs without arms, because they make standing hard. Raised toilet seats are available.
• Avoid jumping, sudden turns and activities with a high risk of falling while the hip heals.
• Do not lift heavy objects until you are told it is safe.

Your surgeon may give you different instructions that suit your operation, so follow their advice first.

5. Driving and work

The NHS advises waiting at least 6 weeks before driving after a hip replacement or a total knee replacement, and at least 3 weeks after a partial knee replacement, and checking with your doctor first ^{[1, 2]}. People usually return to work when they feel ready: typically about 6 weeks after hip replacement and 6 to 12 weeks after knee replacement, depending on the type of work ^{[1, 2]}.

6. Possible complications

Both operations carry risks ^{[3, 4]}:

• Blood clots. A clot in a leg vein is called deep vein thrombosis. If it travels to the lungs it is called a pulmonary embolism and is serious.
• Wound infection. This is uncommon and usually treated with antibiotics, but infection deep in the joint may need more surgery.
• Nerve, blood vessel or ligament damage. This is uncommon.
• Ongoing knee problems. These can include trouble bending the knee, pain, stiffness or a feeling of instability.
• Hip dislocation or wear. The hip may dislocate, causing pain, swelling or clicking, and an implant can wear over time ^[4].
• Leg length difference. The operated leg may end up slightly longer after hip surgery, though most people do not notice ^[4].

The NHS says most knee replacements last about 25 years, and implants for the hip are designed to last at least 15 years but can wear over time ^{[3, 4]}. MedlinePlus says over 90 percent of artificial knee joints last more than 15 years, and that smoking slows wound and bone healing ^[5].

7. When to see a doctor

The NHS says to get an urgent doctor's appointment or call a health helpline if, after a replacement, you have throbbing or cramping pain in the leg, a high temperature or feeling hot, cold or shivery, oozing or pus from the wound, or redness, tenderness, swelling or pain that is not improving or is getting worse. These can be signs of infection or a blood clot ^{[3, 4]}. If you have a metal-on-metal hip implant, tell your care team about new hip pain, reduced movement or a popping or clicking sound ^[4]. Pain and swelling in the leg together with difficulty breathing or chest pain could be a pulmonary embolism and needs immediate help. Do not drive yourself ^[3]. In an emergency, call your local emergency number (112 in India, 911 in the United States).

8. Conclusion

Recovery after knee or hip replacement takes months and relies on early movement, regular physiotherapy exercises, sensible precautions and follow-up visits. Knowing the warning signs of infection and blood clots helps you get help quickly. Your surgeon and physiotherapist decide the plan for you, so ask them if anything is unclear.