The First Two Weeks at Home After a Knee Replacement

The clinical side of the first fortnight gets covered properly before you leave hospital. The practical side often does not, and it turns out to be what people most want to know: how do I wash, how do I sleep, what do I actually need to buy, and is my scar meant to look like that.

None of it is complicated. It is just rarely written down, and it is difficult to ask about in a ten-minute appointment.

This page is the practical companion to the week-by-week recovery timeline. If you have not had surgery yet, preparing for a knee replacement covers what to sort out beforehand — most of what follows is far easier if it is organised in advance.

Washing and showering

The most common question, and the one people are most reluctant to ask.

It depends entirely on your dressing, so the instruction you were given at discharge governs. Many modern surgical dressings are waterproof and allow a shower within a day or two. Others must stay completely dry until they are removed. If you are not certain which you have, phone and ask — it takes a minute and it is a much better use of a phone call than most.

If you can shower:

• A non-slip mat and a shower stool are the two things that prevent the single most common accident after joint surgery. If there is any doubt about balance, use both
• Get the water temperature right before you get in. The skin around the scar is numb and cannot be relied on to tell you it is too hot
• Keep the operated leg out in front rather than standing on it while you turn
• Pat the area dry rather than rubbing, and let it air for a few minutes

If you cannot shower yet, washing at the sink works perfectly well for a fortnight. A no-rinse foaming cleanser, a flannel and a bowl covers it. Hair is the awkward part — over a kitchen sink, at a basin with a jug, with a dry shampoo in between, or with help. People living on their own do this routinely and it is entirely manageable.

What not to do: no baths, no spas, no swimming pools and no ocean until the wound is completely healed and you have been told it is fine. Soaking a healing wound is a different proposition from running water over a sealed one.

Sleeping, and the leg at night

Broken sleep in the first fortnight is close to universal. It improves as the pain settles, and it is a large part of why week two feels harder emotionally than it does physically.

Position. Most people sleep on their back early on — it is the easiest position to keep the knee straight in, and keeping it straight is the priority. Side sleeping usually becomes possible once the knee is less sore, often with a pillow between the knees.

Prop the calf, not the knee. A pillow directly under the knee is the most comfortable thing in the house and it quietly works against your straightening. Put it under the calf and heel so the knee hangs straight.

On elevation at night: elevate if it helps you sleep, and do not lie awake maintaining a position. Daytime elevation, when you are resting anyway, does most of the work. Sleep does the rest, and sleep is not optional.

The bedding problem. Many people find sheets or blankets resting on the leg unpleasant — the skin is sensitised, and the weight is enough to be irritating. Sleeping on top of the covers under a light blanket solves it, as does anything that holds the bedding off the leg.

Other things that help: ice before bed as routine rather than in response to pain, timing the evening dose of pain relief so it covers the small hours, and getting up and moving briefly if the knee has stiffened rather than lying there waiting for it to pass. Pain relief after a knee replacement covers the medication side, and night pain specifically.

Restless legs. A crawling, twitchy, cannot-keep-them-still feeling at night is commonly reported in the early weeks. It is unpleasant rather than dangerous, and reduced activity, disturbed sleep and medication changes all contribute. If it is persisting, raise it with your GP rather than working through the remedies circulating online — checking iron levels and reviewing your medications is the sensible first step.

The wound and the scar

What is expected in the first fortnight:

• Bruising spreading downwards towards the calf, ankle and occasionally the foot. This looks dramatic and is simply gravity moving blood that was already there
• A rim of redness along the wound line itself
• Swelling of the knee, and often the whole lower leg
• Warmth around the knee — a new knee runs warm for months
• Small blisters where a dressing has pulled against swollen skin. Common, and usually settle once the tension comes off
• Numbness to the outer side of the scar, which is expected and permanent in part. Numbness, zaps and nerve pain explains why

What is not expected, and needs a phone call:

• Fluid, blood or discharge coming through the dressing or from the wound
• Redness spreading outwards from the wound rather than sitting along it
• Increasing pain, heat or swelling rather than gradually settling
• Fever or chills, or feeling generally unwell
• The wound opening, or edges separating

If you are unsure, photograph it and phone the rooms. Do not wait for the next appointment to show someone something that is worrying you now, and do not try to decide from a photograph on the internet whether yours looks the same.

Longer term, the scar stays pink or red and slightly raised for several months and fades over about a year to eighteen months. Once it is fully healed, scar massage and keeping it out of the sun both help the final appearance. Ask at your review when to start.

What is actually worth having

Keeping this honest: a great deal is sold to people recovering from joint replacement, and most of it is optional.

Genuinely useful:

• Ice packs — several. So there is always one frozen. You will use them more than you expect, and the simple wrap-style pack the hospital provides is usually the most practical thing in the house
• A walking aid fitted to your height. Crutches or a frame, sized by your physiotherapist rather than guessed
• A firm chair with arms that you can stand up from without hauling. Low soft armchairs are the enemy for a fortnight
• Something to prop the heel on — a rolled towel, a foam bolster, a cushion. Anything that supports the calf and leaves the knee free
• A non-slip bathroom mat, and a shower stool or rail if there is any doubt at all
• A long-handled grabber, which saves a great deal of awkward bending
• A raised toilet seat, particularly if your toilet is low
• A bag or small backpack, because both your hands are occupied by the walking aid and carrying a cup of tea becomes a genuine problem

Optional — some people find them worthwhile, nobody needs them:

• Cooling machines that circulate iced water through a wrap. They are convenient and they are not more effective than ice packs changed regularly. If you buy one, freezing water bottles rather than buying ice is the usual economy
• TENS units. Evidence for them after knee replacement is limited. They are not harmful and some people find them helpful; they are not a substitute for the pain relief plan
• Compression garments beyond whatever you have been prescribed. Ask before adding anything

A sock aid and a long-handled shoe horn sit somewhere between the two lists — unnecessary for most, invaluable if bending to your feet is difficult.

Getting through the day

Little and often. Short walks several times a day beat one long effort. The knee responds badly to a single big push and well to repetition.

Rest properly between efforts. Leg up, heel supported, ice on. This is not time off from recovery — it is a working part of it, because swelling physically limits how far the knee will bend.

Expect the evenings to be worse. Swelling accumulates through the day. A knee that is fine at ten in the morning and miserable at eight at night is behaving normally.

Set the house up around one base. A chair, a side table, the ice, the medication, a drink, a phone charger and something to prop the leg on. Moving around should be a choice rather than a requirement.

Keep moving, though. Long stretches of sitting still raise the risk of clots and stiffen the knee. Get up regularly even when there is no particular reason to.

Take the pain relief on schedule. The most common and most costly mistake of this fortnight, covered properly on the pain relief page.

And accept the help. The first two weeks are the stretch where people most need a hand and are most reluctant to ask for one.

If you are on your own

It is entirely manageable and it takes more planning.

Meals cooked and frozen in advance. Everything you use daily brought up to waist height so nothing needs a deep reach or a bend. A way of carrying things while both hands are on a walking aid. A phone kept on you rather than across the room. Somebody who checks in daily and can be called on at short notice.

Say so before surgery rather than after. If going straight home is not practical, a short stay on a rehabilitation ward can be arranged, and that is a normal path rather than a failure.

This page is general practical information. Where the instructions from your surgical team differ from anything here — particularly about your dressing and when the knee can get wet — follow theirs.

If something about the first fortnight is worrying you, phone the rooms on (08) 6332 6365. Appointments can be made through the contact page.