Knee Replacement Surgery – What To Expect Each Month For 12 Months After

In this video, I’m going to overview what you can expect to happen each month after having a total or a partial knee joint replacement surgery. Now typically care for any replacement surgery ends about four to five months after the operation is done, but full recovery usually takes 12 months. For the majority of patients, be sure to watch the end of the video so that you can learn about what you should be doing four to five months after your surgery and beyond that up to a year. And this is information that surgeons just won’t be able to tell you.

I’m Dr. David specialist, physical therapist from El Paso manual physical therapy. And this channel is dedicated to helping people stay healthy, active and mobile, while avoiding unnecessary surgery injections and medications. Please consider subscribing to our channel so that you don’t miss out on any of the helpful videos that we post every single week.

So let’s talk about month one, you’ve just had your surgery, your knee is swollen and stiff, and you’re kind of freaking out probably in the hospital, you’re going to be in the hospital after this procedure is done. And what will happen the very next day within about 24 to 48 hours is a physical therapist is going to come and knock on your door in the hospital and they’re going to get you up to walk.

This happens almost every single time unless you’ve had some sort of complication. Or you have some other prior condition that prevents you from doing that, the surgeon is going to want you to stand up on your leg and begin to move around a little bit, then once you get sent home, you’ll probably be doing physical therapy at home, a physical therapist will come to your house, or you might be going to a clinic, it just depends on your situation.

And the priority during this first month after having a knee joint replacement is to get the swelling under control, and to get the range of motion backing your knee to be able to straighten it out all the way and bend it as much as you can. And also, to begin to get more mobile to begin to get on your feet more and walk around a bit, what you can expect is to be able to bend your knee to about 120 degrees.

So just to give you a perspective, this knee joint bends to about 90 degrees, and you need to be able to bend it another 30 degrees past that, hopefully your other knee has that at least that much motion, you got to get your knees as even as possible. And then you got to be able to straighten out your knee 100% to the day even the week after surgery, you might just bend about this much anywhere between lacking 10 degrees or 10 degrees short of zero.

And then 60 or 70 degrees is real common right after surgery, you’ll be given stretches from the surgeon likely and from your physical therapist, to get your knee to bend and straighten more, you’ll have to begin to do those multiple times a day. Other goals that you’re going to have to reach are to begin to stand on your feet and walk around for five to 10 minutes at a time.

And you’ll definitely be using a walker at the very least a cane, the majority of people will be using a walker, one of those big devices that that folds and opens up they’re kind of they kind of get in the way of things, but you need that stability from that device. So that you can be able to get to the bathroom or get to the kitchen and just get around in the home. And don’t plan on doing very much at home for the first month after treatment.

You’re going to want to have help ideally, have some meals already cooked for yourself, or have somebody cook for you have somebody do your laundry, you’re just going to need a rest and recover so that you don’t flare up the knee joint. So it doesn’t swell more because you want the swelling to go down. And so you definitely don’t mess up the procedure.

Since the procedure is still fresh all the implants that the metal parts that they put into your knee are still trying to stick to where they’re supposed to stick. And if you move around too much and you’re too active, you can loosen those parts. And that’s a bad situation. That’s where you’re going to potentially have to go back in for revision or it’s just going to slow down your recovery and mess up the surgery, you don’t want that something else that you’ll likely encounter during that first month after surgery is something called a continuous passive motion machine.

A CPM machine is what it’s often referred to in the healthcare field. And this is a big device that your leg sits in, you put it on your bed or on the couch, and then you strap your leg into it. And it’s usually got a remote control that’s wired to the machine. And what it does is it bends your knee very slowly and gradually and you set it to the degrees how far you want it to bend, and then it starts to straighten out your knee very gradually.

And the purpose of this is to give you some continuous motion, while you’re just sitting there lying there. And people will sleep in this device will be in it for over an hour to several hours at a time. And then we’ll have to get out of it at times as well. But the whole idea with this is to make sure that you get some motion in your knees so that you don’t stiffen up too much and not get your full range of motion. In the second month after knee replacement.

You might still be doing physical therapy at home, or you might be in the clinic at this time. The priority here is going to be to get all your motion back you should have already been gaining motion during the first month and you’re going to want to maximize your motion here in the second month.

You want to get completely flat; you want to straighten out your knee all the way, and then get all the way all the bending that you can achieve your knee joint where it’s healing where the surgical incision was. And with all the components that they put in there, everything’s fusing the way that it’s supposed to, it’s all scarring down the way that it’s supposed to, and you want that scarring, you don’t want excessive scarring. And there’s a chance of that happening.

Because it’s such an invasive procedure. I mean, they, they cut your knee wide open, and they’re replacing the ends of your bones. It’s really a phenomenal surgery. It’s a beautiful thing that we have this available to us. But it takes a lot of healing. And there’s a high risk for over healing or putting up putting in too much scar tissue. So making sure that you move and stretch that knee joint is of utmost importance right now.

But you do want to find a balance between how much you’re stretching and how much it aggravates you, because it is not typically very comfortable to stretch. And if you overdo it, it can promote more swelling, you do you need the swelling to go down further this month, but you will probably have some swelling for several months, maybe even the full year your knee is just not going to be the same on that side that was operated compared to the other neat for at least about a year, you’ll also become more active during this time your standing tolerance and walking tolerance should increase past 10 minutes, you should be able to last even up to 20 minutes at this point.

Of course, still using the walker, you don’t want to take a spill, you don’t want to fall or even have a stumble where you kind of start to fall and you have to catch yourself because if your legs move suddenly, that could loosen the hardware, the implants that were put into your knee. And you don’t want that to happen.

So it’s of utmost importance that you take great care in your balance and your ability to walk around and make sure that there’s nothing that can trip you throw rugs are a common thing that people trip over in the house, little rugs or mats that you have on the floor.

Pets are another common thing. Another reason why people will trip not just the pets themselves, but the things that they leave around, you know pet toys or things that pets have. It’s during this month, too, that if you have stairs at home, you need to be able to start to use them so that you can begin to get the strength back. And you should have more range of motion at this time to tolerate going up and downstairs.

So I need to begin to practice that during this time. Your wound, your surgical incision should be closing up all the way at this point. And now just want to note here you have to protect against infections, you have to keep that wound clean the whole time after surgery. And as long as it closes up and you have a nice scar tissue develop, then you’re safe from a lot of bad things happening.

But there’s still a lot of healing that’s occurring inside your knee, right where the implants attached to the bone, there’s still a lot of healing happening. And you’ve lost tons of strength at this point as well. So you’ve got to gain all that strength back in order to get back to normal. Now in the third month after your knee replacement surgery, you’ll likely still be going to physical therapy once twice, maybe three times a week, you need to finish up any range of motion limitations that you have, you need to get all the range of motion back.

Now in some cases, people don’t quite get all the bending or all the straightening. But it’s enough to get by and not limp too bad. And that might be where you settle that could be your new normal range of motion for your knee. It just varies on the the individual the amount of arthritis they had in the past. It could be the strength limitations that they had in the past as well. But it is right now this is the window of playability in your tissue. So you want to be able to stretch as much as possible.

Again, just as long as you don’t cause more swelling to happen. You should be obsessed with stretching your knee to get it as straight as possible. That’d be the priority over bending it but then you do want to get it to bend as much as it’ll go. At least even with the other knee. That’s a good milestone to hit.

At this point, you should be able to tolerate being on your feet for 30 minutes or more and you’ll probably be getting out of the walker, you’ll be able to walk more confidently without having to hold on to stuff you should feel like you’re getting more strength backing your leg especially if it’s straightened out all the way.

In fact, you might be in good enough shape that your physical therapist or your surgeon might recommend that you begin to exercise do cardiovascular exercise, like cycling on a bike, you may have already been doing some of that under the guidance of a physical therapist. Or you might even be instructed to begin walking for exercise like getting on a treadmill and walking or going out outdoors walking somewhere that’s safe, you know that the grounds not uneven, and that there’s a very low risk of you tripping and falling.

Now this exercise is not going to be intense, you’re going to gradually ramp it up, you’re not going to start at 30 minutes, potentially, you might be a lot slower than you were before that some people do recover quite fast and you can even tell if they had a knee replacement. But you still have to take it easy and make sure that the exercise that you’re doing is not going to have a later effect the next day or even a couple days after you don’t want to loosen that hardware. During this third month after the surgery.

People are usually encouraged to do more active things at home like yard work or house chores that require more strength or kneeling more use of your legs and you should be able to tolerate doing it better, you might still move a little slower than you have in the past. But you need to get back to doing those things to challenge your leg and get the knee joint to behave like it was before, you might still have some swelling in that knee, there may not be any swelling at all.

And there may not be any pain, but there might still be some thickness, you have to of course, realize that the were the bone attaches to the prosthesis is what they call it, the replaced parts of your knee, the there’s still a lot of healing happening there, and there might be some thickness of the bone. So if it’s hard bone like swelling, then I wouldn’t be too concerned.

But if it’s the squishy type of swollen that feels hot around your skin, then that’s the kind of swelling that’s typically of concern for people, you’re doing too much likely, you’re either stretching too aggressively, or you’re on your feet too much, or you’re just being too active in some way. And you need to back off a bit to make sure that you progress nicely in your in your function. In the fourth month after your knee replacement surgery.

This is typically where you’re wrapping things up with the surgeon and with physical therapy, they’re usually going to graduate you from physical therapy, you’ve done plenty of cycling there, you’ve done plenty of Treadmill walking, lots of quad sets are usually making sure that your thigh muscles on the front of your thigh are working really good because those do get shut down right after a knee replacement surgery. And it’s critical for you to get good function and those quadricep muscles in the front of your thigh.

So that you can walk and do everything that you need to do, there should be little to no swelling at this point, maybe just that bone thickness that I was talking about if you do have swelling, and there’s something that you need to address, but you shouldn’t have any more at this point. Range of Motion might be just a teeny tiny bit limited. If anything, right now hopefully you gained everything you were going to gain in the first two to three months.

But you might still need to be stretching in month four, that does happen quite commonly, it would be great for you to get to 130 degrees, give or take. If you’re at least 120 degrees, then you’ll be able to do tons, but you’ll be a lot more comfortable in kneeling and squatting, doing things with your knee later on in life. If you can get to about 130 degrees, the surgeon is usually done with you at this point, they’re congratulating you on the outcome and you’re getting back to normal.

But in reality, you’re probably still feeling your knee every morning, you find limitations throughout the day, you still have to sit down at times, you’re probably in a lot less pain if you had severe arthritis going into the surgery, but you’re still going to have limitations that are going to follow you around for up to a year after the surgery. And that’s completely normal. One of the big problems that people often complain of is numbness on the front part, usually the inside part of the knee.

And that happens because in order for them to access the knee joints, they’re having to cut the skin. So here’s the right leg. Now I’m going to cut the skin right over the knee right where your incision would be. And they have to peel everything open to get to the joint itself. Well, there’s a nerve that runs from the inside of the thigh and wraps around from the back towards the front of the knee to right here. And it does cross the midline of the knee.

So when they cut that open, they have to cut that nerve. And it’s common for people to get a little area of numbness somewhere on the front of the knee. And that might never grow go away. Or it might just very slowly return over time I’ve seen people have mixed results with that. But if you don’t ever have that sensation back, it’s not a terrible thing, it’s just going to, it’s just going to feel funny, you know, if you touch your leg there, women often have to be careful shaving in that spot because they can’t feel it very well.

So just look closely what you’re doing. And just clothes can feel different on that spot as well. Now if you choose to, you might do a follow up with your surgeon, or you might continue physical therapy if you still have any remaining limitations that you want to address with them.

But like I said, most therapy, most surgical consults and follow ups will end at this point. And it’s about month 567 and eight that you should begin to address the root problems that set up the knee arthritis that led you to this point where you’re going to have a knee replacement, and that’s usually a muscle imbalance that sets you up.

A muscle imbalance is a weakness on one side of the body and a relative strength on the other side of the body causing an imbalance in the joint. And the way that it happens in the knee leading to near arthritis is typically the quad muscles in the front of the thigh are too strong relative to the glute muscles up in the back of the hip on that same side. Now you might be thinking I’m not that strong to begin with. And or you might be very strong you might think to yourself, I have strong glutes, I work them out.

What I’m talking about is a relative imbalance. So even if you’re very strong or you’re very weak, if your quads are relatively stronger than your glutes, it’s going to change the way that the force is distributed that your knee and when that’s kept up for years and decades at a time, it begins to wear down the knee joint inappropriately which sets up the arthritis and if that’s never addressed, then it progresses and progresses and that that imbalance is not painful typically, it’s the effects of it that are painful when you work out your quads.

So you’ve always exercise, you’re more of a fit person, and you feel like you’ve always had strong quads, but you haven’t paid attention to your glutes as much. And then you begin to have near arthritis or knee problems over the years, then that’s a problem, you have to understand that your, your quads are too strong, and you have to start focusing on getting your glutes stronger to, to compete with the strength from the quads, to normalize the pressures down at your knees.

It’s not hamstring strength. hamstring strength, is really not something that we should be pursuing only if you’re a bodybuilder. But if you’re just looking at fixed eating balance, it really comes down to the glute strength. And it’s because of the way that attaches to the hip joint up here controls the bottom of the thigh bone, and what happens, the motions that happen at the knee.

So if you have good glute strength, and you’re using that strength appropriately, then you can normalize the forces down here and put the quads under better control. This is information that a surgeon is not going to be able to tell you and a physical therapist probably won’t be able to tell you to because most physical therapists don’t have this, this understanding of how the body works, their job, which they’ve probably already done with you if you had the replacement is to help you after you’ve had a surgery to get your motion back to get you back on your feet and back to basic exercise.

But optimizing your body to where you get rid of the muscle imbalances, so that the forces are normal at your joints is not a common thing that’s done in physical therapy clinics or in surgeons offices. So the priority in months 567 and eight in the four months following your aftercare with the surgeon. And in a typical bout of physical therapy, after having a knee joint replacement, your priority should be to fix the muscle imbalance.

Because if you don’t fix that muscle imbalance, what’s going to happen is think about it, your physical therapist has probably just implanted in your head that the surgeon too likely that you need more quad strength because your quads shut down after your surgery. And the past few months, you’ve been strengthening the heck out of your quads, and now they’re working great and you’re feeling better, and you can move around.

But the muscle imbalance has not been addressed, you still lacked strength, enough strength up in the glutes to counteract the strength that you’ve developed in your quads. So now it’s time to shift away from the quad strengthening and focus on a good solid foundation for strengthening for the rest of your life to maintain your new knee joint.

Because if you continue with that imbalance, then there’s a high probability that your knee pain is going to return even though your joints has been replaced and you no longer have the cartilage, they’re the same bone on the ends of your bones here, you can still get knee pain, because of loading your knee joint inappropriately from that muscle imbalance.

So what you’ve got to work on next is your glute strength and even your foot strength because if you’re artists collapsing quite a bit, or you just don’t have good support in your ankle and foot, it messes with the stability of this shin bone, which is the top the bottom half of the knee joint at the top right here that bone. If your surgeon allowed you to return to higher impact activities like running and jumping, you might be getting pursued at this point, you got to gradually move into it, of course.

And what I would recommend doing if you’re going to go back into any activity, whether you’re going to be competitive, or going back to the gym, or you’re just you’re not going to do that you just want to make sure that your muscle imbalances are fixed. Look into our 28 Day Knee Health And Wellness Boosts Program it’s linked in the description below.

It’s a program that’s 100% online and on demand. It’s me coaching and teaching you through how to fix this muscle imbalance so that you get the appropriate strengthen your glutes and your feet as well so that your pressures and your knee joint are normalized moving forward. These are done with bodyweight exercises or just a little bit of weight so you can get at the store that you might use. And you don’t have to use them if you don’t want to.

But going through this program is going to help you to make sure you fix that imbalance so that your knee is healthy for the long term and help you get to the next phase of your knee rehabilitation.

The last three months of your rehab, you really need to up the strength and having a good foundation of strength meaning you’re using your muscles appropriately so that you can really push it later on. That’s going to keep you safe for the rest of your life and protect your knee replacement.

Now moving into months 9, 10, 11 and 12, this is where you start to have a lot more fun you’re you can begin to do quite a bit of things and assuming that you fix the muscle imbalances that your quads are not over dominance, then you can go back to gym exercises full speed you can probably even pursue running as long as your surgeon has allowed you to and you should be able to be very normal at this point house activities should resume you just might still feel a little odd in your knee.

A common sensation that people have is clicking and you can feel the metal parts kind of touching each other at times, and it makes a sincere it makes a sound, and it also gives a sensation inside the knee joint. And that’s normal that’ll happen. You just want to gradually move into more advanced activities, I can’t stress that enough.

A lot of people, especially if they have an athletic background, or they’re very active before, they want to go back to full speed, and you just have to do a little bit more than you did before. And then see how your body responds. And then do a little bit more again, make sure that your knees okay, and then a few days later, do a little bit more, and gradually work your way back up.

If you were an avid walker before, and you’re walking three plus miles a day, then you want to start with one mile and maybe go up a mile and a quarter, and then a mile and a half to scope in small increments very gradually over time to make sure that your knee joint is safe, I highly recommend that you pursue strength training, you need to get to a gym or purchase gym equipment where you add weight to your body so that you can grow your muscles, specifically your glutes, your quads do need to get stronger, but only as strong as your glutes will allow.

In other words, don’t pursue more quad strengthening, as I said before, that’s going to spell disaster for the future, you have to get good strong glutes and foot muscles are very important as well. If you’ve never lifted weights before, you’re not sure about the muscle imbalance thing, then you might hire a trainer or get some specific training for how to use the machines and how to use the weights at the gym that you go to or at home.

Make sure you get guidance. And it helps for accountability too, because most people will drop off on their improving their fitness for their knee about five, six months in, they might do a little bit of strengthening but nine to 12 months out after having a knee joint replacement. It is rarely ever done. I’ve only seen a small percentage of people that really exhausts all the strengthening that they should be able to do during that first 12 months they stop.

Typically, between six and nine months, making sure that you commit to exercise even if it takes hiring a personal trainer is money well spent, not only will you probably be fitter and look healthier overall. But you don’t want to have to have a knee revision. You don’t want to have to have another knee surgery later on or cause some hip or foot problem or back problem in the future because you didn’t strengthen your knee appropriately.

Now let’s talk about beyond 12 months, what should you be doing after 12 months? And what can you expect? Well, you can expect your knee to finally feel normal, you can finally have days now where you wake up and you start going to your routine. And you forget that you had a knee replacement, it’s almost a thing that you forgot that you went through for the past year.

People often have the experience where they say yeah, I walked the dog, I went an exercise at the gym, I was on my feet at the store I did I was my active usual self, and I don’t even feel my knee anymore. Having that kind of outcome means that you put in a bunch of work a bunch of exercise typically a bunch of effort in maintaining your knee range of motion. In the year after your knee replacement surgery.

It’s not just about getting the procedure done. It’s about finishing up all the rehabilitation you have to do afterwards, it would be wise to continue to pursue strengthening more even beyond what you’ve already done at this point in your knee joints should be able to tolerate it just fine. And I’m not talking impactful exercises. Let me make a distinction here.

Weightlifting like doing squats and deadlifts or using machines at the gym does create some impact on the knee joint, but it’s typically not as much and it’s not as dangerous. As activities like running or jumping. Those types of activities might be able to be tolerated fine if you have any replacements.

But your surgeon is probably going to tell you to very cautiously proceed into it or they may just not even allow you to but weightlifting is typically encouraged because it’s done in a controlled environment. As long as you’re not sloppy with your technique. And you know what you’re doing around the gym, you’re just not your first time going, it’s going to be very beneficial for you.

And you should pursue getting more strength because it’s going to protect your whole body but especially the replacement that you had, you should be keeping up a regular exercise routine going at least two to three times a week. It doesn’t need to take long as little as 20 minutes could be enough to maintain your strength for the future and even progressive it you have to make sure to have a good mix of cardio exercise and strengthening exercise.

Now this is where people make the biggest mistake is they get back to being able to walk or maybe even do a little bit of jogging do some sort of cardio exercise where they’ve really enjoyed the bike and they continue using the bike. After they have an ear replacement surgery, and they skip the weights they skip the resistance training and they end up getting weaker and feeding into the muscle imbalance because we’re using their quads too much during the walking and cycling and they’re neglecting the strength in the glutes and in the feet.

One of the biggest mistakes you can make is avoiding weight training. So you have to build that into your workout routine. Like I said get accountability if you need to get a good workout friend, or hire a trainer or just get yourself on a scale Were you weakly hit this exercise in this exercise and this exercise to strengthen your glutes and your feet and other leg muscles as well so that you’re evenly gaining strength throughout your legs, or at least maintaining it.

If you have not had a knee replacement surgery, you’re just thinking about it and you wanted to see this video to see what you might expect, there’s a chance that you might be able to avoid it altogether, I encourage you to go check out our playlist for knee arthritis help, it’s linked in the description below.

Or you can go to our channel homepage and find the knee arthritis help playlist, we’ve got tons of videos full of exercises, stretches advice that you can begin to do to see if your knee arthritis will improve.

And maybe there’s a chance that you don’t even need any joint replacement. If you’ve already had a knee joint replacement and it didn’t go well for you, you’re still having pain, you’re getting concerned because you’re thinking, golly, I did this to get out of pain and I’m still in pain or maybe it’s potentially worse. hope is not lost, you might not need to have a revision, you might just need to you might be in the middle of the phases here and you didn’t progress much because your health care ended, you know you’re you stopped go to the surgeon and the physical therapist.

So go back to this video and see what I talked about in month 567 and eight, go check out that 20 Day program that might be the next thing that you need to do to make sure that you get out of pain and protect your knee joint, your replaced knee joint so that it’s not going to get worse and put you in that situation where you’re looking at getting some other procedure done.

If you thought this video was helpful for you, please give us a thumbs up share it with somebody that you know needs to hear this. And please subscribe to our channel if you haven’t already so that you don’t miss on any of the other videos that we’re going to post here in the near future. Thanks so much for watching. We’ll see in the next video guys. Bye