İhsan ErenAnkle pumps
Lie on your back or sit with your legs out straight. Pull your toes up towards you, then push them down. Working your calf muscles boosts your circulation; do this often from the first days after surgery.
10–20 reps every hour1–3 daysTime to discharge after hip replacement for people in good general health
6 weeksApproximate time before trying to walk without an aid after knee replacement
At least 6 weeksBefore driving after a total knee or hip replacement
6–12 weeksTypical time to return to work after knee replacement
What to expect in the first weeks
In the weeks after surgery, swelling, bruising and warmth around the joint, and pain, especially at night, are to be expected; they ease over time. Full recovery can take months.
You usually start walking while you are still in hospital, with crutches or a walking frame. As your confidence grows, you move first to a single crutch and then to a walking stick. Doing the exercises your physiotherapist recommends regularly helps your recovery and prevents complications.
From the first few days
- Keep your leg raised when you rest, to reduce swelling.
- Take your painkillers as your doctor recommends, before your exercises.
- Do ankle pumps often throughout the day.
- Take short but frequent walks; do not stay still for long periods.
- Keep using your medication or stockings to prevent blood clots for as long as advised.
Things to keep in mind after knee and hip replacement
- Knee replacement: straightening fullyDo not put a pillow under your knee when you sleep; a knee that stays bent may, over time, no longer straighten fully. When you raise your leg, put the pillow under your calf and heel.
- Knee replacement: bendingIncreasing how far your knee bends is one of the most important goals of the first weeks. Heel slides and seated knee bends are used for this.
- Knee replacement: the first 6 weeksDo not sit with your legs crossed for the first 6 weeks.
- Hip replacement: movement restrictionsIn the first weeks, many centres advise not bending your hip more than 90 degrees, not crossing your legs, not bending down towards your feet, and avoiding low chairs and toilets. Recent studies show that routine restrictions do not reduce the risk of dislocation; your surgeon will decide which ones you need to follow.
- Hip replacement: activityIn the first months, avoid jumping, sudden twisting and movements with a high risk of falling; walk every day, as far as is comfortable for you.
Exercises at home
Six key exercises after joint replacement
These are basic exercises that are commonly used after knee and hip replacement. Your surgeon and physiotherapist will decide which ones suit you, when, and within what limits. You may feel mild pain during exercise; stop if you have sharp pain, discharge from the wound or a clear increase in swelling.
Towel press
Lie on your back and place a small rolled-up towel under the knee of your operated leg. Press the back of your knee down into the towel, tightening the muscle at the front of your thigh, and hold for 5 seconds. This helps the knee straighten fully.
10 reps, 3 times a dayHeel slides
Lie on your back. Slide your heel along the bed towards your buttocks, bending your knee as far as is comfortable, then slowly straighten it. A plastic bag under your heel helps it slide more easily. After hip replacement, follow your surgeon's advice on how far you may bend.
10 reps, 3 times a daySeated knee extension
Sit upright on a chair. Slowly straighten the knee of your operated leg and tighten the muscle at the front of your thigh; hold for 5 seconds, then lower slowly.
10 reps, 2–3 times a dayStraight leg raise
Lie on your back and bend your good knee. Keeping the knee of your operated leg straight and tightening your thigh, lift the leg up to the level of your other knee, then lower it slowly. Ask your physiotherapist whether this exercise is suitable for you.
10 reps, twice a daySit-to-stand from a chair
Sit in a chair with armrests that is high enough, and place your operated leg slightly forward. Push up on the armrests with your hands to stand, then sit back down with control. This is a key movement for everyday independence.
5–10 reps, 2–3 times a daySafe everyday living at home
Getting your home ready before surgery makes the first weeks much easier and safer.
- When going up stairs, step up first with your good leg; when going down, step down first with your operated leg and your walking stick.
- Use a chair with armrests that is high enough; after hip replacement, a raised toilet seat makes things easier.
- Remove slippery rugs, tidy away cables on the floor and light your way at night.
- Put grab rails and a non-slip mat in the bathroom.
- A long-handled shoehorn and a reaching aid let you get things done without bending down.
Video
Exercise videos after joint replacement
From the YouTube channel of US physical therapists Bob Schrupp and Brad Heineck. Do the exercises only as far as your surgeon and physiotherapist allow.
Two crucial exercises after knee replacement
The two key movements for straightening and bending the knee.
Exercises 4–6 weeks after hip replacement
An exercise programme for the period after the first few weeks following surgery.
Frequently asked questions
When can I start walking?
You usually start walking soon after surgery, in hospital, with crutches or a walking frame. After a knee replacement, as your confidence grows you move first to a single crutch and then to a walking stick; after about 6 weeks, if you feel ready, you can try walking without an aid.
When can I drive?
After a total knee or hip replacement, you are advised to wait at least 6 weeks; after a partial knee replacement, this may be 3 weeks. Get your doctor's approval before you start driving.
Which movements should I avoid after a hip replacement?
In the first weeks, many centres advise not crossing your legs, not bending your hip more than 90 degrees and avoiding low chairs. However, a review covering 8,835 patients could not show that applying these restrictions routinely reduces the risk of dislocation, so some centres are relaxing them. Your surgeon will decide which movements you need to avoid, based on your surgical technique.
Can I put a pillow under my knee?
Do not put a pillow under your knee when you sleep. If the knee stays bent for long periods, it becomes harder for it to straighten fully. If you want to raise your leg, put the pillow under your calf and heel, not under your knee.
When can I go back to work?
When you feel ready; after a knee replacement this is usually 6–12 weeks, and after a hip replacement about 6 weeks. It may take longer if your work is physically heavy.
Should I exercise before surgery?
Yes. The American Physical Therapy Association's guideline on knee replacement recommends strength and flexibility exercises before surgery. Going into surgery with strong muscles makes the recovery easier.
When to seek help right away
After surgery, contact your surgeon or see a doctor without delay if you have any of the following:
- Throbbing or cramping pain, or swelling, in your leg and especially your calf (possible blood clot)
- Shortness of breath or chest pain together with pain and swelling in the leg (a clot may have travelled to your lungs; call 112)
- Fever, chills or shivering; discharge from the wound or signs of infection
- Redness, tenderness, swelling or pain in the joint that does not improve and keeps getting worse
- Sudden severe pain in the hip, the leg looking shorter or turned, or being unable to put weight on it (possible dislocation)
Sources
- Jette DU, Hunter SJ, et al. Physical therapist management of total knee arthroplasty. Phys Ther. 2020;100(9):1603.
- Korfitsen CB, et al. Hip precautions after posterior-approach total hip arthroplasty among patients with primary hip osteoarthritis do not influence early recovery: a systematic review and meta-analysis of randomized and non-randomized studies with 8,835 patients. Acta Orthop. 2023;94.
- NHS. Recovering from a knee replacement.
- NHS. Complications of a knee replacement.
- NHS. Recovering from a hip replacement.