KNEE
General timeline for return to activity following Total knee replacement:
One of the most common questions that PTs and MDs will get from patients is how long is it going to take before I am back to normal after my total knee replacement? The most common answer is.... It depends! While this is frustrating, there are many factors that go into how long it takes to recover including prior level of function, goals, compliance with the rehab program, tissue healing time, pain, strength, and Doctor's Orders!
As a general overview of tissue healing, bone takes 6-8 weeks to heal. This means that the bone that needs to heal to the prosthetic components of your joint replacement needs time to integrate itself into your body, skin and fascia-so your incision can take 4-6 weeks to heal but things such as diabetes, smoking, malnutrition, and hydration may affect this timeline. Further, muscle and tendon take up to 12 weeks to heal and even longer to strengthen. So now that we have established these timelines how does that translate into what you can do?
When can I walk? Immediately! A physical therapist will get you up and walking the same day as your knee replacement! Now, you will be walking with an assistive device such as a walker or crutches initially, but you will and should be on your feet. The next question is more complicated: When can I walk without my assistive device? This is where the timeline becomes more personalized. Your therapist will work with you to determine when it is appropriate for your safety as well as the mechanics of how you walk to start to decrease the level of support you walk with; this usually will look like transition to 1 crutch or a straight point cane and then to nothing if it is appropriate for you! On average, we see people who were not using an assistive device prior to surgery transition to a cane or single crutch 2-3 weeks post surgery with PT guidance and stop using the cane 4-6 weeks after surgery.
When can I drive? This is a great question and it depends on what leg is affected and what type of car you drive. For most people returning to drive with an automatic transmission car after a Knee replacement on the right leg is going to take slightly longer than if it were your left. A very rare (nowadays) return to a standard transmission with a clutch will follow the same timeline regardless of if you have had your right or left knee replaced. The truth of the matter is that there is no scientifically proven guideline for return to driving but some things that your therapist will look at are: being off narcotic pain medications (you cannot drive under the influence), can your knee bend enough to get into the car safely. And finally, are you able to do a step up with that leg. For an emergency stop you will need to press on average 40-100 lbs into the pedal of a car. If you can complete a step up and therefor push your body weight through that limb without pain or hesitation, it is a good sign that you could be ready to start to drive. Most therapists will recommend that you try driving for the first time in an empty parking lot with supervision prior to getting on the road. Typically we see this anywhere between 2-4 weeks for Left knee replacements to 4-8 weeks for a Right knee replacement.
When can i get into my Bath or Hot tub? Heat can be a great tool for pain management and to manage stiffness after a joint replacement however soaking the incision can result in longer wound healing and increased infection risk which are serious complications after a joint replacement and can lead to additional surgeries if not handled with care. Skin as we discussed earlier takes 4-6 weeks to heal if not longer. Something that most people don't realize is that to the medical community a scab is technically an open wound! So as long as there is still scabbing present on your incision you should NOT be submerging your incision in water. So no baths, hot tubs, pools, sprinklers, lakes or oceans. This is sometimes the most variable between patients so the best course of action is to ask your doctor or physical therapist to check your incision before going into the water.
When can I get back to playing sports? Again this is one of the more variable timelines as this becomes more dependent on your strength and level of activity or prior to your knee replacement. If you stopped your sport 10 years ago, there is a good chance that the joint replacement alone will not get you back to that same level of activity. It also depends on what activity you want to do, lower impact sports like road biking, swimming, hiking, walking, even light weight lifting will take less time to return to than medium or high impact sports such as tennis, pickleball, and running.
Big take aways!
A 2024 research article from the Netherlands found that 8 out pf 10 people returned to normal activities of daily life by 6 months after a knee replacement. In the same study they found that by 3 months post op, most participants had returned to putting on their socks and shoes, walking without a cane or walker, getting groceries, and climbing stairs. Knee replacement surgery isn’t a magic fix overnight — but it can be life-changing. This study shows that most people are back to living independently, working, and enjoying hobbies just a few months after surgery.
1.Peters MCWM, Pronk Y, Brinkman JM. Eight of ten patients return to daily activities, work, and sports after total knee arthroplasty. World Journal of Orthopedics. 2024;15(7):608-617. doi:https://doi.org/10.5312/wjo.v15.i7.608
