What to Know and Do Before and After Knee Replacement Surgery

Knee replacement surgery can be a life-changing procedure for people suffering from severe knee osteoarthritis. However, before choosing to have it done, it's essential to understand what to expect and how to prepare both physically and mentally.

“It's extremely common to be anxious about undergoing this type of surgery, especially because it's more of the patient's choice whether or not to have it, and having that choice can be very anxiety provoking,” says Cynthia Kahlenberg, MD, an orthopedic surgeon at HSS. “In the end, people tend to do extremely well and be very pleased with the outcome,” but it helps to go in with realistic expectations and a full understanding of the process.

Here, Dr. Kahlenberg walks through the key considerations before knee replacement surgery. 

Preparing for a Knee Replacement

Before undergoing knee replacement surgery, it's crucial to have explored more-conservative treatment options such as injections, physical therapy, and anti-inflammatory medications, Dr. Kahlenberg says, if they’re appropriate for you.

Once you’ve exhausted alternatives to knee replacement and the surgeon says you’re a good candidate for surgery, there are some steps to take to ensure the best outcome.

Get any medical conditions under control well before surgery.

Making sure you’re medically optimized means your primary care doctor and other specialists agree that your medical conditions, such as diabetes and obesity, are well-managed.  “That helps to minimize complication rates,” says Dr. Kahlenberg.

For people with diabetes, achieving good control of blood sugar levels before surgery can significantly reduce the risk of infection and improve wound healing. 

Quit smoking.

Ditching cigarettes for at least six weeks before your operation and six weeks after surgery is highly recommended to minimize complications, she says. Commit and get a support system in place to cheer you on.

Eat a well-balanced diet before and after surgery.

Following an eating plan that’s rich in fruits, vegetables, and protein can be helpful for healing after knee replacement surgery. 

Talk to your medical team in the weeks leading up to surgery and inform them of any supplements and vitamins you take. Some are okay to continue taking throughout the preoperative period, whereas others should be stopped before the surgery as they can have an impact on bleeding, Dr. Kahlenberg says.

Strengthen the muscles around the knee.

You’ll want to be as strong as possible going into the surgery to help with the recovery, says Dr. Kahlenberg. “Try to stay active, keep the muscles strong, and in particular, strengthen the quadriceps muscles to help with the recovery.”

If that’s too painful, she suggests doing weight-bearing exercises or building up strength with cycling or swimming to get in better shape before surgery.

Preparing for Postoperative Life

You’ll likely need some help getting around and making modifications to your day-to-day life while recovering from this significant knee operation.

“Recovery is so individualized,” says Dr. Kahlenberg. “Some people bounce back immediately whereas others need a little more time.” 

Set your living situation up for success. 

If you sleep upstairs or need to go up and down stairs to use the bathroom, that might be more challenging in the first few days after surgery. Most patients are able to go up and down stairs when they leave the hospital, but it can be helpful to have a friend or family member stay with you or to stay  somewhere where everything is all on one level for the first few days.

Expect fatigue. 

It's common to feel more fatigued after surgery. You’ll likely also feel sore. You probably won’t be ready to take on many household chores in the early period after surgery, says Dr. Kahlenberg. Getting household duties taken care of ahead of time or arranging for someone to take care of them while you recover will be helpful. 

You’ll also want to have some meals prepared for the week after surgery so you don’t have to stand and cook. If family members and friends ask how they can help, request a healthy meal that’s easy to warm up or ask for assistance with a simple chore that first week, like taking out the garbage.

Have your pain plan ready.

In the first one to two weeks after knee replacement, the focus is on healing and decreasing inflammation. That’s usually done with ice packs or an ice machine applied to the knee several times a day. 

Many people do require narcotic pain medicine in that early period as well. “At HSS, we try to use a multimodal pain medication regimen, which means we use different techniques together,” says Dr. Kahlenberg. “This includes nerve blocks around the knee, an anti-inflammatory medication, non-narcotic pain medicines, and then narcotic pain medicines as needed.” 

Your medical team will want to know about progress you’re making, pain improvement, and mobility improvement. “It's very common to have a lot of swelling in the first couple of weeks after surgery, but overall, we'd like to see a little bit of improvement each week to make sure that the patient is moving in the right direction,” she says.

Managing Expectations Post-Operation

Recovery after knee replacement surgery varies from person to person, and it's essential not to compare your progress with others. While some individuals may bounce back quickly, others require more time to recover fully. Dr. Kahlenberg suggests setting realistic expectations and focusing on healing during the initial weeks post-surgery, particularly with respect to tiredness and pain. 

Some patients will experience more pain than others and be more reliant on narcotic pain medication for a time. If that’s the case, you won’t be able to drive and the medication might impact how energized you feel. You might not be as productive at work and need more time to complete physical or mental tasks in general. 

“Most people feel improvement by the six-week mark, and then three months after are feeling significantly better and getting back to more active pursuits,” she says.

For any other questions you have about knee replacement surgery, it’s best to talk to your orthopedic surgeon and healthcare team.