Phase 1
Hospital Phase: Immediate Recovery
Day 0 – Day 3🎯 Goals
- Sit up and get out of bed safely with support
- Walk with walker for short distances (at least 15 metres)
- Start moving the knee to prevent stiffness
- Control pain and swelling
- Manage stairs if needed for discharge home
⚠️ Precautions
- Full weight bearing allowed with walker/stick
- No twisting or pivoting on the operated knee
- Do not place a pillow under the knee when lying down
- Keep heel elevated on a rolled towel to straighten the knee
- No resistance exercises yet
- Watch for DVT signs (see alert below)
🚨
DVT Warning: Tell Your Doctor Immediately If:
Calf becomes painful, red, or unusually swollen · Sudden chest pain or breathlessness · Operated leg becomes cold or pale · These are warning signs of a blood clot and require urgent attention.
Exercises (Start Day 1 in Hospital)
- Ankle pumps: move foot up and down, 20 reps every hour
- Thigh squeeze (quad sets): press knee down into bed, hold 5 sec, 10 reps
- Buttock squeeze: tighten both buttocks, hold 5 sec
- Straight leg raise: tighten thigh, lift leg 30 cm, hold 2 sec, lower slowly
- Knee bending: slide heel towards buttocks and back, as far as comfortable
- Sitting knee bend: dangle leg off bed, bend and straighten
- Standing knee bend: stand at bed, slowly bend knee back
- Sit-to-stand practice: slide to edge of chair, push up using arms and good leg
- Walking with walker: short walks in the ward 3–4 times a day
🧊 Ice / Swelling Control
- Apply ice pack (wrapped in cloth) for 15–20 minutes
- Use 4–5 times per day, especially after exercise
- Never apply ice directly to skin
- Elevate the leg above heart level when resting
🚶 Discharge Readiness Checklist
- Knee bends to at least 80°
- Knee straightens to within 10° of full
- Can do straight leg raise independently
- Can walk 50–100 metres with walker safely
- Can manage 2–3 steps if home has stairs
Pain Management: What to Expect
Painkiller (Basic)
Paracetamol (500–1000 mg)
Every 6–8 hrs as needed. Safe to use regularly for 4–6 weeks.
Anti-inflammatory
Etoricoxib / Celecoxib
Take with food. Avoid if kidney or heart issues. As prescribed.
Nerve Pain
Pregabalin / Gabapentin
For burning/tingling pain around knee. As prescribed: can cause drowsiness.
Short-term (Stronger)
Tramadol / Tapentadol
Only if severe pain. Take at night. Avoid driving. Wean off by week 2.
Blood Clot Prevention
Rivaroxaban / Aspirin
As prescribed (usually for 2–6 weeks). Do not skip doses.
Injection (In Hospital)
Pericapsular Block
Given during surgery into the joint. Provides 12–24 hrs of pain relief.
Phase 2
Early Recovery at Home
Week 1 – Week 6🎯 Goals
- Achieve knee bending of 110° or more
- Fully straighten the knee (0°)
- Walk comfortably around the home without support
- Climb stairs with one hand on railing
- Reduce swelling and pain significantly
⚠️ Precautions
- No squatting (Indian toilet): use Western commode or raised seat
- No kneeling on operated side
- Avoid low chairs or sofas: sit on firm, elevated surface
- Wound must be kept dry until fully healed (10–14 days)
Week 1–3 Exercises
- Continue all Phase 1 exercises
- Heel slides: lie down, slide heel towards buttocks slowly
- Stationary cycling: if available, start with small arcs of motion
- Standing knee bends: hold chair, bend knee backwards
- Side leg raise: lie on side, raise top leg 30 cm
- Mini squats: 0–30° bend only, holding chair/wall
- Physio: joint mobilisation, scar massage after wound heals
Week 4–6 Exercises
- Step-ups: one step height, use railing
- Sit-to-stand from normal height chair
- Cycling: full revolution if ROM allows
- Walking outdoors: flat surfaces, gradually increase distance
- Balance exercises: stand on one leg briefly, holding chair
- Progress knee bending towards 110° with physio guidance
🏠 Daily Life Adjustments
- Indian toilet: Permanently avoid: use Western commode only. Raised commode seat recommended.
- Floor activities: Permanently avoid sitting cross-legged (padmasana), namaz on floor, yoga floor poses
- Two-wheeler: Not allowed for 3 months
- Auto/car: Short journeys allowed from Week 2: avoid long trips
- Home physio: If outpatient physio not accessible, home exercise as taught in hospital is adequate
✅ Ready for Phase 3 When:
- Knee bends to 110° or more
- Knee fully straight (0°)
- Walking community distances (500–800 m) comfortably
- Minimal swelling and pain
- Good thigh muscle strength: can do SLR easily
Phase 3
Strengthening Phase
Week 7 – Week 12🎯 Goals
- Knee bending to 120° or more
- Climb stairs with alternating legs (no step-to pattern)
- Return to most daily activities and light work
- Walk long distances outdoors without limping
- Thigh and hip strength near-normal (4/5)
Exercises
- Squats: progress to 60–70° depth
- Lunges: with support initially
- Leg press: if gym available
- Step-ups / step-downs: higher step
- Balance board or single-leg balance
- Walking: ramps, uneven ground, outdoors
- Swimming / water walking: excellent low-impact option
- Continue cycling for endurance
🏠 Daily Life Adjustments
- Light housework: cooking standing, gentle dusting: OK from Week 8
- Temple visits: walking with footwear OK; avoid sitting on floor or steps
- Light farming/field work: defer to Week 12+
- Two-wheeler riding: avoid until Week 12 minimum
- Driving: Wait 6 weeks minimum; must be off strong painkillers
✅ Ready for Phase 4 When:
- ROM ≥120°
- Thigh/hip strength ≥4/5
- Stairs: one leg per step, both directions
- Walking all surfaces without significant limp
Phase 4
Return to Full Activity
Week 12 – Week 20🎯 Goals
- Return to recreational activities
- Full independence with all daily tasks
- Pain-free walking, stairs, and daily life
- Maintain strength and joint health long-term
Exercises
- Continue and progress all Phase 3 exercises
- Increase walking distance and pace
- Swimming: all strokes
- Cycling outdoors (flat terrain)
- Yoga: non-floor poses as tolerated
- Activity-specific training as needed
Activity Guide: When Can I Return to Normal Life?
| Activity | Allowed? | When | Notes |
|---|---|---|---|
| Walking (flat ground) | YES | Immediately | With walker in hospital, progress to stick, then unaided |
| Western commode | YES | Day 1 | Use arm rests or raised seat if needed |
| Indian-style toilet | NEVER | Permanently avoid | Use Western commode only. Raised commode seat recommended permanently. |
| Climbing stairs | YES | Before discharge | Hold railing; good leg up first, operated leg down first |
| Driving | CAUTION | Week 6 | Wait 6 weeks minimum; must be off strong painkillers |
| Two-wheeler | WAIT | 3 months minimum | Risk of fall; balance must be fully restored |
| Floor sitting / cross-legged | NEVER | Permanently avoid | Use chair at all times. Floor sitting puts excessive stress on the implant. |
| Swimming | YES | Week 6–8 | After wound fully healed; excellent rehabilitation |
| Cycling (stationary) | YES | Week 3–4 | Start with partial arcs; progress to full revolution |
| Cycling (road) | CAUTION | Week 12+ | Flat terrain only; avoid potholes and rough roads |
| Light housework / cooking | YES | Week 4–6 | Take breaks; avoid prolonged standing >20 min |
| Light office work / desk job | YES | Week 3–4 | Take hourly walking breaks; do ankle pumps at desk |
| Field work / manual labour | CAUTION | Week 12–16 | Light only; avoid heavy lifting, prolonged squatting |
| Walking on sand/beach/pilgrimage | CAUTION | Week 16+ | Good footwear essential; avoid long distances initially |
| Cricket / badminton | DISCOURAGED | - | High-impact pivoting sport; not recommended after TKR |
| Walking / swimming / cycling | ENCOURAGED | Long-term | Best activities to maintain joint health lifelong |
🚨 When to Call Dr. Satish Reddy / Come to Hospital Immediately
🔴 Emergency Signs
- Sudden severe pain in calf, chest, or breathlessness
- Leg becomes cold, pale, or numb
- High fever (>101°F / 38.5°C) with wound redness or pus
- Wound starts opening or bleeding heavily
- Sudden severe pain in the knee after a fall
🟡 Call Clinic Within 24 Hours If:
- Knee swelling suddenly increases significantly
- Pain is not controlled despite medications
- Wound is not healing or looks infected
- You feel the knee "click" or "give way" suddenly
- You are unable to bend the knee more than previous visit
📅 Follow-up Schedule
🗓 Routine Follow-ups
- 2 weeks: Wound check, suture removal
- 6 weeks: ROM, gait, X-ray if needed
- 3 months: Strength assessment
- 6 months: Functional review
- 1 year: Annual X-ray + review
🏋 Long-term Exercise Advice
- Walk 30 min daily: lifelong habit
- Stationary cycling or swimming 3x/week
- Thigh-strengthening exercises: continue forever
- Avoid weight gain: reduces implant stress
- Wear supportive footwear at all times
🏠 Daily Life Adjustments
- Avoid sitting on charpoy or low beds
- Use chair for meals instead of floor
- Firm mattress recommended
- Handrails in bathroom strongly advised
- Non-slip mat in bathroom: essential