Recovery from a joint replacement is measured in weeks and months, not days, but it starts on day one, and most of it happens at home. The timelines below are typical for a straightforward total hip or knee replacement. Yours will be tailored to you, and the written program you receive after surgery takes precedence over this page. The detailed week-by-week programs, with exercises, milestones and the questions people ask at each stage, are in the rehabilitation guides: one each for knee replacement, anterior hip replacement and posterior hip replacement. For the recurring question “is this normal?”, there is a single page: What is normal after a hip or knee replacement.
The first days (in hospital)
You will be helped out of bed and onto the new joint on the day of surgery or the morning after. This is not bravado, early walking is the single best protection against blood clots and chest complications, and the new joint is designed to take your weight immediately.
Physiotherapists will teach you to walk with a frame or crutches, get in and out of bed and a chair, and manage stairs. Most people go home after two or three nights, some after one, some after four, once they are safe on their feet. Some go to a rehabilitation unit first, particularly if home has many stairs or little support.
Expect swelling, bruising and soreness. You will have pain medicines, usually a blood thinner for some weeks, and clear wound-care instructions.
Weeks 1–2
- Walking short distances at home, several times a day, with crutches or a frame
- Doing your exercise program, little and often beats one heroic session
- Swelling and disturbed sleep are normal; ice and elevation help
- Knees: bending is work. The exercises that restore bend matter more than any other part of knee rehabilitation
Weeks 2–6
- Progressing from frame to crutches to a stick as your balance and strength allow
- Walking further outdoors; most people are down to one stick or none by four to six weeks after a knee or posterior hip, and sooner after an anterior hip
- Most of the sharp surgical pain settles; what remains is muscle soreness and stiffness that responds to exercise
Weeks 6–12
- Walking without aids, back at the shops, and largely independent
- Strength keeps building; low-impact exercise (walking, exercise bike, hydrotherapy) is encouraged
- A knee can remain warm and a little swollen for months; this on its own is not a concern
Three months to a year
By three months most people have most of their result. Improvement continues quietly for a full year, the last of the swelling settles, strength returns, and the joint stops announcing itself. It is common to forget the joint by the end of the first year, which is the real goal.
Red flags, call rather than wait
Contact the rooms, your GP, or the hospital promptly if you notice:
- A temperature of 38°C or higher, shaking chills, or feeling generally unwell: call the rooms the same day
- Increasing pain in the joint after the first week, rather than settling: call the rooms the same day
- Redness spreading from the wound, or discharge, leaking or opening of the wound: call the rooms the same day
- A new one-sided calf pain, tenderness or swelling, possible blood clot: see your GP the same day
- Chest pain, sudden shortness of breath, coughing blood or feeling faint: call 000. This can signal a clot in the lungs
- A fall onto the new joint, or a sudden change in what it can do
None of these should be watched overnight to see how they go. Early treatment of a wound problem or a clot is simple; late treatment is not. For everything that is probably normal but worrying, pain, swelling, warmth, stiffness, numbness, clicking, bruising, a lump, see What is normal after a hip or knee replacement.
Driving, work and sport
- Driving. You must be off strong pain medicines, able to make an emergency stop at full force without hesitation, and have practised the movements in a stationary car. For most people this is four to six weeks after a knee or a posterior-approach hip, and two to four weeks after an anterior-approach hip, often sooner for a left-side joint in an automatic. Braking studies show reaction time back to its pre-operative level at about two weeks after a right hip and about four weeks after a right knee, but those are averages. Dr Broadhead confirms the timing for you; your insurer expects that conversation to have happened.
- Work. Desk-based work is usually possible from one to six weeks depending on the joint and the approach: about four to six weeks after a knee, one to three after an anterior hip, two to four after a posterior hip. Physical work takes longer, usually two to three months, sometimes with modified duties in between. Raise your job’s actual demands at the two-week review so a plan is in place early.
- Sport. Low-impact activity is encouraged for life: walking, swimming, cycling, golf, bowls, doubles tennis. Skiing and hiking are realistic for many. High-impact running and jumping sports put wear on the implant, and most surgeons (Dr Broadhead included) advise against them as regular exercise on a replaced joint.
The follow-up
Every joint replacement patient is reviewed after surgery on a set schedule: a wound check at about two weeks, a clinical review with an X-ray at six to eight weeks, then reviews with X-rays at six months and twelve months. A three-month review is added if progress is slower than expected. After the first year, X-rays are repeated periodically over the years to watch the implant. If anything about the joint changes between reviews, do not wait for the next appointment, call.