Home after a knee or hip replacement: the first two weeks, from a physical therapist

Joint replacement is one of the most successful surgeries in medicine, and the first two weeks at home decide a lot of the result. Patients who move early and correctly get their range back, sleep better, and get off pain medication sooner. Patients who wait until it stops hurting lose ground that is hard to recover.

Here is what I tell every patient on the first home visit.

The first week: the goal is motion and swelling control

Ankle pumps. Point and flex the feet, twenty at a time, every hour you are awake. This is your first line of defense against blood clots and it costs nothing.

Quad sets. Lying or sitting with the leg straight, tighten the thigh muscle and press the back of the knee down for five seconds. Ten to twenty repetitions, several times a day. For a knee replacement this is how you earn full straightening, which matters more than bending early on.

Heel slides. Lying on your back, slide the heel toward your bottom to bend the knee as far as comfortable, then straighten. This is the bending work. It is uncomfortable. It is supposed to be, within reason.

Straight leg raises. Once the quad set is solid, lift the straight leg six to eight inches and lower slowly.

Ice and elevation. Fifteen to twenty minutes of ice after exercise, several times a day, with the leg elevated above the heart. Swelling is the enemy of motion.

Walk, briefly and often. Short walks through the house every hour or two with the walker, rather than one long walk that leaves you exhausted.

Hip replacement: know your precautions

Depending on the surgical approach, your surgeon may give you movement precautions for six weeks or longer. The classic ones after a posterior approach are no bending the hip past 90 degrees, no crossing the legs, and no turning the toes inward. That means a raised toilet seat, a firm high chair, no low sofas, and a reacher or sock aid for dressing. Some approaches have fewer restrictions. Follow the sheet your surgeon gave you, and if you do not have one, ask. We will build the home program around it.

Pain medication: use it to move

Take pain medication as prescribed, timed so it is working when you exercise and when you sleep. The purpose is to let you do the work, not to let you avoid it. Pair opioids with a bowel plan from day one, because constipation after surgery is miserable and common.

Warning signs: do not wait

• Calf pain, swelling, warmth, or redness in either leg, which can signal a blood clot. Call the surgeon the same day.
• Chest pain or sudden shortness of breath. Call 911.
• Fever over 101, increasing redness around the incision, or drainage that is thick or foul smelling. Call the surgeon.
• A sudden pop, new deformity, or inability to bear weight on the new joint. Call the surgeon.

The second week: function

By the second week we shift toward the things you actually need to do. Stairs with the walker or a rail, using "up with the good, down with the bad." Getting in and out of the car. Sit to stand from your own chairs and toilet. Longer walks, gradually. For knee replacements we keep pushing both full extension and bending, because the window to gain range narrows with time. We measure range every visit and report it to your surgeon.

Most patients transition to outpatient therapy once they can leave the house comfortably, and we coordinate that handoff so there is no gap.

The Jacksonville specific advice

Heat and humidity make swelling worse, so the summer patients we see benefit from staying in air conditioning for the first few weeks and elevating more than they think they need to. And make the walk to the mailbox a planned exercise, not a whim. Uneven driveways and a hot afternoon are how people end up on the ground.

Getting home therapy set up

Ask your surgeon's office to fax orders to 904-638-8752 before your surgery date so the first visit can be scheduled for the day after you get home. Or call 844-808-9096 and we will reach out to the office. Medicare covers home physical therapy in full for eligible patients.

This article is general information, not medical advice. Follow the specific precautions and exercise instructions from your surgeon and therapist.