What not to do after knee replacement: Top 7 mistakes to avoid

what not to do after knee replacement

When looking at what not to do after knee replacement, there are a few common mistakes I see as a physical therapist. I spent a couple of years as a home care physical therapist seeing people after hip and knee replacements. Mistakes such as too much sitting, putting a pillow underneath the knees, and not fueling your body to promote healing are a few things to avoid that can help improve your healing.

A knee replacement surgery is a big decision. Before making the decision it is incredibly important to weigh the pros and cons as well as how osteoarthritis is impacting your quality of life. 

I have a post here dedicated to helping you make a confident and informed decision for yourself.

I've had a knee replacement, now what?

Post-operative rehabilitation and care of your new knee is incredibly important. 

As a physical therapist, I spent a few years helping people heal after total knee and hip replacements, working in home health. I was able to learn a ton about the recovery process as well as find out what the common mistakes were along the way. 

Some people do really well with joint surgery and others have a more difficult time. 

This is why this article on what not to do after knee replacement is so important. Your actions after surgery can truly impact how your new joint heals. 

Please note there can be adverse reactions to a knee replacement and this doesn’t mean you have done something wrong. With this surgery there is always risk for infection, allergy to implant, and other things that can happen that are out of your control.

What I want to show you today are things that are largely in your control to decrease your risk of other adverse reactions.

The reality is….if recovery is not followed appropriately- this scary fact keeps coming up: 

"One yearafter TKA [total knee arthroplasty], patients report having greater difficulty with kneeling, squatting, moving laterally, turning, cutting,carrying loads, stretching, performing lower extremity strengthening exercises, playing tennis, dancing, gardening, and participating in sexual activity, when compared to healthy adults"

Bade et al 2010

But there is hope to return to these activities and actually enjoy them! Keep reading to find out how.

What not to do after knee replacement: 7 common mistakes

Taking care of your new knee is crucial in order to get the outcomes you are likely searching for: reduced pain and improved mobility.

A knee replacement does not automatically result in pain relief so it is important to follow these guidelines along with the protocol of your surgeon for optimal healing.

This quote below is to help bring about the importance of post-operative care and dedication to this process.

Up to 30% of patients report dissatisfaction with the outcomes of their TKA [total knee arthroplasty] despite the absence of radiological or observable physical complications, such as infection or problems with prostheses. Patient dissatisfaction with TKA is higher when self-reported pain and functional outcomes do not improve or recovery outcomes do not align with preoperative expectations

Ditton et al 2020

Dedication to recovery can help you get the most out of your knee and start adventuring again! 

1. Don't forget to move your knee

Especially early on in the recovery process, sitting too much in one position with your legs hanging down can lead to ankle and foot swelling. When this happens, walking can become difficult. 

After a total knee replacement, stiffness can come on rather quickly so it’s important to stay ahead of it. 

Simple movements in a seated position or in a laying down position may be helpful earlier in recovery. Progressing to spending more time in standing is important as your joint continues to heal. 

Movement will help to improve blood flow, reduce stiffness and heaviness of leg, and continue to improve range of motion. 

This exercise below is an example of a movement you can do in a seated position to help work your knee out. 

When looking at what not to do after knee replacement, lack of movement is something you cannot afford to do if you want optimal results out of your new knee.

The goal is to move every 10-15 minutes if possible to prevent fluid from collecting in your joint. 

As you progress into your recovery, stiffness may start to become less prevalent but frequent movement will be just as important.  

2. Don't rest with a pillow directly under your knees

One of the most important aspects of recovery from a total knee replacement is restoring range of motion. Without appropriate knee bending and straightening, you may find activities like walking, stairs, and even standing are difficult to accomplish. 

Placing a pillow underneath your knee can negatively impact your knee straightening ability. This is why it made the list of what not to do after knee replacement. 

Resting for a while with your knee in a slightly bent position can make straightening your leg very difficult as your knee becomes stiff. 

The best way is to support your entire leg with a pillow (such as a body pillow), not just underneath your knee. This will cause your leg to stay in a straightened position. See picture below.

what not to do after knee replacement

3. Don't overdo it

Trying to do too much right away can leave you with high levels of pain and swelling. 

As you move through the healing process, it is advised to increase your daily activity gradually- even if it feels good. 

Split up daily tasks if you need to and make sure to take rest breaks in between, especially in the first 8-10 weeks. As you begin to feel more comfortable, you can start to do more including going out of the house for errands. 

Keep in mind, everyone is going to heal a little differently so there isn’t a specific time point when you will be cleared for tasks like driving. It is based on how your knee is moving and your ability to react quickly if needed.

When I was working as a physical therapist in home care, this was one of the most common mistakes I saw people make. Doing too much right away can lead you down a pain hole that can be pretty difficult to climb out of.

4. Don't stop when pt stops

So often patients are discharged from traditional physical therapy (PT) once their pain is controlled and they can meet basic functional goals. 

Rarely do people get to continue until they are able to do adventurous things like hiking, kneeling, higher impact exercise, squatting, etc. There are people who are years out from their replacement but don’t have the ability to squat and kneel like they want to. 

Yes, I said kneeling. It can be possible even after a total joint replacement.

"There is currently no evidence that there is any clinical reason why patients should not kneel on their replaced knee, and reasons for not kneeling could be addressed through education and rehabilitation"

Wylde et al 2019

One of the mistakes I see is that people tend to stop putting a priority on exercise once they have graduated from physical therapy. Exercise does continue to remain incredibly important especially if you have goals for adventure, for travel, or to return to activities you love

The idea though is unfortunately not just continuing to follow the piece of paper you were given for the next 3 years. Instead, progressing exercise is extremely important. 

Once out of PT though, many people feel lost with exercise. They may feel unsure what is safe and what should be avoided. Fear of re-injury can also play a part. 

That is why I created the Arthritis Adventure Blueprint. It walks you through step by step on how to regain your strength back starting with seated workouts and moving on up to using weights and even some higher impact activity once your body is ready. 

There are current members of the Blueprint who have gone through a knee replacement and are dedicated to getting the most out of their surgery so they can get back to a leading an active life- no matter if they are one year out or 5+ years out from surgery. 

5. Don't forget food plays a part

Food plays a vital part of recovery both right after surgery and with continued recovery down the road. What’s interesting is food is almost never discussed as a part of our traditional medical model. 

Were you told that protein is incredibly important when it comes to aiding in wound healing? 

Were you told that certain foods can increase inflammation and irritation inside of your joint- contributing to increased pain? 

With osteoarthritis, it is so important to look at what you are eating and make sure you are fueling your body with the right foods. Prioritizing fruits, vegetables, quality protein sources, and other whole foods is incredibly important. 

Most people are actually unaware that food does play a role in arthritis pain. Certain people may be more sensitive to food groups such as processed sugar and/or gluten but not everyone will be impacted in the same fashion. 

That is why the Arthritis Adventure Blueprint not only contains workouts, it also contains information on what foods to eat, how to prioritize protein and what to look for when grocery shopping to ensure you’re fueling your body in the right way. 

6. Don't try to tough out the pain

When looking at what not to do after knee replacement- it is extremely important to discuss appropriate pain management. 

Oftentimes I found people would try to wean off of pain relieving strategies too quickly. Pain can be intense, especially in the first few weeks so it is important to make sure you get a handle on the pain as much as you can. 

Strategies such as: prescribed pain medications, frequent and gentle movement, icing, and the right amount of activity can help to keep pain at bay. 

If pain levels get too high, motivation and willingness to move decreases and therefore brings on more stiffness. High levels of pain can also disrupt sleep which can actually make you more sensitive to pain- a vicious cycle you don’t want to be in. 

As healing continues, you may continue to experience varying levels of pain which is why building appropriate muscle support and balance is extremely important. It is truly incredible how powerful movement and muscle strength can be for arthritic joints, even if they have been replaced.

7. Don't give up hope on your adventures

Just because you have had a joint replacement does not mean you have to set a low bar on what you can accomplish in the future. 

You can relearn how to squat.

You can relearn how to get on the ground. 

You can relearn how to go up and down stairs.

You can get back to traveling and walking longer distances. 

These things are all possible with the right steps forward. 

Making sure you have built adequate strength, maintain good range of motion and continue to improve your stamina- the world can be yours! 

Don’t sell yourself short. 

If you want to make adventure possible for yourself and feel your best after this surgery- the Arthritis Adventure Blueprint is waiting for you.

Conclusion

It is totally possible to have a successful knee replacement and be able to enjoy life.

Recognize there are factors that are outside of your control but also that there certainly are factors that can increase your chance of success. 

My ultimate goal is to help you get set up on the right path forward so you can make all of your adventures possible. 

When looking at this list of what not to do after a knee replacement, don’t be overwhelmed. Keep in mind everyone’s progress may look different. 

As long as you continue to try your very best to help your knee regain it’s function- these tips can help continue to guide you along this adventure. 

Happy healing and see you inside the Arthritis Adventure Blueprint! 

arthritis adventure blueprint

The Arthritis Adventure Blueprint

Dr. Alyssa Kuhn’s signature program to help you go from hopeless to hopeful with osteoarthritis. You will learn the secrets to arthritis pain relief that actually work- including exercise, diet, and other ways to control inflammation! Say goodbye to short term pain relief, it’s time to make it last.

References

Bade MJ, Kohrt WM, Stevens-Lapsley JE. Outcomes before and after total knee arthroplasty compared to healthy adults. J Orthop Sports Phys Ther. 2010;40(9):559-567. doi:10.2519/jospt.2010.3317
 

Ditton E, Johnson S, Hodyl N, Flynn T, Pollack M, Ribbons K, Walker FR, Nilsson M. Improving Patient Outcomes Following Total Knee Arthroplasty: Identifying Rehabilitation Pathways Based on Modifiable Psychological Risk and Resilience Factors. Front Psychol. 2020 May 29;11:1061. doi: 10.3389/fpsyg.2020.01061. PMID: 32670136; PMCID: PMC7326061.

Wylde V, Artz N, Howells N, Blom AW. Kneeling ability after total knee replacement. EFORT Open Rev. 2019;4(7):460-467. Published 2019 Jul 7. doi:10.1302/2058-5241.4.180085
 

Disclaimer: This post is for general informational purposes only. It should not be used to self-diagnose and it is not a substitute for a medical exam, cure, treatment, diagnosis, and prescription or recommendation. It does not create a doctor-patient relationship between Dr. Kuhn and you. You should not make any change in your health regimen or diet before first consulting a physician and obtaining a medical exam, diagnosis, and recommendation. Move Well Age Well, LLC and Dr. Alyssa Kuhn, PT, DPT are not liable or responsible for any advice, course of treatment, diagnosis or any conclusions drawn, services or product you obtain through this post, video or site. Complete all exercises at your own risk.

1 thought on “What not to do after knee replacement: Top 7 mistakes to avoid”

  1. Great information. So glad Adventurealive appeared on my Instagram feed. I’m hooked. I had a total knee replacement and for sure over did it. Pain got out of control and took months to recover. I was told to walk “a lot and do my exercises frequently. The PT and clinic failed to ask me about my normal exercise routine. Big mistake. Walking a lot meant 4 k a day one week post op for me. At my first f/u The physician chastised me and said 500 m. “Walk a lot” to me meant something different. I was fit; swimming, biking, running; I wished they had asked. Their assumption I was 65yrs old and looked frail due to 25lb weight loss due to uncontrolled pain. If they had only asked.
    Thanks for helping to put compassion back into healthcare.
    Beverly

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