The short answer
- The exercises are the recoveryThe NHS says doing the exercises early helps the long-term strength and movement of the knee. One NHS trust warns that after about three months it becomes very difficult to improve how far the knee bends.
- Pain relief comes before the exercisesRegular pain relief, taken as the discharge letter says, is what makes the exercises possible. Ice and keeping the leg raised help with the swelling.
- Weeks for the basics, and months to recover fullyStitches come out at about 10 days and there is a check at about 6 weeks. The NHS says full recovery may take several months or longer.
- What daily help costsCarers on PrimeCarers charge £18 to £25 an hour with our fee included. Council reablement, where it is offered, is free for up to six weeks.
Clinical timings on this page come from the NHS and NHS trust leaflets. Agencies charge £28 to £35 an hour for a similar visit.
The daily exercises
Why the daily exercises matter most after a knee replacement
After a hip replacement, much of the care at home is about avoiding certain movements. After a knee replacement the work is the opposite: bending and straightening the new knee several times a day, even while it is sore, so that it does not stiffen.
The operation stretches and bruises the muscles around the knee. The Royal Berkshire NHS Foundation Trust leaflet on exercises after a total knee replacement explains that this causes swelling and weakness, which is why the exercises start the day after surgery. It also warns that scar tissue tightens over the first six weeks, and that after three months it becomes very difficult to improve how far the knee bends. The NHS guidance on recovering from a knee replacement says the same in plainer terms: following the exercises early on helps the long-term strength and movement in the knee.
That leaflet starts people on at least five of each exercise once or twice a day, rising to ten of each three or four times a day if the pain and swelling do not get worse. Doing that alone on a sore knee is hard. This is where somebody at home makes the biggest difference, and the day below shows how the sessions fit around the tablets, the washing and the meals.
On waking
Tablets first, then wait
Tablets first, then wait
The knee at this point
Stiff and sore after the night, because the evening pain relief has worn off.
What a helper does
Brings the morning tablets as the discharge letter sets them out, with a drink and breakfast. The first exercises wait until the tablets have had time to work.
Mid-morning
The first exercise session
The first exercise session
The knee at this point
Tightening the thigh, lifting the straight leg and bending the knee on the bed, as the physiotherapist showed.
What a helper does
Reads out the sheet, counts the repetitions and writes down how it went. The exercises are your relative’s to do, so the helper encourages rather than pushes the knee.
Late morning
Washing, dressing and the stockings
Washing, dressing and the stockings
The knee at this point
Standing for long makes the ankle swell, and clothes are hard to get over the operated leg.
What a helper does
A wash sitting down, or a walk-in shower if the dressing is showerproof, the operated leg dressed first, and the compression stockings back on.
Late morning
Leg up and an ice pack
Leg up and an ice pack
The knee at this point
Swelling builds as the day goes on, and swelling makes the knee harder to bend.
What a helper does
Gets the leg up on a stool or the sofa and wraps an ice pack or frozen peas in a damp tea towel, taking it off after 20 minutes at most.
After lunch
The second session and a short walk
The second session and a short walk
The knee at this point
The same exercises as the morning, with the knee already warmed up by a few hours of moving about.
What a helper does
Lunch made and eaten sitting at a table, then the exercises, then a short walk indoors with the crutches or sticks the physiotherapist chose.
Early evening
The third session and supper
The third session and supper
The knee at this point
Tired, and often more swollen than in the morning.
What a helper does
The evening tablets on time, the last exercises of the day, the leg up again, and a meal that does not need standing at the cooker.
Bedtime
Settling for the night
Settling for the night
The knee at this point
The NHS says not to sleep with a pillow under the knee, even though it can feel more comfortable.
What a helper does
A clear, lit path to the toilet, the crutches within reach of the bed, water and the night-time tablets where your relative can reach them.
Shaded rows are the exercise sessions. The number of sessions and repetitions is set by your relative's physiotherapist, and the tablets and their timings are the ones on the discharge letter. Ice and stocking advice from nhs.uk and NHS trust leaflets.
A helper does not do the physiotherapist's job. They make sure the sessions happen, count, encourage, and tell you or the physiotherapist if the knee is bending less than it was. The hospital discharge and post-operative care guide covers the weeks either side, and recovery at home after a hip replacement covers the other common joint operation.
Pain and swelling
Keeping the pain and swelling low enough to do the exercises
A knee replacement relieves the pain of arthritis, but the surgery itself leaves the knee sore for weeks. Managing that pain, so that the exercises can be done, is the practical centre of the first fortnight.
What the NHS and trust leaflets advise
- Pain relief taken regularly, as the discharge letter sets out, rather than waiting until the pain is bad
- The exercises timed for when the tablets are working
- The leg kept raised as much as possible to bring the swelling down
- An ice pack or frozen peas wrapped in a damp tea towel, for no more than 20 minutes at a time
- The compression stockings worn at all times, taken off only to wash them
What to avoid
- A pillow under the knee at night, which the NHS says not to use
- Standing for long periods, which can make the ankles swell
- Ice straight onto the skin, or ice on skin with poor feeling
- Pushing on through a sharp pain rather than stopping
- Sitting with the legs crossed in the first six weeks
The Royal National Orthopaedic Hospital's advice on pain at home after a knee replacement says that in the first few days it can help to take the extra pain relief an hour before the exercises. Only use what has been prescribed, and ask the ward pharmacist before discharge how the tablets should be spaced. The Royal Berkshire leaflet gives a simple test for how hard to push: a moderate ache that settles quickly is fine, while severe pain that takes hours to settle is not.
Some hospitals send people home with about a week of painkillers, and the leaflets from South Tees Hospitals and Manchester say to contact the GP for more. Book that before the supply runs low. If your relative is not used to managing several new tablets, what a private carer can do with medication explains what a carer can and cannot help with.
Swelling can last three months or more, and one trust leaflet says the knee may stay slightly warm for three to six months. A warm knee on its own is expected. Redness, swelling or pain that is getting worse rather than better is different, and is covered under what to watch for.
Week by week
What each stage of the recovery looks like, from the ward to the months after
The NHS gives the main timings, and the trust leaflets fill in what each stage usually looks like at home. Every recovery runs at its own pace, and the surgeon's and physiotherapist's instructions come first.
There are two main types of operation. In a total knee replacement, the most common kind, the ends of the thigh bone and the shin bone are replaced. In a partial knee replacement only the worn side of the knee is replaced, the cut is smaller, and the NHS says recovery should be quicker. The stages below describe a total knee replacement.
- Day 1 to 4
Home from the ward
The NHS says people usually go home 1 to 4 days after the operation, once they can get about safely on crutches. They leave with compression stockings, an exercise sheet, and often about a week of painkillers.
- Week 1 to 2
Sore, swollen and doing the exercises
The Royal Berkshire leaflet expects people to be walking confidently around the house by the end of week two, often on one crutch or none indoors. Washing, dressing, meals and getting the sessions done are the jobs that need help.
- Day 10
Stitches or clips out
A nurse takes them out after about 10 days, usually the practice nurse at the GP surgery. Some hospitals ask the family to book this appointment, so check before discharge.
- Week 3 to 6
Walking further, and needing less help
Short walks outside with sticks, building a little each day. From week four one trust says the knee usually starts to move more freely, though it still aches. The NHS says to try walking without an aid after about 6 weeks if your relative feels ready.
- Week 6
The follow-up, and driving
There is a follow-up appointment about 6 weeks after the operation. The NHS says to wait at least 6 weeks before driving after a total knee replacement, or 3 weeks after a partial one, and to check with the doctor first.
- Month 3 to 12
Strength and confidence come back
The NHS says no lifting or moving anything heavy, such as vacuuming or carrying shopping, for the first 3 months. The Royal Berkshire leaflet expects stairs and daily activities without restrictions by 3 to 6 months, and says an ache along the joint can last up to two years.
The NHS says it may take several months or longer to recover fully, depending on age and general health. Somebody who was already unsteady, or who lives alone, will need help for longer than the timings above suggest, and post-operative rehabilitation and convalescent care covers what a slower recovery involves.
The house, stairs and car
What the house needs, and how to manage the stairs and the car
The NHS suggests preparing the house before the operation: things used often within easy reach, meals in the freezer and transport arranged. These are the parts of a house that cause difficulty on a new knee.
The stairs
Chairs, the bed and the toilet
Washing
The kitchen
The car
The advice on stairs and washing comes from the Royal Berkshire leaflet, and the stair rail from the Sandwell and West Birmingham Hospitals leaflet. Some trust leaflets add that your relative should tell their car insurer about the operation before driving again. What to arrange before discharge day is a fuller list for the week before, and the right equipment to aid the elderly covers raised seats, grabbers and rails.
Your relative will come home with a frame, crutches or sticks, and the physiotherapist decides which. Which walking aid fits and why the fitting comes first explains what they are checking. Where a council assesses that equipment or a minor adaptation is needed, it is free: the Care and Support (Preventing Needs for Care and Support) Regulations 2014 stop a council charging for community equipment, and count an adaptation as minor if it costs £1,000 or less.
How much help, and the cost
Who visits, and how much help is realistic in weeks one to six
Help after a knee replacement comes from several places, and none of them covers the whole day. The NHS covers the clinical side, and the family usually has to fill the rest.
| What it covers | When and how long | What it costs | |
|---|---|---|---|
| NHS physiotherapy | The exercise programme, checking the bend and straightening, and changing the exercises as the knee improves | Advice before discharge, then follow-up that depends on the hospital and where you live, usually as an outpatient | Free at the point of use |
| Practice or district nurse | The wound check and taking out the stitches or clips | At about 10 days | Free at the point of use |
| Council reablement | Short-term help with washing, dressing and moving about again | Where it is offered after a hospital stay | Free for up to 6 weeks, by regulation |
| Family and friends | Often the nights, the lifts to appointments and the shopping | Whatever people can keep up alongside their own jobs | No money, at a cost to whoever is doing it |
| Hourly visits from a carer | Washing, dressing, meals, medication prompts, company through the exercises, shopping and housework | Booked as you need them, and heaviest in the first fortnight | £18 to £25 an hour on PrimeCarers, our fee included |
| A carer overnight or living in | Somebody there at night for the toilet and the tablets, or day and night for somebody living alone | The first few nights, or booked by the week | Sleeping nights from £130, live-in from £1,050 a week |
NHS physiotherapy
- What it covers
- The exercise programme, checking the bend and straightening, and changing the exercises as the knee improves
- When and how long
- Advice before discharge, then follow-up that depends on the hospital and where you live, usually as an outpatient
- What it costs
- Free at the point of use
Practice or district nurse
- What it covers
- The wound check and taking out the stitches or clips
- When and how long
- At about 10 days
- What it costs
- Free at the point of use
Council reablement
- What it covers
- Short-term help with washing, dressing and moving about again
- When and how long
- Where it is offered after a hospital stay
- What it costs
- Free for up to 6 weeks, by regulation
Family and friends
- What it covers
- Often the nights, the lifts to appointments and the shopping
- When and how long
- Whatever people can keep up alongside their own jobs
- What it costs
- No money, at a cost to whoever is doing it
Hourly visits from a carer
- What it covers
- Washing, dressing, meals, medication prompts, company through the exercises, shopping and housework
- When and how long
- Booked as you need them, and heaviest in the first fortnight
- What it costs
- £18 to £25 an hour on PrimeCarers, our fee included
A carer overnight or living in
- What it covers
- Somebody there at night for the toilet and the tablets, or day and night for somebody living alone
- When and how long
- The first few nights, or booked by the week
- What it costs
- Sleeping nights from £130, live-in from £1,050 a week
Reablement is free for the first six weeks under regulation 4 of the Care and Support (Preventing Needs for Care and Support) Regulations 2014, where a council provides it. PrimeCarers introduces carers and clients to each other and does not provide or manage care, so hours and rates are agreed between you and the carer, who is self-employed.
NICE guidance on joint replacement, NG157, says everybody should be given advice on doing their rehabilitation themselves before leaving hospital, with a point of contact, and that supervised outpatient physiotherapy should be offered to people who struggle with daily activities or are not reaching their goals. Ask the ward whether follow-up physiotherapy will be at a clinic or at home, and who books it. The Royal Berkshire leaflet says to ring the physiotherapy department if you have not heard within two to four weeks.
For the first fortnight, a morning and an evening visit of an hour each covers the washing, dressing, meals, tablets and two of the exercise sessions. That is 28 hours, which comes to £560 at the typical rate of £20 an hour on PrimeCarers. Through an agency, at £28 to £35 an hour, the same fortnight costs £784 to £980. From week three, as walking and washing get easier, the visits can drop to a few a week for the shopping, the heavier housework and a walk outside, since the NHS says no carrying shopping or vacuuming for three months. The hourly cost of care at home sets the rates side by side, and what a carer can do in one hour shows how much fits into a visit.
Reablement is worth asking about while your relative is still on the ward, because not every council offers it after a planned operation. Reablement, the free six weeks explains how it works and what happens when it ends. If the nights are the part nobody can cover, short-term night care after a hospital discharge explains sleeping and waking nights. When you are ready, you can search carers near your relative's home and compare rates and reviews. Every carer on PrimeCarers has had an identity check, a right to work check and an enhanced DBS check on the Update Service, and an online interview. Their insurance covers them while they work, separately from those checks. We do not check qualifications or training, so ask the carer directly about any experience after joint surgery.
What to watch for
The signs that need a phone call, and who to ring
The NHS says most people who have a knee replacement have no complications, and that problems are usually minor and treatable. It is clear about the signs that should not be left to see how they go.
Ring 999 or go to A&E
An urgent GP appointment or 111: a clot or an infection
The ward or the surgeon's team
The GP surgery
The first two cards come from the NHS list of complications of a knee replacement. A carer who visits twice a day sees the wound, the walking and the knee every day, so they are often the first to notice a change. They do not give clinical advice, but they can tell you the same morning. Avoiding readmission covers why people go back into hospital after an operation.
Questions
Questions families ask about recovering from a knee replacement at home
Plan for daily help for the first two weeks and less after that. The NHS says people usually go home 1 to 4 days after the operation, return to work after about 6 to 12 weeks, and that it may take several months or longer to recover fully. The heaviest need is at the start, when washing, dressing, meals and the exercises all need a hand.
It is different. After a hip replacement the main task is avoiding certain movements. After a knee replacement the main task is bending and straightening the knee several times a day while it is sore, and one NHS trust says that after about three months it becomes very difficult to improve how far it bends. That makes pain relief and the daily exercises the centre of the first weeks.
A total knee replacement replaces the ends of the thigh bone and shin bone. A partial one replaces only the worn side of the knee. The NHS says a partial replacement has a smaller cut and a quicker recovery, and it says to wait at least 3 weeks before driving after a partial replacement, rather than at least 6, and to check with the doctor first.
Help with washing and dressing, the compression stockings, meals and drinks, prompting medication, keeping your relative company through the exercise sessions, ice and keeping the leg up, shopping, housework and getting to appointments. A carer does not give clinical advice, dress the wound or replace the physiotherapist. Carers on PrimeCarers charge £18 to £25 an hour with our fee included, typically about £20.
Everybody should be taught the exercises before leaving hospital. After that it depends on the hospital and the area: many people are referred for outpatient physiotherapy, and NICE says supervised sessions should be offered to people who struggle with daily activities or are not reaching their goals. Ask the ward where follow-up will happen and who arranges it.
It is better not to be alone for the first day or two. The tablets need to be taken on time, the leg is stiff first thing, and getting to the toilet at night on crutches is when falls happen. After the first week it depends on how steady your relative is, whether there are stairs, and whether they can make food and drinks sitting down.