What Not To Do After Knee Replacement

10 Things To Avoid After Total Knee Replacement

After your knee replacement you will be told all sorts of things from your surgeon, nurses and therapists  Things like ‘Be sure you do your therapy, take your medicine and get some sleep.’  

things to avoid after knee replacement

But what about things to avoid after surgery?  What should you NOT do after your knee replacement surgery? 

My home care patients are often not told the things to avoid after knee replacement, being rushed out of the hospital in haste to clear space for the next surgeries.  In reality the things to avoid might be MORE important than the things you should do.   

Below are 10 things you should not do after knee replacement surgery:

1. Do Not Use Heat Too Soon After Knee Replacement

For the first few weeks after surgery you 100% cannot use direct heat on your knee replacement.  This includes heating pads, over the counter hot patches and hot water bottles. 

Your knee will be very swollen for the first 4-6 weeks after surgery.  While heat feels good and relaxing, it can also increase swelling to the area.  Heat draws in additional blood flow which in turn can increase swelling.

I advise my clients to only use ice on the knee for the first 2 weeks after surgery for pain relief.  Ice can help greatly with pain control as well as decrease swelling to the knee after surgery.  

You may wonder if you can take a hot shower and let the water hit your knee, assuming you have a waterproof dressing.  The answer is yes as long as it is a normal shower run time, not 30 minutes worth of heat. 

A hot shower does not have the same heat and swelling effects as a direct heating pad or hot water bottle.  Just don’t submerge your leg in a hot bath or tub.

2. Do Not Mess With Your Incision After Knee Replacement

After your surgery your incision will be covered by a surgical dressing for roughly 7 days.  Once it comes off and begins healing, it might be tempting to put something on the incision like a cream or balm.  

Do Not Put Anything On Your Incision Until Your Surgeon Tells You To Do So.  Read that line twice. The incision will be a straight line across your kneecap (patella) and should be left alone until your surgeon informs otherwise.

Likely your surgeon will allow basic soap and water to keep it clean however no ointments, lotions, Neosporin, Polysporin, nothing unless directed by your doctor.

Putting anything on the incision that could cause irritation or breakdown of the skin would be very detrimental to your new knee.  Ensuring that the incision is fully closed and healed will prevent infection and put you in the best position for full recovery.

3. Do Not Sit Too Long With Your Foot On The Floor After Knee Replacement

It can be very tough to find a comfortable position after you return home from knee replacement surgery.  Naturally you would think that you should give it plenty of rest and sitting normally would be ok.

In reality, sitting with your knee bent and feet on the floor is a bad position to be in for too long after surgery.  When your leg is down on the floor it can be very difficult for your leg to maintain good circulation.  

With poor circulation can come increased pain and swelling into your calf and foot regions.  Maintaining good circulation is also extremely important to prevent blood clots or deep vein thrombosis (DVT) formation which can be life threatening.  

Instead of sitting with your knee bent, place your leg straight on an ottoman or recliner chair.  Keeping your knee straight is important to promote knee extension which is a main early goal in your recovery.   Straightening your knee to its maximum is vital to your long term total knee success.

4. Do Not Sleep With Your Knee Bent After Knee Replacement

Your surgeon and nurses will remind you after surgery to not sleep with your knee bent.  The most common suggestion is to just sleep on your back for the first few weeks keeping your knee straight.

For those side sleepers or stomach sleepers, sleeping on your back can be difficult if not impossible to do.  Add in trying to keep your knee straight (which can be painful) and you’ve got potential problem.   

The reasoning behind this instruction is to not allow the knee to be in a bent position for many hours.  This prolonged bent positioning could negatively impact your ability to get the knee straight after surgery.

A great option for this sleeping issue is the use of a recliner chair for sleep in the early phase.  A recliner chair works great because it keeps your knee straight while allowing more slack than a mattress.  My patients also report that sleeping in a recliner allows them better quality sleep vs. a standard mattress.  

Bottom line:  Keep your knee as straight as possible and do not sleep with your knee bent in the first few weeks after surgery.

5. Do Not Go Without Pain Medication After Knee Replacement

Most people after surgery are willing to take their prescribed pain medications as they provide pain relief.  Every so often I do have patients in my home care practice that refuse to take any prescribed narcotic pain medications.

Often times the reasoning is personal, sometimes having addiction issues in their family history and other times having other medical issues which don’t mix well with narcotics.  Whatever the reasoning, the important part to emphasize is that it is very difficult to recover from TKR without outside pain control measures.

Even those who are taking their pain medications as prescribed have difficulty completing the physical therapy exercises.  Your PT routine involves forced bending and straightening activities which place stress on your swollen, irritated knee joint.  Its going to hurt, sometimes a lot.

Please take your prescription pain medications to make your recovery a lot easier.  You will be weaned off of them by your physical therapist and doctor as they are not long term medications.

For those forgoing any high level pain medications, at minimum you should be taking 1000 mg of Tylenol 3 times per day.  In addition, you will need to be icing your knee all day long  to substitute for the lack of pain medications.

If you choose to go without narcotics most likely you will be behind in your rehab and struggle to gain full mobility.  The pain after surgery will simply limit your ability to do your PT exercises to your the best potential.

6. Do Not Drink Alcohol After Your Knee Replacement

Wait, what did you just say Mr. PT Guy?  I can NEVER have beer or wine again once my knee is replaced?!? No, that’s not what I’m saying at all.

What I AM saying is that for the first 3-4 weeks after your TKR, you will be on strong pain medications to help your recovery.  When you are taking these medications along with all of your other meds, mixing in alcohol is a very bad idea.  

Why you ask?  First, you need to be in full control of your body seeing that you will not be walking or moving around anywhere near normal early on.   Adding in alcohol places you at a higher risk of falls or tripping early on at home.

In addition, alcohol is a blood thinner by nature.  Since you will already be taking additional blood thinners such as aspirin or Eliquis you cannot afford to thin your blood too much for fear of internal bleed.

The bottom line is your surgeon will not allow you to drink alcohol both before AND after knee replacement for your own safety.  You will get the ok to return to alcohol once you are off of the strong pain medications and blood thinners and your surgeon clears you at your follow up appointment.

7. Do Not Return Work Too Soon After Knee Replacement

Probably the biggest mistake I see my patients do is attempt to go back to work too soon after TKR.  This is especially true for those who have desk jobs or more sedentary jobs.  

Knee replacement surgery recovery time off work is something my patients always ask about. Its an important decision both financially and health wise so be sure to give yourself time to rehab properly.

You may think you can get back to work in a week or so after knee replacement.  The reality is that you will struggle to keep your leg in any seated or stationary position for more than 20-30 minutes.

what not to do after knee replacement

Because of this, sitting at a desk or computer for an hour or longer will be nearly impossible.  Sure you can move around and try to keep the leg comfortable however you will fail.

Your work productivity will be very limited in the first few weeks after knee surgery.  You should be putting your focus on your recovery and physical therapy at home rather than trying to do work tasks.

Do yourself a favor and take at least 2 weeks off of work after your knee replacement.  Even better would be taking 3-4 weeks off to allow yourself to begin outpatient physical therapy and start getting out of the house more.  

For those with more labor or construction related jobs, you will likely need 2-3 months off before you return to your job in full.

8. Do Not Travel Too Soon After Knee Replacement

How long after knee replacement can you fly is another common question from my patients.

Of course you will want to get back to traveling and taking vacations with your new knee.  Just make sure that you give yourself plenty of time for recovery at home before you attempt any travel.

By travel this includes both air and land travel of any significant distance away from home.  I suggest to my patients to avoid any driving of more than 4-5 hours within the first 8-10 weeks after knee replacement.  

Why you ask?  First of all, you are not allowed to fly within the first month after knee replacement anyway.  The chance of blood clots in your leg forming in a pressurized airplane cabin increases greatly.

Second, sitting in a car or airplane seat for any period of time will be extremely uncomfortable for you.  Taking a trip or vacation will be a miserable experience with a new knee so please avoid doing so at all costs within the first few months.

Avoiding driving long distance after knee replacement is the smartest move you can make.

9. Do Not Rush Back To Activities Too Soon After Knee Replacement

If your reason for getting your knee replaced was to return to activities or sports, be patient with your expectations.  Yes you will get back to being active again but you must let your knee recover first.

Thinking about mowing the lawn a week after your knee replacement?  Think again.  You will need to wait at least 6 weeks to return to grass cutting.  Yard work and outdoor maintenance would be in the same boat.

Be warned though that you will not be successful returning to high impact sports such as running, jumping or deep bending activities.  Those would include basketball, volleyball, soccer or football.

If you want to get back into swimming, walking, golf, bowling, yoga or pickleball you can be successful.  These are safer lower impact activities that you can get back to doing after your knee replacement with the proper physical therapy. Just be sure to properly rehab before returning too soon.

How long will you need to wait to return to sports?  I suggest to my patients in the 2-3 month range for most of these lower impact sports.  You may be able to do so sooner however I would not have that expectation.

10. Do Not Be a Hero After Your Knee Replacement

Are you the ultimate competitor?  Likely you’ll want to prove to everyone that you got back to full strength faster than anyone in knee replacement history.  Would be a great story to tell, right?

I’m here to remind you that there’s way more chance of damaging your knee in your valiant efforts than there would be if you simply follow the rules.  Listen to your physical therapist and ask questions of when you can start doing certain activities.

The last thing you need is to push too hard or do too many exercise reps and potentially open up your incision or cause the new joint to be loose.  Yes these things can happen and do happen so this is not an old wives tale.

Do not feel pressured to do activities or go places too early in your rehab.  Listen to your knee and you will make the right choices.  If you’re one of the lucky ones with minimal pain then be extra careful as you will be tempted to act normal too soon.

Final Thoughts on What Not To Do After Knee Replacement

  1. Do Not Use Heat Too Soon After Knee Replacement
  2. Do Not Mess With Your Incision After Knee Replacement
  3. Do Not Sit Too Long With Your Foot On The Floor After Knee Replacement
  4. Do Not Sleep With Your Knee Bent After Knee Replacement
  5. Do Not Go Without Pain Medication After Knee Replacement
  6. Do Not Drink Alcohol After Your Knee Replacement
  7. Do Not Return Work Too Soon After Knee Replacement
  8. Do Not Travel Too Soon After Knee Replacement
  9. Do Not Rush Back To Activities Too Soon After Knee Replacement
  10. Do Not Be a Hero After Your Knee Replacement
About Jeffrey Roth MPT

Owner and operator of Roth Therapy Services in Pittsburgh, PA focusing on in home rehabilitation physical therapy services.


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