Top 5 Mistakes After Knee Replacement

Knee replacement surgery is one of the most common and successful orthopaedic procedures performed in the UK, with over 100,000 operations carried out each year. While the procedure itself has been refined over decades, the recovery period remains critical to achieving optimal outcomes. Unfortunately, many patients unwittingly make mistakes during recovery that can compromise their results and prolong their rehabilitation.

If you've recently undergone knee replacement surgery or are preparing for the procedure, being aware of common pitfalls can help you avoid unnecessary setbacks. This guide examines the top five mistakes patients make after knee replacement surgery and provides practical advice on how to prevent them, ensuring you get the best possible results from your procedure.

One of the most critical mistakes patients make after knee replacement is not taking their physiotherapy programme seriously enough.

Why It's a Problem

After surgery, your knee will be stiff, swollen, and initially weaker than before. Dedicated physiotherapy is essential for:

• Restoring range of motion
• Building strength in the muscles supporting your knee
• Improving stability and balance
• Reducing pain and swelling
• Preventing scar tissue from limiting movement

Many patients stop their exercises once basic function returns or when exercises become challenging. However, this can significantly limit your long-term outcomes.

What Should Happen Instead

Successful rehabilitation requires commitment to a structured programme:

• Attend all scheduled physiotherapy sessions
• Complete the prescribed home exercise routine daily
• Continue exercises for the full recommended period (typically 3-6 months)
• Communicate with your physiotherapist about pain or difficulties rather than simply stopping

A study from the Royal National Orthopaedic Hospital found that patients who fully adhered to their physiotherapy programme achieved 30% better functional outcomes at one year compared to those who didn't complete their recommended exercises.

While following your rehabilitation programme is essential, pushing yourself beyond recommended guidelines can be equally damaging.

Signs of Overdoing It

• Increasing rather than decreasing pain
• Persistent swelling that worsens after activity
• Joint warmth and redness
• Setbacks in your ability to perform previously achieved movements
• Exhaustion or inability to complete daily activities after exercises

Finding the Right Balance

Recovery after knee replacement is not a linear process, and pushing through pain can cause complications:

• Follow your surgeon's and physiotherapist's guidance on activity progression
• Increase duration and intensity gradually (usually 10% per week)
• Allow rest days between more demanding activities
• Use pain as a guide—some discomfort is normal, but sharp or severe pain is a warning sign
• Remember that healing continues for up to 12 months after surgery

Mr James Hopkins, Consultant Orthopaedic Surgeon at Leeds Teaching Hospitals, notes: "We often see patients who believe that doing more exercise faster will speed recovery. Unfortunately, this commonly leads to inflammation, increased pain, and ultimately delays in regaining function."

Infection is a serious potential complication after knee replacement surgery, with deep infections potentially requiring further operations.

Infection Risk Factors

Proper wound care is essential as the surgical site heals:

• Not keeping the wound clean and dry
• Removing dressings prematurely
• Swimming or bathing before the wound is fully healed
• Failing to recognise early signs of infection

Preventing Infection

Follow these guidelines to minimise infection risk:

• Follow your hospital's specific wound care instructions precisely
• Keep the wound dry when showering (using waterproof dressings or covers)
• Avoid swimming pools, baths, and hot tubs until your surgeon confirms healing
• Maintain a clean environment during recovery
• Wash hands thoroughly before touching the area around your incision

Warning Signs to Watch For

Seek medical attention immediately if you notice:

• Increasing redness, warmth, or swelling around the incision
• Persistent or increasing pain not controlled by prescribed pain medication
• Discharge or unpleasant odour from the wound
• Fever or feeling generally unwell
• Opening of the wound

Effective pain management is essential after knee replacement, but approaches that are too aggressive or too passive can both cause problems.

Avoiding Dependence on Pain Medication

While controlling pain is important:

• Follow prescriptions exactly as written
• Begin reducing opioid medications as soon as possible
• Transition to paracetamol and NSAIDs (if approved by your doctor)
• Track medication use to ensure you're not exceeding recommended dosages

Non-Pharmaceutical Pain Management

Complement medications with proven non-pharmaceutical approaches:

• Cold therapy for acute pain and swelling (15-20 minutes several times daily)
• Proper elevation of the leg
• Gentle movement as approved by your physiotherapist
• Relaxation techniques for managing discomfort
• Compression garments if recommended

Perhaps the most common mistake is having unrealistic expectations about how quickly normal function will return.

The Reality of Recovery

A full recovery from knee replacement surgery takes time:

• Initial recovery phase: 6-12 weeks
• Return to light activities: 3 months
• Continued strength improvements: 6-12 months
• Maximum benefit from surgery: Up to 2 years

Many patients become frustrated or discouraged when they aren't "back to normal" within a few months. This can lead to depression, abandoning rehabilitation exercises, or attempting activities before the knee is ready.

Setting Realistic Expectations

• Understand that recovery is gradual and non-linear
• Celebrate small improvements rather than focusing on limitations
• Recognise that temporary setbacks are normal
• Keep a recovery journal to document progress
• Discuss realistic timelines with your surgical team before the operation

What to Expect Long-Term

Most patients can expect:

• Significantly reduced pain compared to before surgery
• Ability to walk moderate distances
• Return to low-impact activities like swimming, cycling, and golf
• Some activities may remain challenging or inadvisable (running, high-impact sports)
• Occasional mild discomfort, especially during weather changes or after extensive activity

Recovering from knee replacement surgery is a significant undertaking that requires patience, commitment, and the right approach. By avoiding these five common mistakes—neglecting physiotherapy, pushing too hard too soon, poor wound management, inappropriate pain control, and unrealistic expectations—you can maximize your chances of an excellent outcome.

Remember that everyone's recovery journey is unique, and comparing your progress to others can be misleading. Focus on following your personalised recovery programme and celebrating your own improvements, however small they may seem.

If you're considering knee replacement surgery or are currently recovering from the procedure, our healthcare provider marketplace can help you find specialist orthopaedic surgeons and physiotherapists who specialise in knee replacement. Having access to experienced professionals throughout your recovery journey can make a significant difference to your overall outcome.