Understanding recovery after joint replacement

Most of the recovery from joint replacement happens in the first six months, and meaningful improvement can continue until around a year 6. Knees are harder work than hips: they hurt more, stiffen faster, and reaching roughly 90 degrees of bend by four weeks, with a full range by around twelve weeks, is the benchmark that shapes the final result 4.

Hip replacement generally produces faster pain relief and needs less intensive rehabilitation. Many people are walking comfortably within weeks and the main risks are dislocation in the early period and doing too much too soon.

Knee replacement is harder. Pain lasts longer, swelling persists for months, and the joint stiffens quickly if range is not worked at. Patients frequently report that the knee felt worse than expected in the early weeks, and knowing this in advance makes it easier to persist.

Straightening the knee fully is the priority and it is the range most easily lost. A knee that cannot fully extend produces a limp, loads the other leg and does not improve on its own later.

Bending is worked at daily, with reaching roughly 90 degrees of flexion by four weeks as the benchmark 4. Range not regained within about three months is harder to recover: manipulation performed within twelve weeks achieves substantially more improvement than manipulation performed later 3. This is why early rehabilitation intensity matters more here than almost anywhere in orthopaedics.

After knee surgery the quadriceps often will not contract properly even though the muscle is intact. This is a reflex inhibition caused by pain and swelling, and it does not simply return with walking.

Specific activation work, and electrical stimulation where activation is very poor, is needed to restore it. Patients who are told to just walk more frequently arrive months later with a knee that still gives way.

Most people get substantial pain relief and a large improvement in walking. Kneeling is often uncomfortable after knee replacement and may remain so. Some awareness of the joint — clicking, a sense of it being artificial — is normal.

High-impact sport is generally advised against because it shortens implant life. Walking, cycling, swimming, golf and doubles tennis are usually fine. Ask your surgeon about your specific implant rather than assuming.

Fever, increasing redness or discharge from the wound, or a joint becoming suddenly hot and much more painful — infection of a joint replacement is serious and time-critical. Calf pain and swelling, or breathlessness and chest pain, may indicate a clot.

Sudden inability to bear weight, or a hip that feels it has gone out of place, needs same-day assessment.