Everything you need to know before your knee replacement. Recovery from total knee replacement requires commitment to physiotherapy. Preparation before surgery improves outcomes.
ℹ️ This appointment usually takes place 2-4 weeks before surgery. Blood tests, health checks, and a full medication review are performed.
Total knee replacement is performed under general or spinal anaesthetic and takes approximately 90 minutes. Hospital stay is typically 2-4 nights.
Routine investigations to check fitness for anaesthetic.
Blood thinners must be paused. NSAIDs should be stopped 1 week before surgery. Continue other medications as advised.
Nasal and groin swabs to screen for MRSA. Decolonisation treatment given if positive.
Quadriceps strengthening exercises before surgery (prehabilitation) improve recovery speed after replacement.
Patients who have a good knee bend (over 90 degrees of flexion) before surgery tend to achieve better movement after. Physiotherapy before surgery to improve range of motion is beneficial.
ℹ️ You will be given a specific arrival time. Do not eat or drink (other than clear water up to 2 hours before) from midnight the night before. Bring your medication list and any documents sent by the hospital.
You will be admitted to the ward or day surgery unit, change into a gown, and be seen by the nursing, anaesthetic, and surgical teams before theatre.
Your surgeon will confirm the procedure, mark the operative side, and you will sign a consent form before going to theatre.
You will meet the anaesthetist in the anaesthetic room. Once anaesthesia is established, the procedure will begin.
After surgery you will wake in the recovery room where nurses monitor your vital signs until you are stable and comfortable.
Most patients having arthroscopic or day-case procedures go home on the day of surgery. Those having joint replacement typically stay 1–2 nights. Before discharge, the team will check your pain is controlled, give you wound care instructions, and confirm your follow-up appointment.
You will be given oral pain relief before discharge. Take it regularly for the first 48 hours rather than waiting until pain is severe.
A nurse will check the wound before you leave and explain how to keep it clean and dry.
You will receive a letter for your GP and details of your next outpatient appointment - usually at 2 weeks for a wound check.
Arrange for a family member or friend to collect you. You must not drive on the day of surgery if you have had a general anaesthetic or sedation.
⚠️ Important: Contact your surgical team urgently if the knee becomes very hot, red, swollen, or begins discharging from the wound. Signs of infection after knee replacement require urgent assessment and treatment.
Avoid getting the wound wet until it is fully healed - usually 10–14 days. Use a waterproof cover or cling film when showering.
Do not wait until pain is severe before taking medication. Regular simple analgesia (paracetamol, ibuprofen if appropriate) is more effective.
This is usually 2 weeks after surgery. Sutures or clips will be removed if used.
Seek urgent advice if you develop increasing redness, warmth, swelling, discharge from the wound, or a temperature above 38°C - these may indicate infection.
Blood tests, MRSA screen, medication review. Begin pre-operative physiotherapy exercises.
90-120 minutes in theatre. Hospital stay 2-4 nights.
Physiotherapist gets you walking with a frame. Knee bend exercises begin immediately.
Quadriceps strengthening and gaining knee bend. Target is 90 degrees by 6 weeks. Stitches removed at 10-14 days.
Return to driving at 8-12 weeks. Swimming and cycling from 8-12 weeks.
Most patients have significantly less pain and better function. However, the replaced knee does not feel identical to a natural knee - some patients notice a difference in sensation or minor clicking. Approximately 85% of patients are satisfied with their outcome.
Most patients achieve 100-120 degrees of flexion. Pre-operative range of motion and commitment to physiotherapy are the most important predictors of post-operative movement.
Most patients return to driving at 8-12 weeks for the right knee, when they can safely perform an emergency stop. Left knee replacement patients with an automatic vehicle may drive earlier.
Kneeling is not dangerous for the implant but can be uncomfortable. Approximately 50-60% of patients are able to kneel after total knee replacement.
The primary aim of total knee replacement is significant pain relief and improvement in walking ability and function. Over 85% of patients report significant improvement in pain and function.
Under general or spinal anaesthetic, through a midline incision over the knee, the damaged bone surfaces are removed using precision cutting guides and replaced with metal components on the femur and tibia, with a high-density polyethylene bearing surface between them. The kneecap (patella) may or may not be resurfaced. The joint is balanced to ensure equal tension throughout the range of movement. A drain may be placed. Takes approximately 90-120 minutes.
Weight loss, physiotherapy, analgesics, activity modification, and walking aids. Appropriate when symptoms are tolerable.
Corticosteroid injection for short-term relief. Should not be given within 3 months of knee replacement due to infection risk.
If arthritis is confined to one compartment, a partial knee replacement may be appropriate with faster recovery and higher satisfaction in suitable patients.
Realignment of the tibia to shift load away from the arthritic compartment. Appropriate for younger, active patients with isolated medial compartment disease. Delays but does not prevent eventual replacement.
Deep infection is the most feared complication after knee replacement. May require removal of all components, prolonged antibiotic treatment, and staged revision surgery. Risk is higher in patients with diabetes, obesity, immunosuppression, or previous knee surgery.
Blood clot in the leg veins or lungs. Anticoagulant medication is given for 2-6 weeks after surgery to reduce this risk.
Some patients develop significant post-operative stiffness despite physiotherapy. Manipulation under anaesthetic (MUA) may be required to break down scar tissue (usually performed at 6-8 weeks if flexion is less than 90 degrees).
The common peroneal nerve (causing foot drop) is at risk. Injury is usually temporary.
All knee replacements may eventually require revision. Modern implants have survival rates exceeding 90% at 15 years.
Problems with the kneecap (patellar fracture, maltracking, or patellar tendon injury) can occur after knee replacement.
Approximately 15-20% of patients experience persistent pain after technically successful knee replacement. The reasons are not fully understood. This risk should be discussed before proceeding.
Expected in the early post-operative period. The knee often remains swollen for 3-6 months.
The scar is often numb on the lateral (outer) side due to division of small sensory nerves. This is permanent but does not affect function.
Minor clicking is common after knee replacement and is not harmful.
Knee osteoarthritis does not improve spontaneously. Non-operative management can control symptoms for a period. Approximately 15-20% of patients remain dissatisfied after total knee replacement despite a technically successful operation - this risk of persistent pain should be discussed before surgery.