Your Knee Replacement Guide
Everything you need to know — what the surgery is, how to get your body and your home ready, what surgery day looks like, and how to recover well. I wrote it the way I'd explain it across the kitchen table. Read it all before surgery, and keep it close for the first year after.
Quick Reference
Phone numbers and warning signs, all in one place. When in doubt, call — I would rather you call us ten times for nothing than wait once on something real.
Watch: Welcome — and congratulations — on the web version of this guide at darinallredmd.com
Call 911 right away for sudden chest pain · sudden shortness of breath or trouble breathing · fainting, confusion, or one-sided weakness. Do not drive yourself. Do not wait to see if it passes.
Travelling, or not sure which number you need? Every clinic's emergency and daytime number is on one page.
Call the clinic the same day — or go to the ER after hours
- Fever over 101.5°F or shaking chills
- An incision that opens, drains fluid, or becomes more red or more painful
- New calf pain or new ankle swelling
- Pain your medicine no longer controls
- Bleeding that won't stop with pressure
Good to know
- Some swelling, warmth, and bruising is normal in every replaced knee — what matters is new, one-sided, worsening symptoms
- Blood clots most often appear a few weeks after surgery, when your guard is down
- Day 2–3 is often the hardest stretch of recovery — it gets better from there
Let’s get to know each other.
A great result is a team effort — and teams do best when they know and trust each other. Take a few minutes to see how I think about your joint and your surgery: watch a few videos, read a little, and you’ll understand why I do things the way I do.
Website: darinallredmd.com · YouTube: @DarinAllredMD · Instagram: @darinwallredmd · TikTok: @darinallredmd
And help me get to know you: come to every visit with your questions written down, and tell my staff what you’re hoping to get back to — hunting, hiking, keeping up with the grandkids. The better we know each other, the better you’ll do.
Reading this on paper? Scan to watch.
Your Three Checklists
Every item is explained in the sections below — but if you do nothing else, work these lists. Patients who do walk in calm and prepared. Your progress is saved on this device, so you can come back anytime.
Must Be Done Before Surgery
Starting 4+ weeks out
The final week
Things That Postpone Surgery
We do not operate until these are corrected — each one raises your risk of infection or serious complication. Surgery is postponed, not cancelled, if any apply:
Strongly recommended — discuss with us if any apply: no heart attack or stroke within the past 6 months; not taking daily narcotic pain medicine; fewer than 14 alcoholic drinks per week; not smoking.
A different kind of "no": some situations don't postpone surgery — they mean your surgery should happen at a larger referral hospital instead of here. Examples: age over 82, BMI 40 or higher, heart failure, dialysis, cirrhosis, a recent heart attack or stent, or a recent blood clot. We'll help arrange that referral.
Things to Buy
Infection prevention — required
Equipment — before surgery week
Medicine cabinet — over the counter
Understanding Your Knee and Your Surgery
Why does my knee hurt?
The ends of your thigh bone (femur) and shin bone (tibia), and the back of your kneecap (patella), are covered with smooth cartilage. Cartilage lets the joint glide and cushions every step. Arthritis is the wearing away of that cartilage. When it wears down to bare bone, bone rubs on bone — and that causes the pain, swelling, and stiffness you feel.
What is a total knee replacement?
A total knee replacement is really a resurfacing of the knee. We do not remove your knee. We remove the worn, damaged surfaces and cap the ends of the bones — a metal surface on the femur, a metal tray with a smooth plastic insert on the tibia, and usually a plastic button on the kneecap. The result is a new, smooth, cushioned joint that moves without bone-on-bone pain.
Did I try everything else first?
Surgery should come after non-surgical care has been given a fair chance: activity changes, strengthening, weight loss, anti-inflammatory medicine, and injections. If you want to go deeper on the non-surgical side, I wrote a book about exactly that — The Surgery-Free Arthritic Knee — available free on this site. When those measures no longer control your pain and your knee is limiting your daily life, replacement is the reliable next step. The final decision is always yours — my job is to make sure you have what you need to make it.
The benefits
Pain relief is the main reason to do the operation, and it is what knee replacement does best. Most patients also walk farther, sleep better, and return to the things they had given up — work, travel, the hills in the fall, keeping up with the grandkids. The goal is your independence.
I want you to have realistic expectations too: about 1 in 10 to 1 in 5 patients say their knee is improved but not everything they hoped for. A replaced knee is a very good knee. It is not a 25-year-old knee. I'd rather tell you that plainly now than have you find it out later.
The risks — honestly
Serious complications are uncommon — overall in the range of a few percent — but no surgery is risk-free, and I won't pretend otherwise. These are the ones we watch for, and what we do about each:
The complication we work hardest to prevent — it's why we ask for the skin washes, the nose treatment, blood-sugar control, and postponement when risks aren't optimized. A deep infection can require more surgery, sometimes removal of the implant while it clears.
A clot in the leg (DVT) can travel to the lungs (pulmonary embolism), which can be life-threatening. Prevention: early walking, moving often, and a blood thinner — aspirin for most patients; a stronger one (such as Eliquis, Xarelto, or Pradaxa) if you are at higher risk. The red-flag symptoms are in the Quick Reference above.
A small number of knees scar in and won't bend well; occasionally this needs a procedure under anesthesia to break up scar tissue. Our Quiet Knee recovery plan keeps swelling down so this rarely happens.
A patch of numbness beside the scar is common and normal and usually shrinks over a year or two. A significant nerve injury is a different, rare event.
Your anesthesia team reviews your specific risks with you before surgery.
Implants can loosen or wear over many years; a second ("revision") surgery is possible if needed. Metal allergy or reaction is rare — tell us if you have a known metal allergy.
What will my new knee feel like?
- Clicking sounds with bending are normal — it is metal and plastic.
- A patch of numbness beside the scar is normal.
- Kneeling is usually possible but often stays uncomfortable. It does not damage the knee.
- Warmth and mild swelling can persist for six months to a year while the knee fully quiets down.
- Full recovery takes a full year — but about 80% of the improvement comes in the first three months.
Am I too old? Too young?
Your general health matters more than your age. Healthy patients in their 80s do well; patients with uncontrolled medical problems need those problems addressed first, at any age. For younger patients, the trade-off is that the implant may not last a lifetime — a conversation we will have together.
Getting Your Body Ready
This is the part you control — and it's where good results are made. We postpone surgery (never cancel it — postpone it) until your risks are optimized, because operating on an unprepared body invites the complications we most want to avoid.
Watch: Getting your body ready — on the web version of this guide at darinallredmd.com
Do you need to see a dentist before surgery?
Mouth bacteria can travel through the blood to a new joint, so an active infection needs to be treated first. But a routine dental visit is not required for everyone. Check anything that applies to you:
Are you ready for surgery? The checklist we use
Before I schedule a knee or hip replacement, you and I make sure a few things are in place. This is the same list my team uses. Check what's true for you. If you don't know a number, your primary care office has it from your history & physical, and the clinic can look it up. You don't have to have every box checked today — the point is to know what still needs work, with time to fix it.
Everyone needs these
Strongly recommended: no smoking or vaping; fewer than 14 drinks a week; no blood clot, stroke, or heart attack in the last year.
Same-day surgery, or a hospital stay?
Same-day (go home)
All of these, plus everything above.
- Under 75 years old
- BMI under 36
- A1c under 7
- Walk without a walker or wheelchair
- No heart or lung condition that needs monitoring overnight
- No heart attack or stroke in the last 6 months
- Able to take anti-inflammatory medicine (like ibuprofen)
Hospital stay (1–2 nights)
A little more room. Everything above, plus:
- No strict age limit — we look at overall health
- BMI under 40
- A1c under 7.5
- A walker is fine
We'll talk about a larger hospital if…
Some situations are safer with more specialists in the building.
- BMI 40 or over
- Heart failure, cirrhosis, or dialysis
- Heart attack or a stent in the last 6 months
- A blood clot in the last 3 months
- High-dose daily opioids or addiction treatment
Tell us at your pre-op visit
- Any metal allergy
- Ozempic, Wegovy, Mounjaro, or any other GLP-1 medicine (we'll tell you when to stop it)
- Every blood thinner and supplement you take
- Rheumatoid arthritis or other medicines that affect your immune system
Bring this list to your pre-op visit. The final call is made by me and the anesthesia team.
The optimization targets
| Target | Why it matters |
|---|---|
| Blood sugar: HbA1c below 7 for outpatient surgery; below 7.5 for the inpatient pathway | High blood sugar dramatically raises infection risk |
| No smoking or nicotine for at least 4 weeks before surgery | Nicotine chokes off healing blood flow and raises infection risk |
| Body mass index below 36 (below 40 for the inpatient pathway) | Higher BMI raises wound and anesthesia complications |
| Good nutrition: albumin 3.5 or above | Low protein stores predict wound problems and infection |
| Blood count: hemoglobin above 12 | Low blood counts may need iron treatment before surgery |
| No cortisone/steroid injection into the surgical knee within 3 months | Recent injections raise infection risk |
| Healthy teeth — no active dental infection | Mouth bacteria can travel through the blood to a new joint. Finish needed dental work at least 2 weeks before surgery |
Eat like healing depends on it — because it does
Surgery is an athletic event for your body — and you wouldn't start a long day of ranch work on an empty tank. Starting at least 2 weeks before surgery and continuing 4 weeks after:
- Protein: about 120 grams per day for women, 150 grams per day for men. A chicken breast or a steak is about 25 grams. Eggs, dairy, beans, and protein shakes all count. Your thigh muscle shrinks fast after knee surgery — protein is how you fight back.
- Daily vitamins (start 2 weeks before, continue 8 weeks after): Vitamin C 1,000 mg, Vitamin D 5,000 IU, and magnesium glycinate 400 mg.
- Water: at least 8 glasses a day.
- Alcohol: cut back now, and none in the 5 days before surgery.
- Caffeine: taper down gradually to avoid a withdrawal headache in the hospital.
Prehab: exercise before surgery
The stronger you go in, the faster you come back — I see it in my patients every week. Spend 10–15 minutes twice a day on these four exercises from now until surgery:
- Quad sets. Lie down, press the back of your knee down into the bed, tightening the muscle on the front of your thigh. Hold 5 seconds. Repeat 10–20 times.
- Heel slides. Lie on your back and slide your heel toward your bottom, bending the knee as far as comfortable. Hold 5 seconds. Repeat 10–20 times.
- Straight-leg raises. Lie on your back with the other knee bent. Lift the straight leg 8–12 inches, toes pointed up. Hold 5 seconds. Repeat 10–20 times.
- Chair push-ups. Sit in a chair with armrests. Push down with your arms and lift your bottom off the seat. Repeat 10–20 times. This builds the arm strength you'll use with your walker.
Walking, swimming, and stationary cycling are all excellent additions if your knee tolerates them.
Medicines to review before surgery
Go over every medicine and supplement you take with your primary care provider and with us:
- Blood thinners (warfarin/Coumadin, Eliquis, Xarelto, Pradaxa, Plavix, and others): your prescribing provider must tell you whether and when to stop and restart them. Never stop these on your own.
- Weight-loss / diabetes shots (Ozempic, Wegovy, Mounjaro, and other GLP-1 medicines): these must be held before surgery for anesthesia safety — they slow stomach emptying. If you take one for diabetes, discuss the hold with your prescribing provider. If you take one for weight loss only, stop it at least 2 weeks before surgery.
- Rheumatoid arthritis or immune-suppressing medicines: ask your rheumatologist which to stop and when.
- If you take daily narcotics: work with your prescriber to reduce them before surgery. Patients who take fewer narcotics before surgery have better pain control and better results after.
Getting Your Home and Your Help Ready
Your coach
You must have a responsible adult with you around the clock for at least the first 3 days after you come home. This is a requirement, not a suggestion — if no one is available, we may have to postpone surgery. Pick someone steady — a spouse, a grown child, a good neighbor. Your coach's job description is in the Coach section of this guide.
Fall-proof your home
Do this before surgery week, while you can still move things — an afternoon of work now can prevent the fall that sets you back:
- Remove throw rugs; tape down or reroute electrical cords.
- Clear clutter from walkways. Make sure paths are wide enough for a walker.
- Add night-lights between the bedroom and the bathroom.
- Put frequently used items — dishes, remote, phone charger, medicines — at counter or waist height so you don't bend, reach, or climb.
- Choose a firm chair with armrests as your recovery chair. Avoid low, soft couches.
- Plan for pets. A loving dog underfoot is a fall hazard the first couple of weeks.
- Cook and freeze meals now, or line up family, friends, or a meal program.
Equipment to have at home
The full shopping list is in Checklist 3: walker, raised toilet seat or grab bars, shower chair with a non-slip mat, ice supplies, and a few helpful extras like a reacher and sock aid.
Insurance and paperwork
- Verify your coverage and expected out-of-pocket costs with your insurance company.
- If you think you may need home health or a skilled nursing facility after surgery, ask your insurer before surgery what qualifies. Choosing a facility without qualifying can leave you with the bill.
- Bring your insurance cards, photo ID, and any advance directive to the hospital.
Coming from out of town?
Many of my patients drive in from across Sweetwater County and beyond. If you'd like to stay in Rock Springs the night before surgery, the Hampton Inn offers a discounted rate for Aspen Mountain Medical Center patients — mention it when you book.
On the drive home after surgery, stop every hour, get out, and walk for a few minutes. Long stretches of sitting still are how blood clots start.
The Countdown
From four weeks out to the morning of surgery — what happens when, so nothing catches you off guard.
Put these dates on your calendar
Enter your surgery date and we'll build a personal set of reminders — skin washes, the night before, warning signs, your follow-ups — and add them straight to your phone's calendar. Twelve gentle nudges, timed to your surgery.
Please pick your surgery date first.
Your personal schedule
Your surgery date stays on this device. Nothing is sent to us or to anyone else — this tool runs entirely in your own browser. You can change or delete the reminders in your calendar anytime.
About 4 weeks before
- See your primary care provider for a history and physical (H&P). This must happen within 30 days of surgery — schedule it early. Expect a physical exam, an EKG, and labs (blood count, chemistry, HbA1c, albumin).
- Review all medicines (Part 2) and make your stop/restart plan for blood thinners.
- Work the optimization targets: blood sugar, nutrition, no smoking. Do your prehab exercises daily.
- Line up your coach, your ride, and your home setup.
- Watch my videos on this site and re-read this guide.
1 week before
- Stop aspirin and anti-inflammatories (ibuprofen, Motrin, Advil, Aleve, naproxen, and similar) — unless your doctor told you to stay on aspirin for a heart stent or similar reason. Tylenol (acetaminophen) is OK for pain this week.
- Stop blood-thinning supplements and herbal products: fish oil / omega-3, vitamin E, garlic, ginkgo, ginseng, turmeric/curcumin. Natural does not mean harmless. Keep taking your Vitamin C, Vitamin D, and magnesium.
- Buy your supplies: CHG antiseptic soap and your two bottles of Ensure Pre-Surgery Clear Carbohydrate Drink. If you cannot find that exact drink, skip it entirely — do not substitute juice, soda, or Gatorade.
- A pre-op nurse will call you this week with your arrival time (about 2 hours before surgery), your personal fasting instructions, and a health-history review.
Watch: The skin washes — on the web version of this guide at darinallredmd.com
5 days before skin & nose cleansing begins
Getting your skin and nose clean is one of the most important things you personally do to prevent infection. It takes a few minutes a day, and it is some of the cheapest insurance you will ever buy. Every day for the 5 days before surgery — and the morning of:
- Nose: apply the nose antiseptic we give you (povidone-iodine or mupirocin) to both nostrils twice a day.
- Skin — the CHG wash, once a day: use clean, freshly laundered washcloths, towels, and clothes each time. Wash your hair and body with your usual products first, then apply a quarter-sized amount of CHG on a wet washcloth from the neck down (never on your face, hair, or genitals). Rub gently for 3 minutes, rinse with warm water, no regular soap after. Pat dry with a clean towel; fresh clothes. No lotion, deodorant, powder, or perfume.
- Do not shave your legs or any hair below the neck during these 5 days (face is OK). Shaving makes tiny cuts that let bacteria in.
- If your skin becomes red or irritated, stop and call us. (If you're allergic to CHG, use an antibacterial soap like Dial instead.)
- Sleep on clean sheets, in clean pajamas, after each wash.
Watch: The night before & morning of — on the web version of this guide at darinallredmd.com
The night before
- Eat a normal dinner, then aim for about 100 grams of healthy carbohydrates in the evening (roughly 5 slices of whole-wheat bread — pasta, rice, potatoes, and fruit count too). Diabetic patients: skip the carb-loading if it will spike your blood sugar.
- Drink one bottle of Ensure Pre-Surgery in the evening.
- No solid food, gum, or mints after midnight.
- Do your final CHG wash and nose treatment. Clean sheets, clean pajamas. Remove nail polish and all jewelry.
- Pack: this guide (or your phone), insurance cards, photo ID, advance directive, a complete medication list with doses, your inhalers/eye drops/CPAP if you use them, glasses/hearing aids/dentures with cases, loose comfortable clothes, supportive shoes, phone and charger, and your walker if you own one. Leave valuables and jewelry at home.
The morning of surgery
- Clear liquids are allowed until 2 hours before your arrival time — water, black coffee, clear juice without pulp. Drink your second Ensure Pre-Surgery bottle in this window, finishing at least 2 hours before arrival. (If your care team gave you different fasting instructions, theirs win.)
- Do your morning CHG wash and nose treatment.
- Take only the medicines your doctor told you to take, with a small sip of water. Diabetic patients: do not take your diabetes medicines — but bring them with you.
- Wear loose, comfortable clothing. Arrive at your scheduled time — about 2 hours before surgery.
Surgery Day
When you arrive
Check in at the front desk. In the pre-op area you will change into a surgical gown and meet your nurse, who verifies your identity, allergies, medicines, and consent forms — you'll hear the same safety questions several times on purpose. An IV is placed for fluids and medicines, the surgical site is cleaned again (any hair removed with clippers, never a razor), and you'll receive IV antibiotics plus medicines that reduce pain, swelling, and nausea before they start. You'll meet your anesthesia provider, and I'll see you to answer last questions and initial your knee.
Your family member can stay with you in pre-op. When you go back to the operating room, they'll wait in the surgical waiting area, and I will come find them as soon as we're done.
Anesthesia: what to expect
For most knee replacements we use a spinal anesthetic plus sedation: numbing medicine placed in your lower back so you feel nothing from the waist down, while sedation keeps you relaxed and dozing — most patients remember nothing. Compared with general anesthesia, a spinal means less nausea, better early pain control, fewer serious complications, and an easier wake-up.
You will also usually receive a nerve block (an adductor canal block) that numbs the knee without weakening your thigh muscle, and I place a long-acting numbing injection around the knee during surgery. Together, these give most patients a comfortable first day.
One warning about nerve blocks
When a block wears off, pain rises and your leg may briefly be weaker than it feels — this is the highest-risk time for a fall. Use your walker, every time.
Things we do during surgery that you won't see — but that matter
- Tranexamic acid (TXA) — a medicine that dramatically reduces bleeding. Transfusions after knee replacement are now rare.
- Dexamethasone — a single steroid dose at surgery, repeated the next morning. One of the best-proven medicines in joint replacement: less pain, less nausea, less inflammation, and it does not raise infection risk.
- Antibiotics into the bone at the surgical site for extra infection protection.
- Active warming — staying warm reduces infection risk (we supply the warm blankets).
- No tourniquet for most patients, no drains, and no routine bladder catheter — older practices we've retired because the evidence shows patients do better without them.
Right after surgery
You'll spend about an hour in the recovery room (PACU) while the spinal wears off, then return to your room and your family.
- You will stand and walk the same day as your surgery, with therapy at your side, as soon as your legs are ready. This is the single best thing you can do to prevent blood clots and pneumonia — and patients who walk early go home sooner.
- You'll start with liquids and advance to normal food as your stomach allows. Nausea is common and treatable — tell your nurse.
- Squeeze-sleeves (compression devices) will be on your lower legs whenever you're in bed — they keep blood moving.
- Do not get up without help on surgery day. Between the block, the medicines, and an unfamiliar room, this is when falls happen. Use your call light every time.
How long will I stay?
This is based on milestones, not a set number of nights. You go home when you can walk safely with your walker, get in and out of bed and a chair, manage pain with pills, eat and drink, and pass urine — and your home support is ready.
- Some patients who meet our outpatient criteria go home the same day.
- Most others stay one night and go home the next day.
- A longer stay happens when your body needs it — but more nights in a hospital bed is not a reward; getting home to your own recovery chair, your coach, and your own bed is where recovery goes fastest.
Before you leave, your nurse will review every discharge instruction with you and your coach, including your medicines, your exercises, and the warning signs. You'll leave with written instructions and prescriptions.
Recovering at Home — The Quiet Knee Plan
The idea is simple: calm the knee down first, then build it back up. A calm, quiet knee lets your thigh muscle wake up, and motion returns with less pain and less pain medicine. It feels slow the first week; it is faster by the first month.
Watch: The Quiet Knee plan — on the web version of this guide at darinallredmd.com
Your four jobs in the early weeks
- Control the swelling. Ice often (20 minutes on, 10 off — don't freeze the skin), keep light compression on, and elevate: toes above the knee, knee above the hip.
- Keep the knee straight. Several times a day, rest your heel on a rolled towel with nothing under the knee and let the knee sag into a fully straight line. Full extension is precious — it's hard to win back if you lose it. Never prop a pillow under the knee.
- Wake up the thigh muscle. Gentle quad sets: tighten the thigh, press the back of the knee down.
- Ease into bending. Gentle seated knee bends toward 90 degrees and slow heel slides through a comfortable range. Don't force it — forcing makes swelling, and swelling sets you back.
Walk short and often — a lap around the living room every hour you're awake beats one long march. More progressive strengthening starts around week 4, once the knee is quiet.
Physical therapy
You should have a physical therapy appointment within a few days after surgery — if you don't, call the clinic and we'll arrange it. Your therapist follows the Quiet Knee Protocol: early sessions focus on swelling control, full extension, quad activation, and gentle motion; strengthening builds from about week 4 on.
Watch: Your pain plan — on the web version of this guide at darinallredmd.com
Your medicines after surgery
- Aspirin 81 mg twice daily with food for 2 weeks (14 days) — this prevents blood clots. Do not skip a dose. If you are at higher risk for blood clots — a previous DVT or PE, a clotting disorder, active cancer treatment, or any other reason for increased clotting risk — aspirin is not enough on its own: you will be prescribed a stronger blood thinner instead, such as Eliquis, Xarelto, or Pradaxa. Take whichever one you were prescribed — never both — and follow its instructions.
- A steroid tablet (dexamethasone 16 mg) the morning after surgery. One dose. It lowers pain, swelling, and nausea, and it does not raise your risk of infection. If you go home the same day, this tablet goes home with you.
- Tylenol (acetaminophen) 1,000 mg every 8 hours, on a schedule, for 2 weeks. "On a schedule" means at set times — not only when it hurts. This is the backbone of your pain control, and it works best when you never let the pain get ahead of you.
- An anti-inflammatory twice a day, also on a schedule. We usually prescribe celecoxib 200 mg. If you would rather use over-the-counter naproxen or ibuprofen, that is fine — take it with an acid reducer such as Pepcid to protect your stomach, and keep it at least 30 minutes after your aspirin dose or 8 hours before it. Never exceed the daily maximum printed on the label.
- Narcotic pain pills are for breakthrough pain only. You may need them for several days; the sooner you're off them, the better you'll feel. Refills are rarely needed, are never done after hours or on weekends, and take about 72 hours — plan ahead. If you take narcotics regularly for another condition, refills must go through your regular prescriber.
- While on narcotics, take a stimulant laxative such as over-the-counter Senna. Narcotics slow the bowel; fiber alone adds bulk but doesn't wake the bowel up. Drink plenty of water.
- Keep taking your Vitamin C, Vitamin D, and magnesium for 8 weeks after surgery, and keep protein intake high (120–150 g/day) for 4 weeks.
Pain: what's normal
Expect real soreness — good days and bad days, and often more swelling in the evening than the morning. Our goal is not zero pain; it's pain controlled well enough to walk, do your exercises, and sleep. Day 2–3 is often the hardest stretch, as the last of the surgical numbing fades. It gets better from there. Ice, elevation, and moving a little, often, are as important as any pill.
Caring for your incision
- You will go home with a waterproof antimicrobial (silver) dressing. Leave it alone — it works best undisturbed.
- You may shower starting the day after surgery, with the dressing on. Let water run over it; pat dry. No scrubbing.
- Do not soak the knee until the incision is fully healed — no baths, hot tubs, or pools.
- The dressing stays on for about 5–7 days. We'll tell you at discharge whether we change it at the clinic or you change it at home (we'll send supplies and instructions if it's you). Change it sooner only if it's leaking at the edges or peeling off — and call us if you see that.
- Wash your hands before any contact with the dressing. Do not touch the incision itself, and do not apply lotions, creams, or ointments to it.
- If you have stitches or staples that need removal, we'll take them out at your 2-week visit.
Sleep, swelling, and the little stuff
- Sleep on your back or either side — whatever's comfortable. Keep the pillow under your ankle/calf, never under the knee.
- Poor appetite for a week or two is normal; keep drinking fluids and hitting your protein anyway (shakes count).
- Constipation is nearly universal — stay ahead of it with fluids, walking, and the laxative.
- Feeling emotionally low or tired in weeks 1–2 is common and passes. If it doesn't, call us — we care about all of it.
- Bruising down the shin and ankle can look dramatic. It's gravity, not a problem — unless it comes with the calf pain or swelling on the warning list.
Getting around safely
- Use the walker until your therapist moves you to a cane — usually 2–3 weeks of walker, then a few weeks of cane.
- You may put your full weight on the new knee unless told otherwise.
- Stairs: "up with the good, down with the bad." Lead up with your non-surgical leg; lead down with the surgical leg and the walker or rail.
- Turn with small steps. Never pivot on the new knee.
- Getting into a car: seat pushed all the way back, back up to the seat, sit, then swing your legs in. Sit in the back seat with the leg supported for longer rides if that's more comfortable.
Milestones: What to Expect When
Every knee is different — these are typical ranges, not deadlines. Don't measure yourself against your neighbor's knee; your therapist and I will tailor goals to you.
Weeks 0–2 calm the knee
Walker at home; short frequent walks; ice and elevation most of the day; gentle motion work. Goals: full extension (knee completely straight), bending toward 90°, quad waking up, swelling trending down. Stitches or staples out around 2 weeks.
Weeks 2–4 restore motion calmly
Swelling continues down; gait smooths out; wean toward a cane as your quad control allows. Bending progresses naturally as the knee quiets. Once the incision is fully healed and dry, you can shower without any dressing — but still no soaking.
Weeks 4–8 build it back up
Strengthening begins in earnest: mini-squats, step-ups, stationary bike, balance work. Off the cane when you can walk without a limp. Bending typically reaches 110–120°. Many patients return to desk work in this window (physical jobs take longer — often 2–3 months).
Weeks 8–12 function
Stairs foot-over-foot, longer walks (½ mile to a mile and beyond), most daily activities back. By three months, about 80% of your total improvement is on board.
Months 3–12 the long tail
Strength, endurance, and the last degrees of motion keep improving for a full year. Warmth and mild swelling after big days can persist — normal.
Driving
Never drive while taking narcotic pain medicine. Beyond that, you need the strength and reaction time to stomp the brake without hesitation. For a right knee this usually takes about 6 weeks; a left knee (automatic transmission) may be sooner. When in doubt, test yourself in an empty parking lot with your coach driving you there.
Returning to activities
- Encouraged for life: walking, hiking, cycling, swimming, golf, dancing, bowling, fishing, hunting, gardening, doubles tennis or pickleball in moderation.
- Discouraged: running, jumping, and repetitive high-impact sports — they wear the implant.
- Kneeling is allowed once the incision is fully healed; it's uncomfortable for many patients but does no harm. Use a cushion.
- Intimacy: safe to resume when you're comfortable, generally within a few weeks. Let comfort be your guide.
Warning Signs — Read This Twice
Call 911 for: sudden chest pain or sudden shortness of breath — this can be a blood clot in the lungs (pulmonary embolism). Also for fainting, confusion, or stroke symptoms. Do not drive yourself. Do not wait to see if it passes.
Watch: Warning signs & when to call — on the web version of this guide at darinallredmd.com
Blood clot in the leg (DVT) — call same day, or ER after hours
- New calf pain — a deep ache or cramp that doesn't act like muscle soreness
- New or increasing ankle/calf swelling, especially one-sided, with warmth or redness
Blood clots most often appear a few weeks after surgery — often after you've relaxed your guard. Keep walking hourly, finish your full 2-week course of aspirin (or your prescribed stronger blood thinner), and stay suspicious of new calf symptoms through week 6. Some swelling, warmth, and bruising is normal in every replaced knee; what raises concern is new, one-sided, worsening symptoms.
Infection — call same day, or ER after hours
- Fever over 101.5°F or shaking chills
- Increasing redness around the incision (a thin pink rim early on is normal; spreading, angry redness is not)
- The incision opens, or drains cloudy or foul fluid — especially new drainage after day 5
- Pain that gets worse day over day instead of better
Also call us for
- Pain your medicines no longer touch
- Bleeding that soaks through dressings and doesn't stop with pressure
- Signs of bleeding from blood thinners: bloody nose that won't stop, bleeding gums, blood in urine or stool, vomiting blood, severe headache
- A fall onto the new knee with new pain, deformity, or inability to bear weight — after hours, this is an ER visit
- Inability to pass urine
For Your Coach
You are half this team. Patients with an engaged coach recover faster, fall less, and get off pain medicine sooner. Thank you.
Watch: Your coach — watch this one together — on the web version of this guide at darinallredmd.com
Before surgery
- Read this guide — especially the warning signs (Part 8)
- Help fall-proof the house and stock the freezer
- Plan to drive to and from the hospital, and to stay around the clock for at least the first 3 days home
- Be at the discharge teaching — you are a second set of ears, and you'll hear things the patient (still on medication) won't retain
The first week
- Falls are the enemy. Be within arm's reach for every walk, transfer, and bathroom trip the first few days. Keep the walker within the patient's reach — always
- Run the medication list: right pills, right times. Keep a written log so doses aren't doubled or missed
- Supervise (and gently insist on) the hourly mini-walks, the ice-and-elevate routine, and the exercises
- Handle meals, fluids, and the laxative schedule
- Watch for the warning signs — you may notice a fever, confusion, or a swollen calf before the patient does
Ongoing
- Drive to therapy and follow-up appointments until driving is cleared
- Expect fatigue and some discouragement in weeks 1–2. Encourage, don't push
- Progress in this operation is measured week over week, not day over day
Follow-Up and Living With Your New Knee
Follow-up schedule
- 2 weeks: wound check, stitch/staple removal, progress review — call the clinic after surgery to schedule this visit
- 6 weeks: exam and X-rays
- 3 months: progress check
- Possibly 6 months and 1 year, then periodically for the life of the implant — a well-functioning replaced knee should still be checked every few years
Pain-medicine refills in the first 2 weeks go through the orthopedic clinic; after 2 weeks, through your primary care provider.
Dental care and your new knee
- No routine dental work (including cleanings) for 3 months after surgery. Finish dental work before surgery instead.
- After that, you do not need antibiotics before routine dental visits unless you have a weakened immune system — this is the current guidance of the American Dental Association and the American Academy of Orthopaedic Surgeons. If your dentist has questions, have them call us.
Everyday life with an implant
- Tell every doctor, dentist, and nurse who treats you that you have a joint replacement.
- Airport security: your knee will set off metal detectors. Just tell the screener you have a knee replacement — no card or proof is required.
- If you ever develop a serious infection anywhere in your body (skin, urinary, dental abscess), get it treated promptly and mention your implant — bacteria in the bloodstream can seed an artificial joint.
- Keep your weight in a healthy range and your muscles strong — the implant's best friends.
Watch: The partnership — on the web version of this guide at darinallredmd.com
A knee replacement is a partnership: my team brings the operation, the protocols, and the follow-through; you bring the preparation, the exercises, and the patience. Hold up your end and the odds are strongly in your favor that a year from now, this knee will be the one you don't think about.
We're honored to take care of you — here at home in Rock Springs.
— Darin W. Allred, MD
The Knowledge Check
Ten quick questions on the things that keep you safe — do them together with your coach. Wrong guesses are fine: you'll see the right answer on the spot, and that's the point. At the end you'll get a completion code to share with the pre-op nurse when she calls.
Watch: The knowledge check — on the web version of this guide at darinallredmd.com
1. A week after surgery you suddenly have chest pain and trouble breathing. What do you do?
2. How do you take your aspirin after surgery?
3. Which of these is a warning sign of a possible blood clot?
4. When do the CHG (Hibiclens) skin washes start?
5. The morning of surgery, which is true?
6. Call the clinic the same day if your temperature goes above:
7. Your first few days home, what's the rule for getting up — even just to the bathroom?
8. Where does the pillow go when you're resting in bed?
9. While taking narcotic pain pills, you should also:
10. It's 9 PM and something urgent — but not life-threatening — is going on with your knee. What do you do?
Attestation — patient & coach together
Patient name Coach namePrivate by design: nothing you enter here is sent or stored anywhere online. It stays on this device only — you'll simply read your completion code to the nurse.
Knowledge Check complete
Keep this handy: read the code to the pre-op nurse when she calls (or show this screen at your visit), and we'll record it in your chart. It's saved on this device, so you can come back to it any time.Questions before your surgery?
Call the Rock Springs clinic — it is always better to ask than to guess.