Preparing for Knee Surgery: Before and After

Your surgeon will order blood work (CBC, metabolic panel, coagulation studies), an EKG if you are over 50 or have heart conditions, and possibly a chest X-ray. A pre-operative physical with your primary care doctor clears you for surgery. Complete these 2-4 weeks before the surgery date. If results show concerns (anemia, infection, uncontrolled blood pressure), surgery may be postponed until resolved.

Stop blood thinners (warfarin, aspirin, ibuprofen, naproxen) 7-14 days before surgery as directed. Stop anti-inflammatory supplements (fish oil, vitamin E, turmeric) 7-10 days before. Your surgeon will provide a specific medication schedule. Continue blood pressure and diabetes medications unless told otherwise. If you take prescription blood thinners, your surgeon may bridge you with injectable heparin.

Stronger muscles before surgery lead to faster recovery afterward. Practice quad sets (tighten the muscle on top of your thigh and hold 5 seconds, 20 reps), straight leg raises (3 sets of 10), and heel slides (bending and straightening the knee while lying down). Do these exercises 2-3 times daily for 4-6 weeks before surgery. A pre-surgery physical therapy session can teach you the proper technique.

You cannot drive for 2-6 weeks after knee surgery (longer for the right knee). Arrange rides to follow-up appointments and physical therapy (typically 2-3 times per week). Have someone stay with you for at least the first 48-72 hours. For knee replacement, plan for 1-2 weeks of in-home assistance with cooking, laundry, and daily tasks. Stock your freezer with prepared meals before surgery.

If your bedroom is upstairs, set up a bed or recliner on the main floor to avoid stairs for the first 1-2 weeks. Place essentials within arm's reach: phone charger, medications, water bottle, remote control, books, and snacks. A small table or TV tray next to your recovery chair keeps everything accessible. You will spend significant time seated or reclined during the first week.

Remove loose rugs, cords across walkways, and clutter from the floor. Install grab bars in the bathroom near the toilet and shower. Place non-slip mats in the bathtub and on bathroom floors. Ensure adequate lighting in hallways and bathrooms (add nightlights for middle-of-the-night trips). Falls during recovery can damage the surgical repair and require additional surgery.

Essential equipment: crutches or a walker (often provided by the hospital), a raised toilet seat (15-25 USD, makes sitting and standing easier), an ice machine or ice packs (you will ice the knee 4-6 times daily), and a leg elevation pillow. Optional but helpful: a shower bench or chair (30-50 USD), a long-handled grabber tool (10-15 USD), and a sock aid device. Your surgeon's office can provide a full equipment list.

Stop eating solid food 8 hours before surgery and clear liquids 2 hours before (follow your specific instructions). Take only approved medications with a small sip of water on the morning of surgery. Arrive 1-2 hours before the scheduled surgery time. Wear loose, comfortable clothing that can fit over a bandaged knee. Leave jewelry and valuables at home.

Bring your ID and insurance cards, a list of all current medications with dosages, your advance directive or healthcare proxy if you have one, your phone and charger, loose-fitting shorts or pants for discharge, and comfortable slip-on shoes (no laces). For overnight stays, bring toiletries and a change of clothes. Leave your crutches or walker in the car for use at discharge.

Take pain medication on schedule for the first 48-72 hours (do not wait until pain becomes severe). Transition from opioids to over-the-counter pain relief (acetaminophen, ibuprofen if approved) as soon as tolerable, typically by days 3-5. Ice the knee for 20 minutes every 2-3 hours while awake. Elevate the leg above heart level to reduce swelling. Pain is highest in days 2-4 and typically decreases steadily after day 7.

Start gentle range-of-motion exercises as soon as your surgeon approves (often day 1 post-surgery). Ankle pumps, quad sets, and gentle knee bends prevent blood clots and maintain muscle function. Formal physical therapy typically begins within 1-2 weeks of surgery, 2-3 sessions per week. Do home exercises exactly as prescribed between PT sessions. Consistency in early rehab is the strongest predictor of good long-term outcomes.

Seek immediate medical attention for: increasing redness, warmth, or drainage from the incision (infection signs), calf pain or swelling (possible blood clot), fever above 101.5 F (38.6 C), chest pain or shortness of breath (pulmonary embolism), or sudden increase in pain despite medication. Blood clots are the most serious risk in the first 2-4 weeks. Take blood thinners exactly as prescribed and keep moving as directed.

By week 2, you should be walking with crutches or a walker for short distances (100-200 feet). By week 4, many patients transition to a cane or walk unassisted for short distances. Target 90-100 degrees of knee flexion (bending) by week 4. Continue physical therapy 2-3 times per week. Swelling is normal for 3-6 months and is managed with ice and elevation.

Most people can return to desk work at 2-4 weeks (ACL) or 4-6 weeks (knee replacement). Resume driving when you can safely brake (right knee: 4-6 weeks, left knee: 2-4 weeks if driving an automatic). Add stationary cycling, swimming (once incision is healed), and progressive strengthening exercises. Pain should be mild and manageable with over-the-counter medication by this stage.

Continue physical therapy with increasing intensity. Target full range of motion matching the other knee. Begin more demanding exercises: lunges, squats, stair climbing without a railing. Most patients feel 70-80% recovered by week 12. Full recovery from knee replacement takes 6-12 months. ACL reconstruction recovery takes 6-9 months before returning to sports. Follow your surgeon's specific timeline for activity restrictions. This guide is informational only, not medical advice.