24 October, 2025

What to Expect After Knee Replacement Surgery: The First Two Days in Hospital

By Dr. Arun Kannan
Consultant Orthopaedic & Joint Replacement Surgeon, Apollo Hospitals – Chennai

 

Introduction

For many people above the age of 55 or 60, knee arthritis and joint degeneration can severely affect everyday life. When pain, stiffness, or deformity become too difficult to manage with medicines and physiotherapy, knee replacement surgery (also called total knee arthroplasty) becomes a life-changing solution.

But one of the most common worries among patients is this:

“What happens immediately after surgery? Will it be painful? How long before I can stand or walk again?”

In this article, Dr. Arun Kannan from Apollo Hospitals, Chennai, explains what the first two days after a knee replacement surgery look like — from the operating room to the recovery ward — so you can walk into your surgery feeling calm, confident, and prepared.

The Day of Surgery (Day 1)

1. Before the Operation

You’ll be admitted the previous evening or on the morning of surgery. Routine blood tests, ECG, chest X-ray, and medical clearance are completed. You’ll meet your anesthesiologist, who will explain whether you’ll receive spinal (regional) anesthesia or general anesthesia.
Most knee replacements today are done under spinal anesthesia, which numbs your legs completely. You’ll be awake but won’t feel any pain during the operation.

2. Inside the Operating Room

Once anesthesia takes effect, both legs will feel heavy and numb. The surgery usually takes about 1½ to 2 hours. Advanced techniques and cemented implants help ensure a strong, stable joint.

You won’t experience any pain while the operation is happening. The surgical team continuously monitors your pulse, blood pressure, oxygen, and comfort.

3. After Surgery – In the Recovery Room

Once the procedure is over, you’ll be shifted to the recovery room or high-dependency unit (HDU) for a few hours of observation. Nurses and doctors will monitor your vital signs closely.

You’ll still feel your legs numb due to anesthesia, and movement will gradually return over the next few hours. Most patients remain alert and aware of their surroundings.

Pain medications are started early through intravenous (IV) infusions to keep you comfortable as the anesthesia wears off.

Day 1 Evening: Regaining Movement and Sensation

As sensation slowly returns, you might feel mild heaviness or tingling in your legs — this is normal.
Your physiotherapist will visit to start simple, gentle exercises:

  • Ankle pumps – moving your feet up and down to improve blood circulation

  • Quadriceps tightening – gently tightening the thigh muscles

  • Deep breathing exercises – to prevent lung congestion after anesthesia

These early movements help prevent clots, improve blood flow, and speed up recovery. You’ll also continue to receive antibiotics and fluids through an IV line.

Pain will be controlled using a combination of oral and IV painkillers, and most patients rate their pain as mild to moderate and easily manageable.

Day 2: Getting Up and Moving

By the next morning, most patients can begin sitting up and standing with help.

1. First Standing and Walking

If you’ve undergone a cemented knee replacement (which is most common), the new joint is strong enough to bear weight almost immediately.
With the help of a walker and your physiotherapist, you’ll take your first few steps — a big milestone in your recovery!

Don’t worry if you feel a bit dizzy or unsteady; this is expected after a major operation. The hospital staff will be by your side to guide and support you safely.

2. Physiotherapy Sessions

Physiotherapy becomes the focus from now on. You’ll do guided exercises several times a day to:

  • Bend and straighten your knee gradually

  • Strengthen the thigh and calf muscles

  • Practice walking short distances with a walker

  • Learn to get in and out of bed safely

Each patient’s progress is individual — some stand within hours, others take slightly longer depending on age, weight, and general health.

3. Monitoring and Pain Control

Throughout this period, your vital parameters — pulse, blood pressure, temperature, oxygen, and urine output — are checked regularly.
Blood tests may be done to ensure hemoglobin levels are stable.

Pain control remains a priority. If discomfort increases when moving, your doctor may adjust medications or use nerve-block injections for better relief.

4. Wound Dressing and Care

On the second or third day, your surgical dressing may be checked or changed. Most hospitals now use waterproof dressings, allowing you to bathe comfortably after a few days.

The wound area is inspected to ensure there’s no leakage or infection. A fresh dressing is applied, and you’ll be encouraged to keep the leg straight when resting.

Understanding the Normal Recovery Timeline

Every patient heals at a slightly different pace, but the first 48 hours generally follow this rhythm:

Time Period What Happens How You Feel
Immediately after surgery In recovery room; numbness due to spinal anesthesia No pain, legs feel heavy
3–6 hours later Numbness reduces; you may feel mild tingling Slight discomfort, controlled by IV pain meds
Evening (Day 1) Begin ankle & breathing exercises Comfortable, under monitoring
Morning (Day 2) Sit up, stand with help, start walker-assisted steps Slight stiffness; sense of progress
Evening (Day 2) Walk a few steps independently, continue exercises More confident, pain under control

When Can You Expect to Go Home?

If you can walk with a walker, use the restroom independently, and your pain is well managed, you’ll typically be discharged within 3–4 days.
Before discharge:

  • Your medications will be explained clearly.

  • A video or printed home-exercise guide will be provided.

  • You’ll learn wound-care and follow-up instructions.

Elderly patients or those with additional medical conditions (like heart disease or diabetes) may need an extra day or two in the hospital for safety.

At-Home Care After Discharge

Once you’re home, continue the routine set by your physiotherapist:

  1. Do exercises twice a day – focus on bending and strengthening.

  2. Use your walker for 3–4 weeks before shifting to a cane or walking independently.

  3. Keep your wound dry and clean.

  4. Follow a balanced diet rich in protein, calcium, and fluids.

  5. Take medicines on time (painkillers, blood thinners, antibiotics).

Avoid sitting cross-legged or squatting for the first few months, and don’t lift heavy objects until cleared by your surgeon.

Common Concerns During the First Two Days

“Will the pain be unbearable?”

No. Modern anesthesia and pain-management protocols ensure that pain remains mild to moderate and well controlled. You’ll receive continuous medication and monitoring.

“Can I move my leg after surgery?”

Yes, though the leg will feel numb initially. Movement and sensation gradually return within a few hours, and you’ll start gentle exercises the same day.

“When will I be able to walk?”

Most patients walk with a walker within 24 hours after surgery. Early walking helps prevent complications and speeds up healing.

“What if I feel weak or dizzy when standing?”

It’s normal. Your body is adjusting after anesthesia and surgery. The physiotherapist will support you and make sure you’re safe.

“When will the bandage be removed?”

The dressing is usually changed on Day 2 or 3 and may stay on for a few more days depending on wound healing. Modern waterproof dressings make it easier to manage at home.

Tips for a Smooth Recovery

  • Be positive and stay calm. Anxiety can increase the perception of pain.

  • Communicate with your nurse or doctor about any discomfort.

  • Follow physiotherapy sincerely. Movement is the key to success after knee replacement.

  • Use ice packs for 15 minutes, 3–4 times a day to reduce swelling.

  • Sleep with a pillow under your ankle (not behind the knee) to keep it straight.

  • Avoid comparing your recovery with others. Each body heals differently.

Realistic Expectations

Knee replacement is a major surgery, but it’s one of the most successful operations in modern orthopedics. Millions of people worldwide have regained pain-free mobility because of it.

Within a few days, you’ll be walking with a walker.
Within 3–4 weeks, you’ll start walking more confidently.
By 6–8 weeks, most patients can climb stairs and resume normal activities.

Patience, consistency, and trust in your medical team make all the difference.

Frequently Asked Questions (FAQs)

1. How long does the anesthesia effect last?

Usually 3–4 hours for spinal anesthesia. Sensation and movement return gradually during the same day.

2. Will there be tubes or drains after surgery?

Some patients have a small drain tube for 1 day to remove excess fluid from the knee. It’s removed the next morning.

3. When can I resume bathing?

Once the waterproof dressing is applied and your doctor approves — typically after 3 days.

4. Can both knees be replaced at once?

Yes, if your heart and lungs are healthy enough and your doctor recommends it. Otherwise, staged (one after another) replacement is done.

5. What type of implant is used?

Most surgeons use cemented implants that fix firmly to the bone, offering strong and durable results. The implant choice depends on bone quality and patient needs.

6. Will I need blood after surgery?

Not always. Only if your hemoglobin drops significantly or if you lose more blood than expected.

7. When can I climb stairs again?

Usually within 3–4 days in the hospital under physiotherapist guidance. Full confidence returns in 4–6 weeks.

8. How long do I have to use the walker?

Generally 3–4 weeks. You’ll gradually transition to a stick or no support as strength improves.

9. When can I drive again?

After 6 weeks — once your knee bends comfortably and your reflexes are normal.

10. How long does a knee replacement last?

Modern implants can last 15–20 years or more, depending on weight, activity level, and care.

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