A patient education article by Dr. Vijay Chandar R., Consultant Orthopaedic Surgeon and Founder of VBJ Bone & Joint Clinic, Kanakapura Road, Bengaluru.
Knee replacement surgery is best thought of as a process rather than a single event. It has a preparation phase, a hospital phase, an early recovery phase at home, and a period of steady progress in the weeks and months that follow. Patients who understand the overall shape of this journey — and their own part in it — tend to arrive on the day of surgery calmer, better prepared, and clearer about what “good progress” actually looks like.
This article walks through the practical journey stage by stage. It is not a rehabilitation timetable, and it does not attempt to tell you exactly what will happen on day 3 or week 6. A separate article covers month-by-month recovery in detail. What this article does is answer the question patients most often bring to consultation: what is going to happen to me, and what should I be prepared for? For a broader clinical overview of the procedure itself, please see our complete patient guide to knee replacement.
Once knee replacement has been planned, preparation begins. The exact timing depends on your general health, the investigations that need to be organised, and the surgical schedule.
Preoperative preparation typically includes a medical assessment to make sure the body is in good shape to undergo anaesthesia and surgery. This may involve blood tests, an ECG or other investigations where indicated, and specialist review for conditions such as diabetes, hypertension, heart disease or lung disease. Longstanding medical conditions are optimised rather than “cured” — the goal is that they are as stable as possible in the run-up to surgery.
Your treating team will also review your current medications. Some medications — particularly blood-thinners, certain diabetes medicines, and some supplements — need specific instructions around the surgical date. Never stop or change your medications on your own. The instructions come from your surgical and medical teams, and they are individualised.
Depending on your medical history and the surgical team’s protocol, dental assessment or treatment may be recommended before surgery in selected circumstances. This is not a universal requirement.
This is also the time to write down the questions you want to ask the surgical team. There is a list toward the end of this article if you find that useful.
The 2026 clinical practice guideline for physical therapist management of total knee replacement (published in Physical Therapy) supports preoperative exercise for patients proceeding to knee replacement, with the aim of improving preoperative and postoperative outcomes including strength, flexibility and endurance. In plain language: doing what you can safely before surgery can support your early recovery afterwards.
Preoperative preparation generally focuses on:
The specific exercises should come from a physiotherapist or the surgical team, not from a generic online plan, particularly if you have significant arthritis or other joint or medical conditions. For background on the underlying condition, see our page on knee arthritis.
The first days at home are much easier when the home is set up for them. Practical steps typically include:
Not every patient needs every item on this list. The point is to look at the home the way a person recovering from surgery would use it, and remove the obvious risks in advance.
Before the day of surgery, it helps to have the following in place:
Specific hospital policies on visiting, admission timing and what to bring vary from hospital to hospital. Follow your hospital’s own instructions.
Follow your hospital’s specific instructions for the day before surgery. These vary between hospitals, between surgical teams, and between individual patients based on their medical history and medications.
You will typically be told:
If any of this is unclear, contact the surgical team rather than guessing. Do not stop medications independently and do not adjust the fasting instructions on your own.
Admission to the hospital is followed by a series of preoperative checks — identity confirmation, a review of your consent, confirmation of the side and site of surgery (which is usually marked with a pen on the correct leg), a final review of your medical history and medications, and vital-sign checks.
You will meet the anaesthesia team. The anaesthetic approach — general anaesthesia, spinal or regional anaesthesia, or a combination — is chosen by the anaesthetic team based on your medical status, your preferences after being informed, and the surgical requirements. This is an individualised decision.
Once you are anaesthetised, the surgical team performs the knee replacement. In broad terms, this involves removing the worn joint surfaces and reconstructing the joint with implants that replace those surfaces. Robotic assistance is a surgical technique that may be used in selected cases; whether it is used in a specific patient is a discussion between the patient and the surgeon and is separate from the general shape of the journey described in this article.
After the operation, patients are taken to a recovery area, where the anaesthesia team and nursing staff monitor waking up from anaesthesia and the early hours after surgery.
In the early hours after surgery, the treating team monitors vital signs, pain, wound and dressing status, fluid balance, and how well you are waking up from the anaesthetic.
Pain management is usually approached with a combination of methods and medications, prescribed and adjusted by your treating team, rather than a single drug given in isolation. Blood-clot prevention — including movement of the legs, mechanical measures such as compression, and any medications prescribed by the treating team — is a routine part of postoperative care after knee replacement. The specific medications and preventive measures used are chosen and prescribed by your treating team, according to your individual circumstances.
The wound is covered with a dressing that will be reviewed and changed according to your team’s protocol.
The 2026 clinical practice guideline supports physical therapy and early mobilisation within 24 hours after surgery for patients who have undergone total knee replacement. In practical terms, some patients begin walking a short distance with a physiotherapist on the day of surgery, and others start the following morning, depending on anaesthesia, medical status, pain control and the treating team’s assessment.
Early mobilisation typically involves:
Progression is individualised. The 2026 guideline supports progressive physical activity based on safety, functional tolerance, physiological response and patient goals — that is, how much you progress on any given day depends on how you are doing, not on a fixed calendar. Some patients advance more quickly than others, and neither pattern is a sign that something is wrong.
Discharge from hospital is a clinical decision, not a fixed number of days. Length of stay depends on factors such as:
Some patients are ready to be discharged sooner than others. Trying to be discharged before you are ready is not helpful; neither is staying in hospital longer than clinically necessary. The treating team weighs all of the above and makes the discharge decision with you.
The first few days at home are a settling-in period. Typical priorities during this phase include:
Detailed rehabilitation protocols — which exercises, how many repetitions, what progression, how to introduce specific activities — belong with your physiotherapist and are covered in more depth in a separate article. What matters in the first few days is being consistent with what you have been asked to do and paying attention to how the knee, the wound and your overall wellbeing are progressing.
Early follow-up with the surgical team typically covers:
The timing and frequency of follow-up visits are set by the treating team and are not universal. Attend the appointments you are given, and raise any concern earlier if something is worrying you between visits.
Some symptoms need attention. It helps to know in advance which ones warrant contacting the treating team, and which ones need urgent medical assessment straight away.
Contact the treating team promptly for:
Seek urgent medical attention for:
Do not wait for the next scheduled appointment if any of the urgent symptoms occur. Urgent care exists for exactly these situations.
Recovery from knee replacement is real and steady, but it is not perfectly linear. Most patients see meaningful improvement over the first weeks and continue to improve for several months. Along the way, there are good days and less good days, and some swelling and stiffness can persist longer than patients often expect.
Discomfort is a normal part of the healing process — not because something has gone wrong, but because tissues take time to settle after any operation. What matters is that the overall direction is one of gradual improvement over time. Two patients having the same procedure can recover at somewhat different rates for reasons that have little to do with either patient having done anything wrong. Comparing your own week 2 to someone else’s week 2 is rarely useful; comparing your own week 2 to your own week 1 usually is.
Returning to normal activities — driving, work, household activities, longer walks, low-impact exercise — is guided by your functional recovery and your treating team’s advice, not by a fixed calendar. Some activities can be resumed sooner than others; some depend on how much strength, range of motion and confidence in the knee has returned.
The general principle is that return to any activity depends on being able to do it safely — being able to control the leg, respond quickly if needed, and tolerate the demand of the activity — rather than on a specific date. Detailed return-to-activity timing is covered in the recovery-timeline article and is best confirmed with your own surgical team.
For a broader overview of the procedure, recovery, robotic assistance and long-term considerations, please see our complete patient guide to knee replacement.
A short, useful list to bring to your preoperative consultation:
If the decision between total and partial knee replacement is still open, see our article on the difference between total and partial knee replacement.
Preparation begins once surgery has been planned, but the exact timing varies. Your surgical team may need time for medical assessment, optimisation, investigations, preoperative exercise and practical preparation at home. The window is set by your circumstances and the surgical schedule rather than a universal rule.
Early mobilisation is recommended within 24 hours after knee replacement when clinically appropriate. Some patients may begin walking on the day of surgery, while others may start the following day, depending on anaesthesia, medical status, pain control and the treating team’s assessment.
There is no single answer for every patient. Length of stay depends on clinical stability, pain control, mobility, wound status, ability to manage safely and the support available at home. The treating team makes the discharge decision with you rather than by a fixed protocol.
Reduce fall and trip hazards, prepare the bathroom and toilet, arrange a suitable sleeping space, organise help with daily activities where needed, and plan safe transport home. Not every patient needs every piece of equipment; the point is to look at the home the way a recovering patient will use it.
Return to driving and work depends on your functional recovery, the demands of your work and your treating team’s advice. There is no single date that applies to every patient. Detailed timing is covered in the recovery-timeline article and confirmed with your surgical team.
Please book a consultation at VBJ Bone & Joint Clinic. Bring recent weight-bearing X-rays if you have them, together with a list of your current medications and any letters from other treating doctors. If the decision itself is still open, see our article on the difference between total and partial knee replacement; if you would like a broader overview of the procedure, see our complete patient guide to knee replacement.
Article prepared as a patient education resource. This information is general and does not replace an individual orthopaedic assessment.
Bring recent weight-bearing X-rays and any prior reports. Consultations at VBJ Bone & Joint Clinic, Kanakapura Road. Second opinions welcome.