Postoperative Care Plan for Knee Replacement at 2 Weeks
At two weeks post-knee replacement, the patient should be engaged in a supervised outpatient physical therapy program 3 days per week with full weight-bearing exercises, focusing on progressive strengthening and range of motion, while monitoring for wound healing and infection.
Immediate Priorities at 2 Weeks Post-Op
Wound Assessment and Infection Monitoring
- Evaluate wound healing status carefully - sutures/staples should be removed if not already done, and the wound should show no significant swelling, erythema, or drainage 1
- Monitor for any signs of surgical site infection including increased warmth, redness, or drainage 1
- If the patient is on biologic therapy for rheumatic disease, these medications should only be restarted once wound healing is complete (typically ~14 days) with no evidence of infection 1
Physical Therapy Program
- Continue structured outpatient physical therapy 3 times per week with supervised sessions, as this approach improves physical function during the first 2 months after surgery 1
- Full weight-bearing should be maintained with proper gait mechanics 1
- Progress from isometric quadriceps exercises to closed kinetic chain exercises, which should have been initiated from week 2 2
Exercise Progression at This Stage
Strengthening Protocol
- Transition from isometric to concentric and eccentric exercises if the quadriceps is reactivated and the knee shows no reactive effusion or increased pain 2
- Closed kinetic chain exercises (such as mini-squats, leg press, step-ups) should be the primary focus at this stage 2
- Avoid open kinetic chain exercises until week 4 post-operatively 2
Range of Motion Goals
- Target progressive improvement toward 0° to 120° arc of motion 1
- Immediate knee mobilization should continue to prevent stiffness and extension deficits 2
- Do not use continuous passive motion machines - strong evidence shows they do not improve outcomes 1
Pain Management
- Most patients at 2 weeks should be transitioning off or have minimal narcotic use 1
- Cryotherapy can be applied for pain control, though moderate evidence suggests cryotherapy devices do not significantly improve overall outcomes 1
- Supervised exercise programs during the first 2 months decrease pain with limited to moderate evidence strength 1
What NOT to Do (Common Pitfalls)
- Avoid continuous passive motion devices - they provide no benefit and waste resources 1
- Do not use cryotherapy devices as a primary intervention expecting significant outcome improvements 1
- Do not delay mobilization or weight-bearing - this leads to stiffness and functional limitations 2
- Avoid progressing to open kinetic chain exercises before week 4 to prevent excessive stress on the healing joint 2
Monitoring Parameters
Functional Assessment
- Gait pattern should be normalizing with minimal to no assistive device dependence 1
- Patient should demonstrate improving quadriceps activation and strength 2
- Activities of daily living should be progressively easier 3
Red Flags Requiring Immediate Attention
- Wound dehiscence, drainage, or signs of infection 1
- Sudden increase in pain, swelling, or warmth 1
- Inability to bear weight or significant regression in function 1
- Signs of deep vein thrombosis (calf pain, unilateral swelling) 4
Expected Timeline Forward
Weeks 2-4
- Continue supervised physiotherapy with progressive resistance 2
- Advance closed kinetic chain exercises with increasing resistance 2
- Work toward independent ambulation without assistive devices 1
Weeks 4-8
- Introduce open kinetic chain exercises in restricted range of motion (90-45°) starting at week 4 2
- Add neuromuscular training to strength training 2
- Continue supervised rehabilitation for optimal outcomes 5, 6