Going Home

Part of The Joint Replacement Guide — Phase 5: Recovery and Rehabilitation · Article 32 of 44 · Hip & Knee

Key Points

Many patients leave hospital within one to three days, although suitable patients may go home on the day of surgery and others need longer.
Pain, swelling, bruising and tiredness are expected to improve gradually, but recovery is rarely completely smooth or predictable.
Follow the individual instructions you receive about your wound, exercises, walking aids, medication and any movement restrictions.
Do not drive until you can control the vehicle safely, perform an emergency stop and are not impaired by pain or medication.
Complete any prescribed blood-clot prevention treatment unless your clinical team tells you to change or stop it.

You will be discharged when the team considers it safe, rather than simply after a fixed number of days. This generally means that you are medically stable, your pain can be managed with tablets, and you can move around safely using the recommended walking aid. You should also be able to manage essential daily activities and any stairs you need to use at home.

Many people leave hospital within one to three days, although some hospitals offer same-day discharge to carefully selected patients.[1,2] Needing to remain in hospital for longer does not necessarily mean that anything has gone wrong.

Before leaving, make sure you know:

which medicines to take and for how long
how to look after your dressing and wound
which exercises and walking aids to use
whether you have any individual movement or weight-bearing restrictions
whom to contact if you have a concern.

Planning some practical help with shopping, meals and transport can make the transition easier, particularly during the first few days.

Pain, Swelling and Tiredness

Pain, bruising and swelling are normal after joint replacement and usually improve gradually. Symptoms can fluctuate: doing more activity on one day may lead to greater discomfort or swelling later that day or the following day.

Swelling may extend below the operated joint, including into the lower leg, ankle or foot. Appropriate movement, the exercises provided by your team and elevation when resting may help. After knee replacement, support the leg in the position recommended by your physiotherapist; prolonged use of a pillow directly underneath the knee may make it more difficult to regain full straightening.

Tiredness and disturbed concentration are also common during the early weeks. Recovery from an operation uses considerable physical energy, and sleep, appetite, anaemia and pain-relieving medicines can all contribute. Allow time for rest while remaining appropriately mobile.

Increasing swelling should not automatically be assumed to be part of normal recovery. Seek prompt clinical advice about new or markedly worsening swelling—particularly if it affects one calf or is accompanied by calf pain, redness, heat or breathlessness.

Wound and Dressing Care

Follow the dressing and showering instructions given by your own hospital because the type of closure and dressing varies. Do not apply creams, powders or antiseptics unless your team has advised you to do so.

A small amount of spotting on a dressing can occur soon after surgery. However, ongoing or increasing wound leakage needs prompt advice from the surgical team because persistent drainage can increase concern about infection. Do not wait for a routine follow-up appointment if the wound is continuing to leak.

Contact your surgical team, GP or NHS 111 urgently if you develop:

increasing or spreading redness around the wound
worsening warmth, swelling or pain
new or increasing discharge, pus or an unpleasant smell
wound edges that are opening
a high temperature, chills or feeling systemically unwell.[3]

Call 999 if you develop sudden breathlessness, chest pain, collapse or another medical emergency.

Sleep

Disturbed sleep is very common during the first few weeks. This may be caused by discomfort, swelling, altered routines or difficulty finding a comfortable position.

There is no single sleeping position that is right for every hip or knee replacement. Advice after hip replacement can vary according to the surgical approach and local protocol, while placing a pillow directly under a replaced knee for prolonged periods may hinder straightening. Follow the positioning advice given by your own team rather than a generic rule.

Stairs and Walking Aids

You should be shown how to use stairs before discharge if they are necessary at home. A commonly taught method is to lead with the non-operated leg when going up and with the walking aid and operated leg when going down. Your physiotherapist may modify this according to your balance, strength, other joints and the type of staircase.

Continue using your frame, crutches or stick for as long as advised. Giving up a walking aid early is not a sign of faster recovery if it causes limping, instability or unsafe walking.

Medication and Blood-Clot Prevention

You will usually leave hospital with pain relief and, where indicated, treatment to reduce the risk of a blood clot. This might include aspirin or an anticoagulant, depending on your operation and individual balance between clotting and bleeding risks.

The medication and duration are not the same for everyone. NICE-recommended options commonly extend for about 14 days after elective knee replacement and for approximately 28 days or longer after elective hip replacement, depending on the regimen selected.[4] Follow the instructions on your own discharge prescription and do not stop treatment early unless a clinician advises you to do so.

Ask for medical advice if you experience possible medication complications, including significant or unexplained bleeding, black stools, vomiting blood, a severe persistent headache, an allergic reaction or repeated vomiting that prevents you taking the prescribed treatment.

Driving

A calendar date alone does not determine when it is safe to drive. You must be able to enter and sit in the car safely, control the pedals and steering, look around appropriately, and perform an emergency stop promptly and without hesitation. Pain, weakness, restricted movement and sedating painkillers can all make driving unsafe.

Many hospital pathways advise waiting at least four to six weeks, and NHS guidance advises at least six weeks after a total knee replacement.[1,5] However, the appropriate timing varies according to the joint and side operated on, whether the car is manual or automatic, your progress and your surgeon’s instructions.

Before returning to driving:

check with your clinical team if you are uncertain
ensure pain or medication will not impair your reactions
check that your motor insurance remains valid
consider practising the necessary movements in a stationary vehicle before driving on the road.

DVLA guidance states that drivers remain legally responsible for maintaining control of the vehicle. You generally need to notify the DVLA if postoperative recovery is expected to affect your driving for more than three months or if another notifiable condition applies.[6]

The First Six Weeks—and Beyond

The first six weeks are a useful early-recovery period, but they are not a universal deadline. Soft-tissue healing, strength and confidence continue to develop for several months, and knee swelling can take considerably longer to settle fully.

If you have an uncemented implant, bone growth onto the implant develops over time, but this does not automatically mean that everyone needs the same restrictions. Follow the weight-bearing and activity instructions provided for your particular operation.

Most importantly, compare your progress with your own earlier function rather than with another patient’s recovery. Contact your team if symptoms are worsening, you are losing function, or you are not meeting the rehabilitation goals agreed with them.

This article provides general information and does not replace individual clinical advice. Your discharge instructions and the advice of your own surgical team take priority.

References

NHS. Recovering from a knee replacement. Available at: https://www.nhs.uk/tests-and-treatments/knee-replacement/recovery/
National Institute for Health and Care Excellence. Joint replacement (primary): hip, knee and shoulder. NICE guideline NG157, section 1.10: postoperative care. Published 4 June 2020; last reviewed 19 December 2024. Available at: https://www.nice.org.uk/guidance/ng157/chapter/Recommendations
NHS. Complications of a hip replacement. Available at: https://www.nhs.uk/tests-and-treatments/hip-replacement/complications-of-a-hip-replacement/
National Institute for Health and Care Excellence. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. NICE guideline NG89, recommendations 1.11.5–1.11.9. Published 21 March 2018; updated 13 August 2019. Available at: https://www.nice.org.uk/guidance/ng89/chapter/Recommendations
NHS. Preparing for a hip replacement. Available at: https://www.nhs.uk/tests-and-treatments/hip-replacement/preparing-for-a-hip-replacement/
Driver and Vehicle Licensing Agency. Surgery and driving. GOV.UK. Available at: https://www.gov.uk/surgery-and-driving

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