The First 24 Hours After Surgery

Part of The Joint Replacement Guide — Phase 5: Recovery and Rehabilitation · Article 29 of 44 · Hip & Knee

Key Points

  • Pain, tiredness, bruising and swelling are expected during the first day, although symptoms should remain manageable and will be monitored.
  • Most patients sit up and begin standing or walking either on the day of surgery or the following morning.
  • Early movement is encouraged when it is safe, but you should not attempt your first mobilisation without assistance.
  • Urinary catheters are not routinely required. If one is needed, it is normally removed as soon as practical.
  • Progress varies. Dizziness, nausea, residual anaesthetic effects or medical concerns may appropriately delay mobilisation.
  • Tell the team promptly about uncontrolled or suddenly changing pain, breathlessness, heavy wound bleeding or new weakness.

Waking Up After Surgery

You will initially be monitored in the recovery area before returning to the ward or day-surgery unit.

It is common to experience:

  • drowsiness or temporary confusion;
  • feeling cold or shivery;
  • nausea;
  • thirst or a dry mouth;
  • numbness or heaviness in the legs after spinal anaesthesia;
  • pain as the anaesthetic begins to wear off; and
  • swelling around the operated joint.

The recovery team will check your breathing, oxygen level, blood pressure, pulse, wound, pain and circulation in the operated leg.

If you have had a spinal anaesthetic or nerve block, sensation and strength should return gradually. A nerve block can sometimes wear off quite quickly, so take the pain relief offered as instructed rather than waiting for severe pain to develop.

Pain: What Is Normal?

Some pain is expected after hip or knee replacement. The aim is not necessarily to make the joint completely painless. It is to control pain sufficiently for you to:

  • rest;
  • breathe deeply;
  • eat and drink;
  • perform the recommended exercises; and
  • begin moving safely.

Pain varies considerably between patients and between hip and knee replacement. A person requiring more pain relief has not failed or necessarily developed a complication.

However, severe pain should not simply be accepted as inevitable. Tell the nursing team if:

  • the medication is not providing sufficient relief;
  • pain is preventing you from moving or breathing comfortably;
  • pain suddenly becomes much worse;
  • the location or nature of the pain changes; or
  • medication is causing troublesome side effects.

Occasionally, unexpected or rapidly increasing pain can indicate a problem requiring assessment.

Multimodal Pain Relief

Modern pain management commonly combines several treatments that work in different ways. This is known as multimodal analgesia.

Your plan may include:

  • local anaesthetic placed around the joint during surgery;
  • a nerve block;
  • regular paracetamol;
  • an anti-inflammatory medicine, if suitable;
  • additional opioid pain relief when required; and
  • ice or elevation where recommended.

Anti-inflammatory medicines are not appropriate for everyone, particularly some patients with kidney disease, stomach ulcers, heart problems or particular medications.

Opioids can provide effective short-term pain relief but may cause nausea, drowsiness, itching, constipation, confusion or slow breathing. The team will balance pain control against these effects and aim to use the lowest effective dose.[1]

Do not take your own medicines from your bag unless the hospital team has specifically agreed that you should do so.

Getting Up and Moving

Most enhanced-recovery pathways aim to help patients sit, stand and begin walking as early as they are safely able.[2]

Before standing, staff will consider:

  • how alert you are;
  • whether spinal sensation and muscle control have returned;
  • blood pressure and dizziness;
  • nausea;
  • pain control;
  • the wound and dressing; and
  • your ability to follow instructions safely.

Your first mobilisation will usually be supervised by a nurse, physiotherapist or other appropriately trained member of staff. You may use a walking frame, crutches or another aid.

The first session may involve only:

  • sitting upright;
  • moving to the edge of the bed;
  • standing for a short period;
  • transferring to a chair; or
  • taking a few assisted steps.

This still represents useful progress. You do not need to walk a particular distance within a fixed number of hours.

Do Not Get Up Alone

Even if you feel well, do not attempt your first walk without assistance.

Anaesthesia, blood loss, pain medicines and lying in bed can cause a temporary fall in blood pressure when you stand. Residual weakness or numbness may also make the operated leg unreliable.

Use the call bell and follow the advice given by staff. Once you have been assessed, the team will explain whether you may mobilise independently or still need assistance.

What If I Cannot Walk on the Same Day?

Many patients stand or walk on the day of surgery. Others begin the following morning because:

  • their operation finished later in the day;
  • spinal anaesthesia has not fully worn off;
  • they feel dizzy, drowsy or nauseated;
  • blood pressure is low;
  • pain requires adjustment;
  • further assessment is needed; or
  • their pre-existing health or mobility makes additional help appropriate.

This does not mean that the operation or recovery has failed. The goal is early safe mobilisation rather than meeting an inflexible deadline.

Swelling, Bruising and the Dressing

Some swelling and bruising are normal after hip or knee replacement. They may become more noticeable over the following days rather than being at their greatest immediately after surgery.

A small amount of marking or spotting on the dressing may also occur. The team will monitor it.

Tell staff promptly if:

  • the dressing rapidly becomes soaked;
  • blood is leaking beyond the dressing;
  • swelling increases suddenly or becomes very tense;
  • pain becomes unexpectedly severe;
  • the foot becomes unusually cold, pale or numb; or
  • you develop new difficulty moving the foot or toes.

Do not remove or disturb the dressing yourself unless instructed.

Blood-Clot Prevention

Early movement is one part of preventing venous thromboembolism—blood clots in the legs or lungs. It does not replace the other preventive measures prescribed for you.

Depending on your individual risk and hospital protocol, prevention may include:

  • blood-thinning medication;
  • compression devices around the legs;
  • stockings in selected patients;
  • ankle-pumping exercises;
  • adequate hydration; and
  • regular mobilisation.

Take blood-thinning medication exactly as prescribed. The type and duration differ between hip and knee replacement and according to individual bleeding and clotting risks.[3]

Tell staff immediately if you develop chest pain, unexplained breathlessness, cough up blood or feel suddenly very unwell.

Catheters and Passing Urine

A urinary catheter is a tube placed into the bladder to drain urine.

Routine catheter use is not recommended for uncomplicated hip or knee replacement.[2] A catheter may nevertheless be required if:

  • you cannot pass urine after surgery;
  • the bladder becomes uncomfortably full;
  • a longer or more complex operation requires urine monitoring;
  • mobility is temporarily very limited; or
  • there is another clinical reason.

Spinal anaesthesia, pain medicines and intravenous fluids can temporarily affect bladder sensation or function. If you cannot pass urine, staff may use a bladder scanner to check how full the bladder is.

Some patients require a single temporary catheterisation rather than a catheter remaining in place. Where an indwelling catheter is used, enhanced-recovery guidance recommends removing it as soon as the patient can pass urine, ideally within 24 hours where clinically appropriate.[2]

Do not feel embarrassed about telling staff that you cannot pass urine or that your bladder feels uncomfortable.

Drips and Intravenous Fluids

You will usually have an intravenous cannula in a hand or arm. Fluids may be given while you are not drinking normally or if your blood pressure requires support.

Intravenous fluids are generally reduced or stopped once you are stable and drinking adequately. The cannula may remain temporarily in case medication or further fluids are needed.

Modern enhanced-recovery pathways encourage oral fluids and normal eating as soon as they are tolerated, rather than keeping patients without food or drink unnecessarily.[2]

Nausea, Drowsiness and Appetite

Nausea and reduced appetite are common during the first several hours. They can result from anaesthesia, opioid medication, low blood pressure or movement after lying down.

Anti-sickness medication is available and can be adjusted if the first treatment is insufficient. Tell staff early rather than waiting until nausea becomes severe.

Drink and eat as you feel able and according to your team’s advice. Some patients manage a normal meal quickly, while others begin with smaller quantities. You do not need to force food if you feel sick, but prolonged inability to drink should be reported.

Drowsiness should gradually improve. Excessive sleepiness, difficulty waking or unusually slow breathing requires immediate assessment.

Observations and Blood Tests

Staff will check your observations frequently at first and less often once they are stable. These may include:

  • blood pressure;
  • pulse;
  • oxygen level;
  • temperature;
  • breathing rate;
  • pain and sedation scores;
  • wound checks; and
  • circulation and nerve function in the operated leg.

Some hospitals perform a routine blood test after surgery to check the blood count, kidney function or electrolytes. Others use blood tests selectively. A postoperative X-ray may be obtained on the day of surgery or later, according to local practice.

Repeated observations are a routine safeguard and do not mean that staff suspect a complication.

Exercises During the First Day

You may be shown simple exercises such as:

  • moving the ankles up and down;
  • tightening the thigh muscles;
  • squeezing the buttock muscles;
  • bending or straightening the operated knee as advised; and
  • taking slow, deep breaths.

The exact exercises differ after hip and knee replacement. Follow the programme provided by your own team rather than adding exercises found elsewhere.

Exercises may be uncomfortable, but they should not be forced through severe or sharply increasing pain.

Rest and Sleep

Hospitals can be noisy, and observations and medication may interrupt sleep. The combination of discomfort, anxiety and residual anaesthetic effects can make the first night unsettled.

A poor first night is common and does not predict a poor recovery. Accept opportunities to rest, but continue the recommended movement and breathing exercises when awake.

Tell staff if pain, nausea, anxiety or another symptom is preventing rest so that it can be addressed.

Your Role Without Unnecessary Pressure

Your participation is valuable. This means:

  • describing symptoms honestly;
  • taking medication as agreed;
  • accepting assistance for early movement;
  • attempting the recommended exercises;
  • eating and drinking as tolerated; and
  • asking when something is unclear.

It does not mean ignoring severe symptoms, pushing through unsafe pain or comparing yourself with another patient.

Recovery is not a competition. Some people progress quickly during the first day, while others need more time because of anaesthesia, medical conditions or the complexity of surgery. Appropriate support and safe progression matter more than speed.

Before the First 24 Hours End

Depending on your pathway, you may already be at home or may remain in hospital.

The team will assess whether you can:

  • move safely with the recommended aid;
  • get in and out of bed or a chair;
  • manage any necessary steps;
  • eat, drink and pass urine;
  • control pain and nausea with an appropriate plan;
  • understand your medicines;
  • follow blood-clot prevention instructions; and
  • recognise the symptoms that require help.

Discharge is based on meeting appropriate clinical and functional criteria—not simply on how many hours have passed since the operation.

In More Depth

Early movement, good pain control, early oral intake and avoiding unnecessary tubes or drips are core elements of enhanced recovery.[2] These measures aim to support normal function and reduce the adverse effects of prolonged bed rest.

No single first-day milestone determines the eventual result. A delay caused by dizziness, urinary retention, pain or another clinical issue can usually be addressed without affecting the final outcome.

The safest approach is active participation within the limits set by your symptoms and clinical team.

This article provides general information and does not replace individual clinical advice. Tell your nursing or medical team promptly about uncontrolled pain, increasing swelling, heavy wound leakage, breathlessness, chest pain, excessive drowsiness or any other concern.

References

  1. Royal College of Anaesthetists. Pain relief after surgery. Published February 2026. RCoA patient guidance.
  2. Wainwright TW, Gill M, McDonald DA, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery Society recommendations. Acta Orthop. 2020;91(1):3–19. doi: 10.1080/17453674.2019.1683790.
  3. 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. NICE NG89.
  4. NHS. Recovering from a knee replacement. NHS recovery guidance.

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