How long should I ICE my knee after knee replacement?

Article Updated 06/08/2022

How long should I ice my knee after knee replacement surgery?

After a total knee replacement surgery many surgeons will often recommend icing the knee as often as possible.

In this article, I will review the current myths and misconceptions about using cryotherapy after knee replacement surgery and what is the number 1 reason to consider icing.

3 of the Most Common Myths Around Icing After Surgery:

1. Icing reduces inflammation
2. Icing reduces swelling
3. Icing helps to heal injured tissue

3 Actual Truths Behind Icing After Surgery:

1. Cold therapy will numb the superficial nerve endings which may reduce the experience of pain.
2. Cold therapy provides a novel stimulus for the central nervous system and may interrupt the transmission of information being perceived as threatening.
3. Cold therapy is inexpensive and easy to use at home. It is convenient and provides you with a sense of control which may help empower you to take control of your pain.

What does the research suggest?

A 2007 study determined that only an analgesic effect was demonstrated with continuous cooling. This study also determined that 4 degrees Celsius (39.2 degrees Fahrenheit) was determined to be comfortable for most patients. [1] A 2012 study analyzing the possible benefits of R.I.C.E. was inconclusive. [2]

How long should I place ice on my knee?

According to Therapeutic Modalities “Cryotherapy is usually applied for 20 to 30 minutes for maximum cooling of both superficial and deep tissues.” In many physical therapy clinics, the common recommendation is 10-minutes of sustained application. A couple of considerations to determine the length of time ice is placed on your post-surgical knee include

1. How cold is the ice pack?
2. Are you placing a piece of cloth or other covering between the ice and your skin?
3. Are you applying ice to a part of the body with a thicker fatty tissue layer?

When should an ice pack be avoided?

The following table comes from Therapeutic Modalities section II page 168 –

Contraindications-for-Cryotherapy

Myth Buster #1 – Cryotherapy does not reduce inflammation.

Inflammation is a chemical process within the body and is largely regulated by the immune system. Placing an ice pack on the skin to change the skin’s temperature will not significantly impact the chemical response to tissue injury and repair known as inflammation.

Myth Buster #2 – Icing reduces swelling

Swelling and edema are also regulated by chemical changes at the site of injury. Changes in temperature applied to the skin can not significantly change the chemistry deep under the skin. If a noticeable change in swelling is noted upon removal of an ice pack it is largely due to the mechanical compression of the ice pack squeezing the fluid out of the area and not due to the cold temperature of the ice pack.

Myth Buster #3 – Icing improves healing.

Since the healing response is autoregulated by the body’s immune system, changes in superficial skin temperature have not been shown to significantly affect healing times. The best-known evidence of healing tissue following surgery includes a short episode of rest followed by an active recovery guided by a physical therapist, occupational therapist, or other qualified healthcare professional.

Summary:

Based on the available evidence, I would recommend using either cold therapy or heat therapy solely for an analgesic benefit. I would advise against taking time away from a more active recovery to sit with an ice pack or heating pad on your knee. If cold or warmth feels good and helps bring relief between bouts of activity these modalities are generally considered low risk for complications and inexpensive.

The bottom line is to do what feels good while you are resting, but stay active and keep moving when possible.

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Cited References:

[1] – Cina-Tschumi B. Evidenz-basierte Pflege am Beispiel von Kälteanwendungen nach ausgewählten orthopädischen Eingriffen–eine Literaturstudie [Evidence-based impact of cryotherapy on postoperative pain, swelling, drainage and tolerance after orthopedic surgery]. Pflege. 2007 Oct;20(5):258-67. German. doi: 10.1024/1012-5302.20.5.258. PMID: 18214217.

[2] – Van den Bekerom MP, Struijs PA, Blankevoort L, Welling L, van Dijk CN, Kerkhoffs GM. What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults?. J Athl Train. 2012;47(4):435-443. doi:10.4085/1062-6050-47.4.14

[3] – Curković B, Vitulić V, Babić-Naglić D, Dürrigl T. The influence of heat and cold on the pain threshold in rheumatoid arthritis. Z Rheumatol. 1993 Sep-Oct;52(5):289-91. PMID: 8259720.