The recovery from a knee replacement surgery can be a challenging phase. Knee replacement, also known as knee arthroplasty or total knee replacement, has become a standard surgical procedure today, and many people are opting to undergo this procedure to replace a knee damaged by arthritis. Plastic and metal parts are used for capping the ends of the bones that form the knee joint and the kneecap. Total knee replacement surgery is usually recommended for those who have a severe knee injury or severe arthritis. Having some swelling, pain, and bruising following total knee replacement surgery is a normal part of the recovery process after knee replacement surgery. Here’s everything to know about total knee replacement and how to manage pain, swelling, and bruising.
Overview of Total Knee Replacement Surgery
A knee replacement surgery is a surgical procedure that is used to replace a damaged knee, usually because of severe arthritis.(1,2,3,4) Also known as knee arthroplasty, the surgery makes use of plastic and metal parts to cap the ends of the bones of the knee joint and the kneecap. This surgery is typically recommended for people who have suffered a severe knee injury or severe arthritis.(5,6) It is more common in middle-aged or older adults since the condition of osteoarthritis is quite common in this age.
Osteoarthritis is a degenerative joint condition that causes a breakdown of the cartilage in the knee joint and also the adjacent bone in the knees. Rheumatoid arthritis and traumatic arthritis can also cause damage to the cartilage of the knees, causing a need for undergoing a total knee replacement surgery. The ultimate goal of a knee replacement surgery is to replace the parts of the knee joint and kneecap that have been damaged and to relieve the knee pain that is no longer controlled by medications and other treatments.(7,8)
Common Post-operative Symptoms After a Total Knee Replacement
Experiencing some amount of swelling, pain, and bruising are some typical symptoms that people experience in the recovery process after a total knee replacement surgery. There are many ways of managing post-operative symptoms after a total knee replacement surgery and ease the recovery phase.
After the initial swelling and pain go down, most people tend to notice a significant improvement in their knee-related problems within just a couple of weeks after having the surgery.
However, in some cases, generalized pain can continue to occur for up to many weeks after the total knee replacement surgery. Swelling tends to last for two to three weeks after the surgery, but in some people, it may continue for nearly three to six months even. The bruising may continue for at least one to two weeks after the surgery.(9,10)
What To Expect Immediately After The Total Knee Replacement Surgery?
In recent years, there have been many advancements in pain management following a total knee replacement surgery. In the last 10 to 15 years, advances in using spinal blocks, regional nerve blocks, and other methods of pain control have made life easier for patients undergoing a knee surgery.(11)
During your knee surgery, your doctor or medical team will either administer a general anesthetic, in which case you will be completely asleep, or a local anesthesia, in which case you will be numb from the waist down but still be awake.
Once the surgery is finished and the anesthesia wears off, your doctor will provide you with certain pain medication either through an intravenous tube or orally, depending on your condition after the surgery.(12,13)
These medications usually include a strong opiate or opioid-like fentanyl, morphine, or oxycodone. They are only meant to be used for a short period of time as in larger doses over time, these medications can cause addiction and physical dependence. It is important to follow your doctor’s prescription and advise to prevent any adverse reactions and reduce the occurrence of side effects.(14,15)
How To Manage Swelling After The Total Knee Replacement Surgery?
Swelling is a normal part of the healing process after total knee replacement surgery. According to data from the American Academy of Orthopedic Surgeons, it is normal for people to experience moderate to severe swelling in the first couple of days or even weeks following the surgery and continue to experience mild to moderate swelling for at least three to six months after the surgery.(16)
You can decrease the swelling by practicing some post-operative exercises that your medical team will show you. Using compression stocking and keeping your leg elevated for several hours each day can help reduce the swelling significantly. However, keep in mind that you should never do any type of exercise after knee surgery without consulting your doctor.(17)
You can also buy a good quality ice pack. Cold compresses or ice packs will prove to be very useful after a total knee replacement. They help reduce the inflammation and swelling in the knee joint and the surrounding tissue and may also provide relief from the pain.
Your doctor may advise you to use an ice pack three to four times in a day for at approximately 15 to 20 minutes each time. If you do not see any improvement or if you want to use the ice pack for a longer time, you should consult your physical therapist or doctor. After a couple of weeks have passed, applying heat to the area may also help.
However, if you see severe or new swelling, you should immediately let your doctor know as this could be a symptom of a blood clot or an infection of the joint.
How To Manage Pain After The Total Knee Replacement Surgery?
After any type of surgery, some pain is to be expected, and it is a normal part of the recovery process. The pain should reduce over time. After a knee surgery, most people prefer to take oral pain medicines for a couple of weeks. These commonly include prescription-strength non-steroidal anti-inflammatory drugs (NSAIDs) like naproxen (brand name Aleve) or ibuprofen (brand names Motrin and Advil).(18)
However, if you have severe pain and it tends to persist, your doctor may also prescribe stronger pain medications like oxycodone (brand name OxyContin) and tramadol (brand name Ultram).
Over-the-counter medications can also be used to relieve temporary pain and inflammation. These include NSAIDs like naproxen and ibuprofen, and acetaminophen (brand name Tylenol).
Your physical therapist will also teach you some exercises and provide massages to help bring down the inflammation. Pain after a total knee replacement will take several weeks to diminish.
How To Manage Bruising After The Total Knee Replacement Surgery?
Bruising around the knee after a total knee replacement may continue to last for one to two weeks after the surgery. Bruising shows up in the form of a purplish discoloration around the knee that indicates there is blood accumulated under the skin.
When you are still in the hospital, your medical team may prescribe a blood thinner to prevent the occurrence of deep vein thrombosis, which may further increase the bruising.(19)
Some form of bruising is normal after a knee surgery and will reduce after some time, but it can also be accompanied by tenderness around the knee. You can reduce bruising and inflammation by keeping your leg elevated.
Home Treatments To Manage Pain, Swelling, and Bruising After Total Knee Replacement Surgery
While you are still at the hospital, you will be made to wear compression stockings, and your doctor is likely to recommend that you continue wearing them for at least two weeks after discharge also. These stockings help reduce pain in the legs and also decrease the risk of developing a blood clot.
Keep the affected leg in an elevated position above the heart level for some time during the day for a couple of days will also help reduce the swelling and pain.
Applying patches and topical creams to the knee can also help bring down the pain and also make it possible to get a good night’s sleep. Such topical creams should include active ingredients like menthol, capsaicin, or salicylates.
Physical Therapy To Manage Pain, Swelling, and Bruising
After a total knee replacement, you will need to undergo physical therapy for some weeks with a qualified physical therapist. Your therapist is likely to use a transcutaneous electrical nerve stimulation (TENS) unit for increasing blood flow and reduce pain in the affected knee and surrounding area.(20,21) These devices work by delivering electrical currents to the skin that helps reduce nerve pain.
However, according to the recommendations of the American College of Rheumatology’s 2019 guidelines, TENS units should not be used in people who have knee osteoarthritis.(22) TENS therapy is not useful for everyone, and studies have shown that people who have high levels of anxiety or pain catastrophizing are less likely to benefit from physical therapy done with the TENS unit.(23)
Your physical therapist will also teach you how to massage the affected leg in order to stimulate the muscles and tissues surrounding the knee.
Your therapist is also going to recommend certain exercises that will help strengthen your muscles, increase the blood flow to the knees, and also help increase your range of motion. This will help promote healing and also help drain away any fluid from the painful and swollen tissues.
It is natural to experience pain while exercising after a total knee replacement surgery, but it is also essential that you make an effort to do some regular physical activity.
However, avoid doing actions or exercises that can cause damage to the affected knee. You should avoid twisting the knee, jumping, squatting, or kneeling after the surgery.
Recovering from a total knee replacement surgery is a different experience for each person. It is common to experience some amount of pain, swelling, and bruising after the surgery. While you will be prescribed medications and exercises to deal with the pain and swelling, if you experience any abrupt changes in your symptoms, you should make sure to let your medical team or doctor know at the earliest. Using pain medications, keeping your leg elevated, using ice packs, wearing compression stockings, massages, and physical therapy can all help to bring down your discomfort and speed up the recovery and healing process.
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- Chmell, M.J. and Scott, R.D., 1999. Total knee arthroplasty in patients with rheumatoid arthritis: an overview. Clinical Orthopaedics and Related Research®, 366, pp.54-60. Wylde, V., Dieppe, P., Hewlett, S. and Learmonth, I.D., 2007. Total knee replacement: is it really an effective procedure for all?. The Knee, 14(6), pp.417-423.
- Trieb, K., Schmid, M., Stulnig, T., Huber, W. and Wanivenhaus, A., 2008. Long-term outcome of total knee replacement in patients with rheumatoid arthritis. Joint Bone Spine, 75(2), pp.163-166.
- Nilsdotter, A.K., Toksvig-Larsen, S. and Roos, E.M., 2009. A 5 year prospective study of patient-relevant outcomes after total knee replacement. Osteoarthritis and cartilage, 17(5), pp.601-606.
- Szöts, K., Pedersen, P.U., Hørdam, B., Thomsen, T. and Konradsen, H., 2015. Physical health problems experienced in the early postoperative recovery period following total knee replacement. International journal of orthopaedic and trauma nursing, 19(1), pp.36-44.
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