Post Surgery - At Home
The hip and knee sections each discuss the specifics of the weeks after surgery, and there are some differences between each. In general, knee replacements are somewhat more challenging in rehabilitation than hips because there is a greater range of mechanical problems and primarily because the knee will become quite stiff if it is not aggressively moved.
However, there are some generalities for the first three weeks after surgery that are common for all joint replacements (both knees and hips) and bear mentioning.
Most surgeons will allow showering (but not submersion!) when the wound is dry. Some surgeons advise waiting until the staples or sutures are removed, although in our practice we generally let patients begin showering two days after leaving the hospital if the wound is dry. Check with your surgeon about when it is acceptable to begin showering (it is usually included in the discharge instructions).
Incisions usually have some redness along the scar for many months. Most knee or hip incisions gradually become a thin white line over the first year after surgery. Some patients are prone to keloid formation, which is harmless but can result in a less cosmetic scar.
Absorbable sutures can sometimes "spit," poking through the skin with a tiny bit of string visible and sometimes some associated fluid. This is not uncommon and is not typically any cause for concern.
Some physicians advocate rubbing vitamin E oil over incisions to decrease scarring. There are also a number of commercial ointments and salves that purport to decrease scarring. There is not significant evidence that these treatments really improve wound healing, although the massaging of the surgical site itself probably is helpful. I often recommend breaking open vitamin E capsules and rubbing the incisions to my patients because the massaging action helps to decrease fibrous scar adhesions.
New incisions are definitely prone to sunburn, however, and if you go to the beach or are out in the sun in the first 12 months after surgery, you should take care to protect the scar from the sun. It should be covered with clothing ideally, or at least very high SPF sunblock.
Some degree of leg swelling is normal after hip and knee surgery, and it is not unusual for some patients to even notice a slight difference between the sizes of the legs for months after surgery. However, it should steadily be improving, and any swelling that suddenly becomes markedly worse should be reported right away as it can be a sign of a blood clot.
Bruising is also normal for a few weeks. This gradually resolves.
It is common for most joints (hips and knees) to make some noise after surgery, often in the form of clicking or popping. As long as there is no specific pain associated with the noise, it is usually harmless. There are numerous reasons for the noises, which are often from tight ligaments or scar tissue or from the contact of the artificial components themselves. Rarely, some materials (e.g., ceramic total hip replacements) can have some "squeaking" noises. Any noises that are associated with specific pain should be reported.
It is common for most surgery patients to have mildly elevated temperatures in the week or two after surgery. However, persistent fevers for more than a week or two, or particularly high fevers beyond 101º F, can be indicative of infection and should be called in. It is a good idea to keep a thermometer at home and simply check if you feel any chills or as if you may have a fever.
Drainage from the Wound
Most hip and knee incisions are dry by the time patients leave the hospital, although it is not unusual for some to have drainage for a week or possibly more. It is more common in larger, obese patients or patients who are undernourished (and have slower healing). It is probably also more common in smokers.
A particularly common source of drainage is the site of a drainage tube if one was used. This is usually the last spot to close up.
As long as the drainage is clear, yellow, or just bloody (sanguinous), there is usually not much need for concern although it should be reported to the visiting nurse or surgeon if it persists more than a few days. Drainage that changes character and becomes thick, green, white, or foul-smelling can be indicative of infection and should be reported right away.
To learn more about Joint Replacement Surgery or to make an appointment, please call us at 203.598.0700.