Importance of minimizing swelling after knee replacement (and other surgeries)
As I sit here writing I’m being given a constant reminder that post-operative swelling needs to be minimized as much as possible. The constant reminder is due to the fact that 4 days ago I had a chondroplasty and medial meniscus repair on my left knee. Yep, PT’s get hurt too and sometimes our best efforts to remain as limber and strong as possible don’t protect us from injury. I hurt mine in Karate doing a round kick. We’re taught to pivot our planted foot and at the end of the kick, our planted heel should have spun around and be facing our target (this prevents injury and gets our hips more involved in the kick; I can’t wait for you to read some of the hip info I’ll be writing abut later). I got lazy (or in a hurry…or didn’t pay attention) and felt the tear when I kicked. DOH!!! Fast forward 8 weeks later and here I sit with a bit of time off, recuperating and writing.
In no way is my injury or surgery as invasive as a knee replacement, nonetheless I have a great deal of swelling and pain. All normal, but post-op edema (Fancy term for swelling and again, totally normal) does need to be controlled as much as you can.
First the “why” and then the “how.”
When you’ve had your knee replaced (or any surgery for that matter), you swell. As noted above it’s normal but “why” is excessive swelling bad?
First, what is swelling?
It’s fluid (think of the clear or pinkish drainage you get from a scrape) that escapes the circulatory system and moves into our tissues. There it sits. Yes, our immune system is utilizing white blood cells to clean things up, but there’s a lot of congestion just sitting there. Here’s a couple of reasons you want to limit it.
Why is it bad?
- It’s painful! There’s probably not a bigger pain intervention you can make than to reduce your swelling. If you are up on it too much, it’s going to swell more, it’s going to get stiff and your pain will increase. My son had a basketball tournament on my post-op day 2 and by the time I got home (after 6 hours of driving and sitting watching hoops) I felt like I had 10 lbs of sausage stuffed into a 5 lb casing. It hurt more and it was much more stiff. 2 hours of elevation and ice helped a great deal.
- It can possibly slow down healing. Think about it, when you have your knee replaced (or shoulder or hip, etc…) there’s a lot of cutting. Blood flow gets interrupted. Even without the addition of swelling you’re not getting as many groceries in and as much garbage out. Now add increased swelling on top of that and it’s adding more pressure into/onto the system. I will guarantee that your little capillaries aren’t flowing as freely when your doing a pufferfish impersonation.
- It puts you at increased risk of a blood clot. I touched on this above, but when blood flow isn’t as good, blood tends to pool (sits there) and that’s when clots can form. There are many more reasons, but these are the big 3.
How do I limit it?
- Equal time (with elevation). I mentioned above that I was up for 6 hours on day 2 following my knee procedure. That’s waaay too long. What I mean by equal time is that if you are up for 2 hours you need be down for 2 hours. With it elevated and with ice on it (30 mins on/30 mins off for the ice). The leg (if it’s your knee or hip) needs to be elevated on pillows and your chest needs to be flat. Recliners don’t count. Swelling does gets removed via the circulatory system, but it also gets removed via the lymph system. If your butt is the lowest point, the lymph drainage will stop and back up there. Get that knee higher than the pump (your heart) and get the ankle even higher.
- Do your exercises. I’m having to constantly remind myself of the same thing right now as my knee is swollen, and frankly the exercises hurt. But you need to do them as it get your muscles firing and they act like little pumps helping to move fluid as well.
- Walk. I’m not contradicting myself here. I do want you down more than you think you need, but I want you walking around as well. It gets the circulation circulating and wakes up those muscles that are just lying there trying to get the tag number of the truck that hit them.
In conclusion, be good to yourself. This surgery is rough enough without adding insult to it. If you have any questions please reach out, I’d love to help.
God Bless!
Chris