Swelling in the leg following hip and knee surgery


Regarding swelling in the leg, this is a common event following a total hip replacement, total knee replacement or a hip resurfacing.


There are a number of reasons why it occurs: 


The most important reason is the bruising and swelling from the surgery.  The surgery on the hip or the knee involves quite a lot of muscle splitting and there is inevitably a fair bit of bleeding.  This is reduced by modern anaesthesia which involves dropping the blood pressure, however in more elderly patients or patients with severe rheumatoid arthritis it is not safe to drop the blood pressure excessively.  


The second confounding factor is that we give the patients anticoagulants or asprin which thin out the blood and tend to stop it from clotting.  The purpose of this is to reduce the risk of a thrombosis in the deep veins of the leg and a pulmonary embolism, so some swelling around the wound is the price that is paid for avoiding these more serious complications.  


It is common to get swelling in the knee following a hip replacement.  This is partly because the knee is twisted a lot whilst the hip is being dislocated and partly because of general swelling in the thigh.  


It is common to get minor degrees of thrombosis in the leg veins or sludging in the leg veins following hip and knee replacement and this exacerbates the tendency to swelling.  


Another key factor in leg swelling is that if the patient sits with their foot on the floor there is a great tendency for fluid to accumulate around the ankle.  This is because, unlike a central heating system, the heart does not pump the blood right around the body.  The blood only gets back into the circulation by the pumping action of the calf muscles.  The right thing to do is therefore to lift the leg up preferably with the ankle above the level of the chest and keep the calf muscles moving.


In more elderly patients any impaired pumping action from the heart tends to exacerbate the problem. 


There is an additional problem in patients who are malnourished as they may have low amounts of albumin protien in the blood, this means that water is more likely to leak from the blood into the tissues.  In extreme cases there may be vitamin deficiencies which affect the pumping action of the heart.


In spite of all these factors the swelling in the leg will normally be improving by one month post-operation.  It can persist for more than three months but it is unusual for it to persist for as long as six months.  The symptom can be helped by leg stockings but leg stockings will actually restrict the leg and overall I do not normally recommend them.


Some great people from the history of Orthopaedics:

The anatomical studies of Leonardo da Vinci, from around 1510, are one of the great achievements of the Italian renaissance.  His work helped to lay the foundations of modern scientific medicine, and orthopaedics in particular


Pioneering Orthopaedic Surgeon Professor Sir John Charnley using the lathe in his workshop at home. John Charnley radically changed the treatment of hip arthritis with his total hip replacement designed in the early 1960s. 


Mr Mike Freeman of The London Hospital sitting with Dr John Insall  (right) of The Hospital for Special Surgery, New York in Mike Freeman's garden in about 1980.  These two individuals were responsible for working out questions of design, balance and alignment which are the basis of all good modern Total Knee Replacements.