Problems after knee surgery like pain, swelling, stiff knee

Here you can read about problems after knee surgery.This page discusses the problems that arise after major surgery like a total or partial knee replacement (arthroplasty) in case of severe knee damage (osteoarthritis or major trauma), or a repair operation necessary after a fracture, a torn cruciate ligament or lateral collateral ligament. The rehabilitation period can take a lot of time. We would like to give you a few tips and tools regarding things you may face during this period, things that are not always described of mentioned in the general information handed out around an operation. Every day problems after knee surgery, so to speak.

A serious complication: arthrofibrosis

A warning first: some people develop arthrofibrosis after knee surgery. Arthrofibrosis is  a severe and disabling disorder of the knee with progressively limited motion and severe and progressive pain. This disorder is caused by the formation of excessive scar tissue, also known as contracted connective tissue, growing within the operated joint. In an early stage we can reverse this condition. In an advanced stage, when there is massive scar tissue, recovery is a long and painful process, often involving additional surgery. Therefore it is of the utmost importance that you recognize and understand what is happening and take action accordingly!

Here you can read about arthrofibrosis, scar tissue in the knee.

Preparation before knee surgery

Preferably, start learning to walk with crutches or other walking aides before surgery. Alas, that is not always possible.

Information and instructions

Tibial plateau fracture
The tibia, the lower part of the knee joint, has collapsed by an accident. Surgery is usually required.

You will receive information about your surgery. Listen carefully and ask anything that could be important to you. After the operation you will receive instructions on your rehabilitation period. For instance: are you allowed to bear full weight, do you have to use crutches or other walking aides? If you are not allowed to bear full weight, how much weight is allowed, and how do you build this up? How much flexing and stretching is allowed? Will you receive a brace and are you allowed to take it off for a short time to exercise or to have a shower? Listen very well, ask as much as you need to. Obey you restricting orders for as long as indicated. Remember: if there are tissues of bones that need to heal, it will take time, you can’t speed up the healing process.

Information your physiotherapist gets

In the Netherlands, your physiotherapist does not necessarily receive minute instructions about restrictions. So it is very important that you understand and explain your restrictions, if any. Of course we may contact your surgeon, but most of the time our patients can tell us exactly what we need to know.

After knee surgery

Even without complications, even if you have permission to bear weight on the operated knee, you will have a process to go through and it will take time!

Lots of information here, hope to be able to help you! Read on!

It takes time to recover

Tibial plateau fracture with hardware
Tibial plateau fracture after surgery: a lot of hardware

“We will do a knee replacement , and you will be up and about in no time”. Some surgeons make it sound very easy. Or something like: “we will repair this fracture beautifully, a few screws here and a plate there and you will be just fine”. They are right, most of the time, and they are right to be proud of their work, but it will never be as easy or as quick as they make it sound. It will take time. A lot of time sometimes.

The human body is not a car that can be fixed by putting some spare parts in it. We have to heal and that is a process. In all the years I have worked with people after surgery, that is what I have learned: People think that they will be fine 3 weeks after a major knee operation. No, revalidation will take time, blood, sweat and tears sometimes and a lot of exercising. Most of these exercises you can and have to do at home by yourself. But in the end, many people are better off. Remember that while you despair.

Warning

Some people recover faster than others. Do not count the weeks, count the months! Do not look at those happy few who recover within 6 weeks. Maybe their problem was less extensive than yours to begin with. This is your body, your journey to recovery. The best you can do is exercise and exercise! Consult a good physiotherapist, do your homework a couple of times every day. Put an exercise bike in your living room and as soon as you are allowed to use it, please do use it!!

Exercising too little too late is just as bad as exercising too soon or too rigorous.

I would advise rather 1 appointment a week with your therapist and 5 times every single day doing your homework, than seeing your therapist 3 times a week while doing nothing at home.

Fatigue

Shortly after the operation people are often tired and need to sleep a lot. This can be an aftermath of the narcosis or just a reaction to major surgery and is completely normal. The body needs rest during recovery. Walking takes more effort, nothing comes easy. The medication you may take could cause extra fatigue. Give in to it: if your body demands rest, take it. Concentration could be an issue too, but that also will resolve.

Stitches

knee with stitches
A few stitches were needed after the removal of an irritating screw. The extended scar from the original operation is clearly visible. Recovery after this second, minor surgery was quick, certainly compared to the recovery period after the big first operation

Stitches can be irritating. You will often be relieved after their removal. The first few days after the operation, depending on how the wound is healing. Exercise, but be careful not to bend your knee too far. The wound could open up or start bleeding. If this happens, please contact your physician.  After the stitches are removed and the wound is well closed, you could apply a fatty cream.

Pain, swelling, redness, warmth and limited movement after knee surgery

The knee has only so many ways to warn us. Pain, thickness, redness, warmth and limited movement are the general signs of an inflammatory response. Those reactions are well known throughout the body. If we do too much with our just operated knee, the knee will warn us with one or more of these reactions.

During the first days after a knee operation pain is to be expected. If you would take too many painkillers, you would not experience pain at all and there would be a danger of overloading the knee. So take pain medication as prescribed, neither too much nor too long. Sometimes these medicines are prescribed because of their anti-inflammatory qualities. You might need them.  Ask your physician when to stop taking your pain medication.

Pain in the operated area, certainly while exercising and within limits, is normal. Remember that maybe bones have been broken, tendons or ligaments are torn, and structures are cut. Surgeons have to use force while operating and your knee is protesting.

However, if you do not move, (presuming you have permission to move of course, sometimes moving is strictly forbidden) the pain will get worse in stead of better. If you lay down your leg and play couch potato, understandable as might be, things get worse. Not exercising will mean more pain, stiffness and thickness. On the other hand, too rigorously performed exercises will do just the same. You will have to find a balance between doing nothing and overdoing. Hence the physiotherapist together with a lot of your common sense.

The first weeks after knee surgery

Surgical screw
Removed screw. It irritated and it interfered with normal movement. This was 8 months after the initial surgery

The knee will get warm and thicker after use. Cooling the knee with cold-packs, ice cubes, (but don’t forget protecting the skin whith a piece of cloth) or a cold towel will ease the pain. As long as the wound is not healed don’t apply cold things on it because that will stop the healing process by reducing the blood flow.

Remember that increased pain, thickness and redness, warmth and limited movement is a reaction on what has happened to the joint. Too much reaction means overload. No reaction at all means that you should do more.

Stiffness and limited movement

After the operation the knee is stiff and limited in movement. By exercising from the moment you are allowed to do so, you will bring back the ability to move. The effect will be a greater range of motion in the joint. Listen to your surgeon, your physiotherapist and your body.

Hardware used to fix a broken knee

Tip: place an exercise bike in your living room. This is probably the best way to really make use of it. A trainer in the attic or in the garage will, at least in my experience, not be used much. You can start using the exercise bike when you have permission to do so. It should be safe for you to get on and off the bike, seek help if necessary!

An average 2-3 weeks after the knee surgery and sometimes much more, you can expect a normal range of motion or you will experience substantial improvement (if allowed to move at all).

Sometimes the mobility of the knee does not get any better or even gets worse. You do your exercises, you do everything right, but pain and stiffness get worse. Walking gets very difficult. You can not bend up to 90 degrees, you can not straighten the knee. It could be you have a serious complication, called arthrofibrosis.

The lower leg

In the course of the day the lower leg and/or the foot may get thicker and gets a different colour than the other leg. Most of the time that is a result from leave the leg hanging.

The solution is simple: elevate the leg above horizontal and support it with cushions. These cushions must be rather soft so they don’t interfere with the circulation. Even better would be a bed with the possibility to elevate the foot section, but we can manage without one.

Support stocking

Sometimes people receive a support stocking to prevent thrombosis. You will almost certainly need help to put it on.

Arthritis knee
Arthritis: a part of the cartilage has disappeared. View from within the knee joint during an arthroscopic operation. Where the cartilage is gone, the bone is exposed. The owner of this knee no longer runs but can walk painfree for 20 km, or cycle for 80 km. Sometimes it hurts but most of the time this knee is just fine! Keep moving!

The lower leg getting thicker, swollen, and coloring all sorts of color (I have them seen pale, blue, green, yellow, purple and red) is part of the deal. Black of course is totally wrong. If you are uneasy about the way your leg is coloring, ask your physician or your physiotherapist, he or she will totally understand your anxiety.

It is normal that the lower leg gets thick during the day a long time after a knee operation. Don’t worry about it. It means you still have to elevate the leg while resting. Once you are up and about, the muscles will start to pump again and this  problem will be solved. Only when the leg doesn’t get any thinner after a prolonged time of elevation you should contact your physician.

Causes for concern

Fierce pain in the lower leg that doesn’t go away despite pain medication and is accompanied by tingling or numbness, maybe with paleness of the skin and paralysis, means you should contact a physician right away. This could mean you are suffering from a compartment syndrome. This is a rare condition that asks for immediate intervention.

A shiny, colored part of the skin in the lower leg or foot, away from the operated knee but at the same leg, that feels cold, warm or wet, possibly with changing toenails, could mean a dystrophy is forming. In that case it is advisable to contact your physician.

Thrombosis. While we can or may not move our leg as we used to, especially when during an operation several blood vessels have been cut off, tiny blood clots could form. Maybe you are on anticoagulants to prevent this, but even then problems could occur. Therefore you should move your ankle very often (as in several times every hour) in every direction. If the calf gets thick, warm and very painful, please contact a physician immediately!

The foot

If you are not allowed to stand on your leg, the skin of your foot may change. Thick layers of callus may form. It looks awful but it is quite normal. You could use hand cream on the foot. Don’t worry.

Since the muscles of the unused foot do not pump the blood around, it may turn cold. Annoying as it may be, it is not harmful. Move the foot up and down (if allowed) regularly, rub it or let somebody rub it, and cover it with a wide sock.

Backache after knee surgery

When you are not allowed or not able to do much, you probably lie on your bed or on a couch a lot. This may eventually cause back problems.

The backache comes from a posture that can only be harmful for our back: hanging in the cushions. Our back feels best when it is regularly moving. We can avoid those complaints by putting a small pillow in the small of the back as to establish a hollow posture. We can also lie down entirely ever so often. Shift the pelvis back and forth, and from left to right often.

Bearing weight again

If you are advised not to bear weight on your leg, please follow that advise. The knee needs to heal and that takes time. The same goes for walking with walking aides: use them as advised. Time heals.

If you are allowed to do everything you want, you still have to use your wits. Even if you are pain-free, you can not do everything at once.

I once had a (young) patient who had broken his leg in 6 different places. He had several operations before he was healed more or less. Before his last appointment in the hospital he decided to go water skiing. His surgeon nor I were amused. What is your opinion?

Tip: arrange for an exercise bike

Buy one, lend one, hire one. An exercise bike should have the following qualities; the saddle should come up and down according to your needs, the pedals should turn easily, the bike should be stable enough when you get up and use it. You don’t need electricity or programs for this purpose.

Like I told already: Of course it is important that you should get up and down without endangering yourself. If need be, seek help from someone.

This way you can exercise on a very regular base, many times a day and for a few minutes every time to start with. Exercising this way is very effective indeed.

How long before my revalidation is complete?

Of course that depends. Sometimes people can walk without any walking aides for quite some distances within 6 weeks, most of the time that takes longer. It depends for instance on your age, the reasons for the operation, the sort of surgery, how well you could walk before the operation, whether you heal quickly. Were there any complications or weight-bearing restrictions? Do not despair if you still can’t do everything you would like in 3 months after surgery. What is important is: are you getting any better? If yes, than be patient. Take your time. You will have to, isn’t it?  If you don’t get any better, please contact you physiotherapist or your surgeon, and take care you do all the right exercises and do them often enough.

Other pages on the subject “knee after surgery”:

Arthrofibrosis, scar tissue in the knee, causing limited motion and excruciating pain.

Pain diary if pain does not seem to diminish.

Taking up sports after knee surgery

Walking the stairs

Going up we put the not-operated leg first en pull up the operated leg. Going down stairs we first put down the operated leg en then the “good” leg. Walking the stairs is not easy, but not impossible. Do not take risks, if need be, sit on the stairs and work yourself up or down…

Reactions are much appreciated. Are grammar and syntax all right?

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