Do you have swelling in your knee after a total or uni-compartmental knee replacement? Are you wondering if it’s normal for the swelling to last for weeks or even months?
Don’t worry, you’re not alone! In this article, we’ll answer all your questions about knee swelling after surgery and give you some peace of mind.
As a qualified physiotherapist with over a decade of experience in home care, hospitals, and rehabilitation centers, I’ve seen it all.
I’ve also conducted extensive research in international scientific literature to provide you with the most accurate information.
So, if you’re worried about knee swelling after surgery, keep reading! We’ll explain everything you need to know and provide tips on how to reduce swelling.
And if you still have questions, feel free to leave a comment – I’ll do my best to answer them!
Last update: April 2023
Disclaimer: Amazon affiliate links (coming soon)
- Swollen knee, knee edema: Are they the same thing?
- Swelling assessment after total knee arthroplasty?
- What are the symptoms of swollen knee after arthroplasty?
- Why does the knee swell after a joint replacement surgery?
- The physiological mechanism : what causes fluid on knee after knee replacement?
- How much swelling is normal after knee replacement?
- Risk factors
- How long does swelling last after knee replacement?
- When should i worry about swelling after knee surgery?
- What reduces swelling after knee replacement?
- Does walking reduce swelling after knee replacement?
- Should I wait until my swelling and pain are completely gone before resuming my activities?
- What is the recovery time after a knee replacement surgery?
- Recovering flexion and extension
- Recovering everyday movements
Swollen knee, knee edema: Are they the same thing?
In everyday language, we use the terms swollen or puffy knee to describe a knee that appears larger than normal. The medical term used for this condition is knee edema, which means the same thing.
Knee edema = Swollen knee = knee swelling = puffy knee
Swelling assessment after total knee replacement (TKR): really?
We can measure the circumference of the knee to determine the extent of the swelling. Typically, we use a measuring tape with the upper part of the patella (kneecap) as a reference point, and compare it to the other side.
In the days, weeks, or months following knee replacement surgery, there may be a difference of several centimeters between the operated knee and the healthy knee. This difference can be 2-3 cm, 5-6 cm, or even more.
This is a very common phenomenon, which does not necessarily indicate a problem.
⚠️ In most cases, measuring this difference is not really necessary because the treatment plan is not affected by the difference in volume between the two knees! It can actually cause more concern than necessary. However, some people may prefer to “monitor” this parameter and find reassurance in taking measurements.
What are the symptoms of swollen knee after replacement?
Often, the skin around the knee also undergoes some changes in color or texture. It may become:
- tight, cracked, or hard,
- or bruises (blue, purple, yellow) may appear. These bruises can sometimes extend from the feet to the hip.
Common symptoms of a swollen knee may also include:
- Increased size or volume of the knee or the foot or lower limb (foot and lover limb swelling after knee surgery is also common)
- Discomfort or pain in the knee joint
- Stiffness or limited range of motion in the knee
- Warmth or redness around the knee
- Fluid accumulation in the knee joint (effusion)
Although this may be concerning at times, in isolation, it is not something to be alarmed about. It is a typical development after a knee replacement surgery.
It is common for the knee to swell and change color after a knee replacement surgery. This does not at all mean that there is a problem.
Why does the knee swell after a joint replacement surgery?
It is very likely that your knee will swell after surgery. This is a normal physiological phenomenon. However, the swelling can be more significant in some people, due to various factors, including genetic predisposition.
The physiological mechanism : what causes fluid on knee after knee replacement?
The swelling is caused by an accumulation of fluids in the various layers of tissue in the knee. It is related to the inflammation of the different tissues.
Inflammation triggering the swelling is a very healthy and therapeutic response! It is an automatic reaction of our immune system, inherited from our ancestors. This inflammation helps to repair damaged tissues.
It brings all the necessary substances to the damaged area through fluids to help the structures heal naturally as quickly as possible. 🚀
Generally, anti-inflammatory drugs (NSAIDs) are prescribed for the first few days after surgery. This limits the inflammatory response, but does not completely prevent it, as it is partly beneficial 🙂. Sometimes it is necessary to continue taking them, and it is often the doctor who prescribes them, sometimes at the request of your physical therapist (in France, physical therapists cannot prescribe NSAIDs).
After knee replacement surgery, there will be inflammatory responses in the knee, causing swelling and edema. This is normal and usual, and it means that your body is doing everything it can to ensure proper healing and recovery!
How much swelling is normal after knee replacement?
Don’t worry too much about the size of the swelling after knee replacement.
Even if your operated knee looks twice as big as the other one, or if the swelling lasts for several months, it’s not necessarily a cause for concern. This symptom alone isn’t enough to worry about.
But you can always talk to your physical therapist or doctor if you need some reassurance.
Some people may experience more swelling than others. Certain factors can affect the amount and duration of swelling. You may have more significant and prolonged swelling if:
- You have certain medical conditions like hypothyroidism, vein problems, or heart failure.
- You are overweight or obese.
- You lost a lot of blood during the surgery.
- You have weak quadriceps muscles.
(Cansabancu 2021 ; Gao 2011)
Being overweight, having certain medical conditions, and losing a lot of blood during surgery can increase the risk of developing swelling after knee replacement surgery.
How long does swelling last after knee replacement?
After an ankle sprain, the joint swells. Same thing happens when you have a knee replacement! This often causes worry and concern for people who see their knee swelling, persistent edema, or a knee that’s colored “strangely” for a long time.
However, swelling after total or unicompartmental knee replacement is a very common phenomenon. It can last for several weeks, months, and even years without being a cause for concern. While it can be a little uncomfortable, the knee pain will gradually decrease even if the swelling persists.
- Swelling is often most pronounced between the third and fifth postoperative day (or the sixth and eighth day) and often affects both lower limbs but more so the operated one. Swelling is greater above than below the knee. (Gao 2011; Loyd 2020)
- Your operated knee increases in volume by an average of about 35% compared to before the operation.
- At 3 months, on average, the volume is still increased by 11% on average. (Pua 2015) In some people, it can increase by 47% (Loyd 2020).
That’s why edema can remain relatively large even 2 or 3 months after knee replacement. This isolated sign should not be a cause for concern.
In the vast majority of cases, the knee will return to its usual volume over the course of months or years, even if you had a lot of arthritis. And if it takes time to recover, look on the bright side: you will still be able to resume all the physical and sports activities you want.
The knee can remain swollen for a long time (several weeks or months) after a replacement without it being a sign of a problem.
When should I worry about swelling after knee surgery?
Swelling after knee surgery is a very common occurrence and it’s totally normal to experience it for several months or even up to a year after the procedure. So, don’t worry too much if the swelling persists for a long time.
However, if you are concerned, it’s always a good idea to discuss it with your physical therapist or doctor. They can provide you with personalized advice and reassurance.
Instead of focusing solely on the swelling itself, it’s important to pay attention to how it’s affecting your daily activities. Are you able to move around comfortably and perform the tasks you need to do? If the answer is yes, then there’s probably no need to worry too much about the swelling.
But if it’s causing significant discomfort or limiting your mobility, then it’s definitely worth bringing up with your healthcare provider.
Overall, it’s important to remember that swelling is a common and normal part of the healing process after knee surgery. Keep an eye on it, but don’t let it consume your thoughts or actions. Focus on your overall progress and take things one day at a time.
What reduces swelling after knee replacement?
I totally get that you’re looking for a way to reduce the swelling in your knee as quickly as possible. It’s natural to be worried about it looking different from your other knee or even feeling uncomfortable or unattractive.
However, I have to be honest with you: we don’t necessarily have a “miracle” solution or even a consistently effective one for significantly speeding up the reduction of swelling.
❌ Ultrasound therapy and other physiotherapy methods (such as cold therapy, TENS electrotherapy), massage, manual lymphatic drainage, compression therapy (compression stockings), and kinesiology taping are not effective in the short or long term for reducing swelling.
Massage does not allow for a lasting reduction in swelling, but you can self-massage if you find it relieves discomfort and temporarily decreases swelling.
✅ The following tips may provide short-term relief for edema, but once they’re no longer applied, the swelling is likely to return:
- wearing compression stockings or compression socks with a class 2 rating. Although compression stockings can reduce swelling in healthy individuals, they don’t appear to reduce swelling in people who have had knee replacement surgery ;
- elevating your leg (with your legs and feet above your hip and heart level)
- limiting the time spent in static positions, such as standing (while doing household chores) or sitting (during meals or computer work). It’s important to alternate between walking and elevating your leg.
Does walking reduce swelling after knee replacement?
Yes, walking can help reduce swelling after knee replacement surgery.
- When you walk, your muscles contract and relax, which helps to pump fluid and blood through your body. This increased circulation can help to reduce swelling in the affected knee.
- Additionally, walking helps to improve range of motion and prevent stiffness in the joint, which can also contribute to reduced swelling over time.
- When you engage in physical activity, your body releases hormones that can help to reduce inflammation and swelling throughout your body.
Should I wait until my swelling and pain are completely gone before resuming my activities?
Important and often counterintuitive thing to note: just because a knee is swollen doesn’t necessarily mean it will hinder walking or even sports activities!
In fact, people with more knee swelling tend to do just as well or even better than those with less or no swelling.
This holds true not only in the days immediately following surgery, but also for longer periods of time.
Swelling will gradually decrease over days, weeks, or even months, regardless of what you do. Elevating the leg, avoiding static sitting or standing positions, wearing compression stockings… all of these things can help reduce swelling.
What is the recovery time after a knee replacement surgery?
Here are some figures on the average recovery time for various things after a knee replacement.
Keep in mind that these are average numbers: some people will recover much faster, while others may take longer, without it being a cause for concern.
Recovering flexion and extension
From the day after the surgery, a physiotherapist will likely help you move your knee a little, especially in flexion and extension. They should also show you movements you can do on your own to maintain or even gain some amplitude. On average, knee flexion is:
- 100° 2 weeks after surgery;
- It increases mainly during the first 12 weeks (3 months), and very little after 26 weeks (6 months);
- 117° 1 year after. (Mehta 2020)
These amplitudes allow you to resume most sports activities.
Recovering everyday movements
It’s difficult to predict with precision how quickly you’ll be able to resume your daily activities. We don’t know what makes some people recover better or faster than others. Even if you had a lot of knee arthritis and were very uncomfortable before the operation, you can still recover well.
Here are the average recovery times I observe in my patients (and I discuss them further in my article on the recovery time after a knee replacement – coming soon!):
|You have much less pain||A few days to a few weeks|
|Swelling and bruises disappear||A few days to a few weeks|
|You walk with crutches or a walker||From the next day|
|You walk without crutches or canes||After 1 to 2 months|
|You can get back into a bathtub without special equipment||After 1 to 2 months|
|You can gradually resume sports (starting with cycling, then other activities)||From 1 to 3 months|
Be reassured by the figures available on resuming sports after total knee replacement:
- 88% of those who have had surgery return to their pre-surgery level of physical and sports activity;
- 10 years after the prosthesis is implanted, 70% continue to participate in sports. (Oljaca 2018)
THE BOTTOM LINE
The knee can remain swollen for a long time (several weeks or months) after a replacement without it being a sign of a problem. Swelling is a common and normal part of the healing process after knee surgery.
Do you have any comments or questions? Your comments are welcome 🙂 !
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You may also like:
Swelling. Loyd BJ, Kittelson AJ, Forster J, Stackhouse S, Stevens-Lapsley J. Development of a reference chart to monitor postoperative swelling following total knee arthroplasty. Disabil Rehabil. 2020 Jun;42(12):1767-1774. doi: 10.1080/09638288.2018.1534005. Epub 2019 Jan 22. PMID: 30668214. Étude plus ancienne : Pua YH. The Time Course of Knee Swelling Post Total Knee Arthroplasty and Its Associations with Quadriceps Strength and Gait Speed. J Arthroplasty. 2015 Jul;30(7):1215-9. doi: 10.1016/j.arth.2015.02.010. Epub 2015 Feb 19. PMID: 25737387.
Gao FQ, Li ZJ, Zhang K, Huang D, Liu ZJ. Risk factors for lower limb swelling after primary total knee arthroplasty. Chin Med J (Engl). 2011 Dec;124(23):3896-9. PMID: 22340316.
Cansabuncu G, Gumus F. Pre-operative predictors of lower extremity swelling following total knee arthroplasty in patients with venous insufficiency and osteoarthritis. Int Orthop. 2021 Oct;45(10):2561-2567. doi: 10.1007/s00264-020-04888-0. Epub 2021 Jan 7. PMID: 33409562.
Treatment of swelling
Effet de la pressothérapie ou des bas/chaussettes de contention sur l’oedème après une PTG : Christensen LMR, Arnesen CE, Möller S, Hyldig N. The effect of compression therapy on post-surgical swelling and pain after total knee arthroplasty. Int J Orthop Trauma Nurs. 2021 Apr;41:100815. doi: 10.1016/j.ijotn.2020.100815. Epub 2020 Aug 28. PMID: 33339752. + Munk S, Jensen NJ, Andersen I, Kehlet H, Hansen TB. Effect of compression therapy on knee swelling and pain after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2013 Feb;21(2):388-92. doi: 10.1007/s00167-012-1963-0. Epub 2012 Mar 28. PMID: 22453307.
Effet des bas de contention à court terme, chez des jeunes femmes sans pathologie : Sugahara I, Doi M, Nakayama R, Sasaki K. Acute effect of wearing compression stockings on lower leg swelling and muscle stiffness in healthy young women. Clin Physiol Funct Imaging. 2018 Jun 3. doi: 10.1111/cpf.12527. Epub ahead of print. PMID: 29862634.
Effet des bas de contention sur l’oedème après arthroscopie du genou : Tischer TS, Oye S, Lenz R, Kreuz P, Mittelmeier W, Bader R, Tischer T. Impact of compression stockings on leg swelling after arthroscopy – a prospective randomised pilot study BMC Musculoskelet Disord. 2019 Apr 9;20(1):161. doi: 10.1186/s12891-019-2540-1. PMID: 30967135; PMCID: PMC6456960.
Effet du bandage compressif sur l’oedème après prothèse de genou : Liu P, Mu X, Zhang Q, Liu Z, Wang W, Guo W. Should compression bandage be performed after total knee arthroplasty? A meta-analysis of randomized controlled trials. J Orthop Surg Res. 2020 Feb 14;15(1):52. doi: 10.1186/s13018-019-1527-9. PMID: 32059737; PMCID: PMC7023752.
Effet de la cryothérapie (froid) sur l’œdème après PTG : Adie S, Naylor JM, Harris IA. Cryotherapy after total knee arthroplasty a systematic review and meta-analysis of randomized controlled trials. J Arthroplasty. 2010 Aug;25(5):709-15. doi: 10.1016/j.arth.2009.07.010. Epub 2009 Sep 2. PMID: 19729279.
Effet du drainage lymphatique manuel : Vergili, Ö. , Canbeyli, İ. D. , Özsar, B. K. , Oktaş, B. & Keskin, S. (2022). The effect of manual lymphatic drainage on postoperative recovery process following total knee arthroplasty. Journal of Medicine and Palliative Care , 3 (1) , 66-70 . DOI: 10.47582/jompac.1077661
Durée de récupération en flexion du genou : Mehta S, Rigney A, Webb K, Wesney J, Stratford PW, Shuler FD, Oliashirazi A. Characterizing the recovery trajectories of knee range of motion for one year after total knee replacement. Physiother Theory Pract. 2020 Jan;36(1):176-185. doi: 10.1080/09593985.2018.1482980. Epub 2018 Jun 13. PMID: 29897271.
Recovery time after knee replacement. Mark-Christensen T, Kehlet H. Assessment of functional recovery after total hip and knee arthroplasty: An observational study of 95 patients. Musculoskeletal Care. 2019 Dec;17(4):300-312. doi: 10.1002/msc.1409. Epub 2019 Sep 6. PMID: 31489996.
Return to sport. Oljaca et al. Current knowledge in orthopaedic surgery on recommending sport activities after total hip and knee replacement. Acta Orthop Belg. 2018 Dec;84(4):415-422.
By Nelly Darbois
I love to write articles that are based on my experience as a physiotherapist and extensive research in the international scientific literature.
I live in the French Alps 🌞❄️ where I work as a physiotherapist and scientific editor for my own website, where you are.
2 thoughts on “How Long does Swelling Last After Knee Replacement?”
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Merci beaucoup pour ce retour,
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