You have recently undergone hip replacement surgery, and you are concerned or curious about the swelling you are experiencing. You want to know how long it will last and what you can do to reduce it.
Well, I have written this blog post specifically to provide reliable answers to these questions, which are often asked by my hip surgery patients.
Whether you have undergone surgery for arthritis (coxarthrosis) or a femur fracture, and whether you have a total hip replacement or a partial hip replacement, using the posterior or anterior approach.
Last update: September 2023
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Here’s what I invite you to (re)discover:
What are the different types of edema/swelling in humans?
Edema is simply the scientific term for swelling.
This swelling is caused by an excess of fluid in the various layers of tissues in the body.
Edema can have different causes, including:
- A cardiac problem.
- Lymphatic issues, such as in the case of cancer.
- Reactions to certain medications.
- Surgery: This is the type of edema that occurs after hip surgery. It is referred to as post-operative edema.
In addition to swelling, one may also have a hematoma. However, they are not the same. A hematoma is a collection of blood that has accumulated in body tissues, whereas in edema, the fluid is not blood.
However, a hematoma can also result in swelling.
Swelling can be quite impressive when one is not accustomed to it. In fact, it is the main reason for emergency department visits in the month and a half following hip surgery, before pain and infection. However, in most cases, it does not require hospitalization. (Source: Geko 2020)
In this blog post, I focus on post-operative edema/swelling, which is often experienced after hip replacement surgery due to fluid accumulation in the body.
Where are the swelling located after hip replacement surgery?
When you undergo hip surgery, it is reasonable to expect that you may experience swelling, specifically around the hip area. However, it is not uncommon or concerning to have edema localized in one or more areas after the operation.
Here are the areas that may become swollen after the surgery, in the weeks that follow:
- All around the hip, including above it, towards the abdomen, varying distances from the incision site.
- The thigh and knee.
- The foot.
- The entire operated leg, and even the other leg.
Here are some pictures of swollen leg after hip replacement:
Swelling after hip surgery is more frequently localized in the hip, knee, foot, or the entire operated leg. Occasionally, it may also occur on the other side.
You may be wondering why your body reacts in this way after the surgery. Let’s now explore the reasons behind these edemas.
What causes swelling in leg after hip replacement?
Here are the main causes of post-operative swelling after hip replacement:
- Tissue manipulation during the surgery by the surgical team.
- Formation of blood clots due to damage to small blood vessels.
- Inflammation occurring in the surgical area and its surroundings. This is an automatic reaction of our immune system, aimed at repairing damaged tissues. The inflammation helps deliver necessary substances to the affected area through fluids, aiding in the natural healing process.
- Reduced activity and altered movement patterns, resulting in decreased fluid circulation and increased fluid accumulation. This is known as “venous stasis” and is the primary cause of swelling in both feet, even if you wear compression stockings.
- In rare cases, edema may be related to an infection or deep vein thrombosis. However, this is the exception rather than the rule, and other symptoms accompany these conditions.
There is also significant variation among individuals. Factors such as age, pre-existing medical conditions, overweight, or genetic predispositions can lead to varying reactions, even if two people undergo the exact same operation for the same reason.
Swelling primarily occurs as a result of the surgery and your body’s response to repair the tissues damaged during the prosthetic placement.
Swelling is generally not a sign of dislocation or loosening of the replacement.
How long does swelling last after hip replacement?
There are several studies that track the progression of swelling after knee replacement surgery. However, this is less common after hip replacement surgery, likely because the swelling associated with knee replacement is more significant and noticeable.
Nevertheless, here are some data:
- Swelling is generally at its maximum 7 days after the operation (source: Holm 2010).
- Only 5% of people who undergo hip replacement surgery report having swelling six months after the operation (source: Heo 2020).
Based on my experience, swelling is most commonly present during the first month. In the majority of my patients, it completely disappears during the second month. For others, it may persist but without hindering the resumption of daily activities, including sports.
Six months after the operation, 95% of those who have undergone hip replacement no longer have swelling. Swelling typically resolves within a few weeks.
Treatment: How to reduce swelling in leg after hip replacement?
There is an almost endless list of medical, surgical, and non-medical treatments that have been suggested to reduce swelling after surgery.
List of suggested treatments for post-operative swelling
Here is a small sample of treatments that physiotherapists, doctors, or surgeons sometimes recommend to combat swelling after total or partial hip replacement:
- Applying cold therapy. This can be done using various techniques such as braces with integrated ice packs, frozen pea bags, ice packs, cryotherapy machines, etc.
- Wearing compression socks or stockings (see on Amazon).
- Using kinesiology taping (those adhesive bands often in blue and pink).
- Using pneumatic compression boots or devices for pressotherapy. These were previously found mainly in physiotherapy clinics or rehabilitation centers, but I now frequently see them being used by my patients. Some orthopedic surgeons in private hospitals in my area even prescribe them for patients to rent for a few weeks.
- Walking with proper foot roll.
- Elevating the foot above heart level.
- Manual lymphatic drainage.
- Massage therapy.
- Taking diuretic medications.
- Consuming a low-sodium diet.
- And so on. (See physical therapy after hip replacement)
Which ones are truly effective?
Many of the treatments I listed are theoretically effective. Their theoretical mechanism of action against edema is coherent. However, the fact that the mechanism is coherent does not necessarily mean that they actually make a significant difference.
In other words, if one group of patients uses these treatments after hip replacement surgery and another group does not, there may not necessarily be a difference in:
- The extent of swelling
- The pain and discomfort it causes
- The speed at which it disappears
That’s why studies are conducted to determine the effectiveness of these treatments.
There are a few studies available, but their quality is not very good because evaluating the effectiveness of these treatments on edema is challenging.
In general, the more rigorous the studies are, the less they show a significant effect of these treatments. At the end of the article, you will find references on this matter, and you can explore the studies in question if you want to delve deeper into the subject.
That’s why my approach with my patients (with hip replacement or any other problem) is as follows: I always recommend a treatment plan that considers four criteria:
☑️ Maximum effectiveness (theoretical/empirical)
☑️ Minimum side effects
☑️ Minimum cost (in terms of time, energy, and money)
☑️ Minimum dependence on others or equipment.
The 5 things I recommend you do
Here are the 5 things I recommend to my patients who have undergone hip surgery, based on these 4 criteria and my readings and analysis of studies on the subject:
- Walk as often as your pain allows after your hip surgery. Use crutches or a walker. Place your foot firmly on the ground. Find the most suitable way of walking for you. As soon as possible, start walking outside, gradually increasing the distance.
- Limit static standing or sitting with your foot on the ground as much as possible, as well as excessive standing in one place. During these moments, blood circulation is less activated compared to walking or being in a reclined position.
- Wear compression stockings (see here on amazon) if you have no contraindications. They can be purchased at a pharmacy or online. They are covered by health insurance and private health funds if you have a prescription from your physiotherapist or doctor.
- Elevate your foot in a reclined position several times a day. Get comfortable on a couch or bed. If you don’t have an adjustable bed, couch, or recliner, use stacks of cushions to position your foot higher than your heart. Arrange the cushions so that your foot doesn’t risk slipping.
- Remember that swelling is generally at its maximum 1 week after the surgery and will decrease over the following weeks, regardless of what you do.
Some of my patients adhere to my perspective and follow these recommendations without doing anything else. Others prefer to implement additional measures. Do what gets you the most support 🙂!
Here’s what I wanted to tell you about this! I wish you a very good recovery! Do you have any comments or questions? Your comments are welcome 🙂 !
If you feel the need to learn more about the recovery period after a hip replacement, I wrote this guide in eBook format:
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You may also like:
- Restrictions after Hip Replacement: Really?
- What kind of pain can you experience after a hip replacement?
- Recovery Time after Hip Replacement Surgery
Here are the references of the scientific publications on which I based this article.
Geko 2020 https://www.gekodevices.com/us/news-events/oedema-swelling-is-amongst-the-most-frequent-reasons-for-90-day-emergency-department-visits-and-readmissions-following-elective-hip-and-knee-surgery/
Swelling recovery Time . Holm B, et al. Thigh and knee circumference, knee-extension strength, and functional performance after fast-track total hip arthroplasty. The American Academy of Physical Medicine and Rehabilitation, 3(2), 117-124. doi:10.1016/j.pmrj.2010.10.019.
Heo, S.M., Harris, I., Naylor, J. et al. Complications to 6 months following total hip or knee arthroplasty: observations from an Australian clinical outcomes registry. BMC Musculoskelet Disord 21, 602 (2020). https://doi.org/10.1186/s12891-020-03612-8
Treatment of swelling leg
Kluga KL, Weber Buchholz S, Semanik PA. Improving Orthopedic-Related Postoperative Edema Management in a Rehabilitative Nursing Setting. Rehabil Nurs. 2019 May-Jun;44(3):151-160. doi: 10.1097/rnj.0000000000000104. PMID: 31034457.
Written by Nelly Darbois
I love to write articles that are based on my experience as a physical therapist and extensive research in the international scientific literature.
I live in the French Alps 🌞❄️ where I work as scientific editor for my own website, where you are.