Swelling after Hip Replacement

Hip or Leg swelling after hip replacement surgery is a natural response of the body to the trauma endured by the tissues during the surgery. Normally the swelling would decrease over a period of days, weeks, or even months.

However, excessive swelling after hip replacement may also be a sign of infection or deep vein thrombosis. The treating surgeon usually prescribes medications after the surgery to prevent infection and deep vein thrombosis.

During a hip replacement surgery, the surgeon removes the diseased head of the femur (thigh bone) along with the arthritic bone in the acetabulum (hip joint socket). The removed head of the femur is replaced with a prosthetic stem and head made of metal parts. A prosthetic metallic shell is placed in the acetabulum and a high-grade plastic liner is placed inside the shell.

The incision of the skin and various tissues to reach the joint is closed in layers after the surgery. The body sends in thousands of cells to heal the incisions and the tissues cut/separated during the surgery known as inflammation.

The influx of these cells also brings in the fluid that builds up in the tissues causing swelling. The swelling is especially prominent in the leg due to the effect of gravity. The swelling is gradually drained by the veins in the body that transport the blood from the tissues back to the heart.

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The swelling may also be controlled by measures such as icing, leg elevation, and the use of compression stockings. Icing may be done using an ice pack which is applied over the hip for a few minutes until the area becomes numb. The cold temperature soothes the nerve ends to help reduce pain.

The cold temperature also leads to narrowing of the blood vessels that bring in the excess fluid. The narrowing (constriction) of the blood vessels leads to a reduction in swelling.

The elevation of the leg also helps in the reduction of swelling after surgery. The patients are advised to raise the legs just above the heart level to help drainage of the excess fluid from the legs back to the body. The patients are often advised to lie down with their legs raised later in the evening, and at night.

Compression stockings help in getting the fluid back to the body by tightening the tissues. Similarly, the patients are advised regular exercises such as ankle pumps to reduce swelling. Contraction of the calf muscles and quadricep muscles during rehabilitation exercises helps in better circulation of the collected fluid.

Normally the swelling after surgery slowly decreases but at times, the swelling may be a sign of serious complications such as infection or deep vein thrombosis. The swelling associated with infection may occur immediately after the surgery or may occur weeks, months, or years after the surgery.

The swelling is usually associated with redness, pain and at times discharge from the operative site. The patients may complain of pain on ambulation and may report fever.

The swelling in the case of prosthetic joint infection is a result of inflammation and the debris produced by the infectious agent. The management of prosthetic joint infection is usually surgical and a staged surgery may be necessary. The surgeon usually performs a series of blood tests and a joint aspiration to determine the infectious agent.

The swelling may also occur as a result of deep vein thrombosis. Deep vein thrombosis is the formation of a blood clot in the veins of the legs. The veins carry the deoxygenated blood back to the heart that pumps the blood to the lungs for it to be re-oxygenated. The blood clot may potentially dislodge from the deep veins and travel up to the lung to cause a condition known as pulmonary embolism.

Pulmonary embolism may cause difficult breathing along with a rapid heart rate and breathing. The condition may be potentially fatal unless treated. Major surgery such as hip replacement, prolonged bed rest/travel are risk factors for deep vein thrombosis. During the incision of the tissues, certain chemicals and factors are released by the body that may facilitate the formation of blood clots.

The leg swelling from deep vein thrombosis occurs as a result of a blockage to the blood flow in the veins and build-up of backpressure. The increased pressure may lead to a decrease in the amount of nutrition that reaches the tissue in the legs. The reduction in nutrition may lead to cell death and subsequent inflammation that may further increase the swelling.

The surgeon usually prescribes blood-thinning medications such as aspirin or heparin after the surgery to decrease the risk of deep vein thrombosis. TED compression socks and exercises such as ankle pumps are also advised to prevent the incidence of deep vein thrombosis.

Hip replacement surgery is a highly successful surgery and some amount of pain and swelling is normal after the surgery that may subside gradually. However, patients and physicians should be vigilant of any signs of swelling that may point towards dreaded complications such as infection and deep vein thrombosis.