Is It Normal To Have Swelling After Knee Surgery
Swelling can be normal after many injuries and some surgeries. When should a patient worry about it, though? In this Ask Dr. Geier video, I explain whether its normal to have knee swelling after arthroscopic surgery.
Wallace asks:Is it normal to have swelling on the knee 3 weeks after arthroscopic surgery to repair a meniscus tear?
When an orthopedic surgeon performs arthroscopic surgery of any joint the knee, shoulder, elbow and more we run a lot of fluid through the joint to distend it and improve our visibility. We try to remove that fluid at the end of the surgery, but swelling after knee surgery can be common.
How long the swelling is present depends on what was done in the surgery. More invasive surgeries, like ACL reconstructions, have more swelling because the bones and the tunnels drilled bleed somewhat. Likewise, although not to the same extent, a surgery to sew a meniscus tear together a meniscus repair can have swelling for several weeks.
In this video, I share some thoughts on what to look for and what you might ask your surgeon about your swelling after knee surgery.
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How Long Does The Surgical Procedure Take And What Exactly Is Done
The actual surgery time is usually about 30 minutes. If extensive work is needed, the procedure may last up to 45 minutes. Most people âgo to sleep completelyâ during surgery with a general anesthetic. Some have surgery with a spinal anesthetic.
Three or four small incisions are made to allow special instruments, including a fiber-optic camera, to be placed into your knee. Sterile saline is brought into the knee joint continuously with tubing to provide a clear view for the surgeon. Torn parts of the meniscus and/or damaged cartilage on the bone surfaces are carefully removed with special arthroscopic instruments. The end result is a knee lined with smooth and stable tissues rather than rough edges.
How To Tell If You Have Scar Tissue After Knee Replacement
It will subside over time as you heal from an injury or knee surgery. If this gets worse, it could be a sign of excess scar tissue. The bending of ones knees. If you walk with a bent knee or cannot straighten your knee with your quadricep muscles, you may be suffering from arthrofibrosis.
When swelling occurs on the knee, it is determined by the amount of time it has been there. It becomes more difficult to inflate as the knee becomes swollen. If the balloon becomes too tightly attached, it will limit how much movement you can make. When fibrosis occurs, it is more similar to the procedure of taping a joint shut. The strength of the tissue and the strength of the tensile forces are both significantly increased. When it comes to fibrosis, genetics is what determines how long you want to sit still for. The X10 knee recovery system, which aids in the prevention of knee scar tissue, is ideal for those who have had knee reconstruction.
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Symptoms Of Knee Arthrofibrosis
- Inability to flex knee
- Difficulty in sitting in a car or in a chair
The workup for arthrofibrosis of the knee requires a full history and physical. It is important to determine the onset of the stiffness, associated injuries or conditions, and the previous treatments to address the issue. X-rays of that side are necessary to determine multiple things including evidence of extra bone healing, joint subluxation or abnormalities of position of the patellofemoral joint. One would also look for evidence of osteoarthritis to include joint space narrowing and bone spurs.
What To Do When An Incision Doesn’t Heal
If you have a non-healing wound, you need to involve your surgeon as soon as possible. If the surgical incision is draining more than 72 hours after surgery, people should either remain in the hospital for observation or have very close out-patient follow up to ensure the wound does continue to heal.
In situations where the drainage is declining, and there is no other sign of infection, these wounds can slowly heal. However, they do require close follow-up as a change in direction should signal more aggressive intervention.
Often physical therapy will be limited in these patients, and bending the knee beyond about 45 degrees may be held for a few days. Bending the knee increases the pressure on the tissues around the scar, and also can lower the oxygenation of those tissues. Keeping the leg straight can help dry an incision in some instances.
Blood-thinning medications can also contribute to a draining wound, and for this reason, sometimes anticoagulation will be held for a period of time in someone who has a persistently draining surgical incision.
If a wound is draining beyond one week after surgery, surgery should be undertaken to ensure there is no sign of a deeper infection and to prevent infection from becoming a problem. There is no role for the administration of antibiotic treatment in the absence of surgical treatment for this type of problem.
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Internal Scar Tissue Treatment Medication
Medication is the first line of internal scar tissue treatment. They are usually used for treatment of acute cases of scar tissue pain and forms part of treatment for chronic scar tissue pain. Over the counter and prescription analgesics are usually used to alleviate the pain but cortisone injections can as well be used.
Some medications may however lead to side-effects or even not be effective in treatment of the pain associated with scar tissue which would then necessitate the use of one or more of other treatment options discussed in the next section.
The 2 Main Approaches For Addressing Scar Tissue After Knee Surgery:
1.) The direct approach for addressing scar tissue after knee surgery is the most common and well known approach to break down scar tissue. It tends to be painful using a knuckle, walking on the knees or using a hard object to press into the painful area in the hopes to break down the scar tissue.
2.) The indirect approach for addressing scar tissue after knee surgery is not nearly as common and is a more subtler and gentler approach for breaking down scar tissue. This approach is based on the bodys innate healing ability to unwind and let go of the tension that is causing the scar tissue to form and protect the knee.
The following videos goes into more details on the 2 approaches and gives a strategy for addressing scar tissue in the knee after knee surgery
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What Type Of Scar Tissue Forms In Arthrofibrosis Of The Knee
There can be varying amounts of scar tissue that can form with arthrofibrosis of the knee. This can be due to a very serious injury whereby the body tries to heal itself, or where there is a fragile portion of the surgery where early motion may not be able to be accomplished immediately after surgery and the body heals itself with loss of scar. Some cases of arthrofibrosis form scar tissue bands that are just enough to prevent motion, while other patients probably have a genetic cause that causes thick and fibrotic scar tissue throughout the knee. For those patients who have relatively thinner scar tissue, that is well mature and does not appear angry and red, the arthroscopic releases for arthrofibrosis of the knee can be very effective. For those patients who have very thick sheets of scar tissue, getting full motion back may be difficult because the arthroscopic surgery itself may be perceived in the body as another injury and the body may try to have another round of scar tissue formation to try to heal itself after a reinjury.
How Long Does It Take To Recover From Knee Debridement
Your recovery time will be four to six weeks, and you will be able to resume all of your normal activities, including sports.
Recovery After Knee Surgery
Following knee surgery, patients who work in sedentary jobs may require one to two days of recovery, while those who work in more physically demanding jobs may require four to six weeks. Following surgery, it is recommended that patients return to physical therapy four to six weeks later and resume sports or exercise by 14 days. Tub baths, swimming pools, and Jacuzzi water should be avoided until the incision heals, and the area around the incisions should be kept clean and dry.
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Cause For Scar Tissue In Your Knee
Scar tissue forms in the body after the healing of a wound. It is the bodyâs natural response to trauma. In the knee, this could come from a surgical procedure or some traumatic injury.
Unlike healthy skin, scar tissue is fibrous and dense and is not very elastic. When scar tissue forms in abundance around a healed injury in the knee, it can cause the joint to âstickâ. This can prevent your joint from its full range of motion.
Arthrofibrosis of the knee, or commonly known as âfrozen kneeâ, is caused by inflammation and excessive scar tissue build up in the knee joint and surrounding tissues. This can be scar tissue inside the knee joint, or around the surrounding tissue of the knee. Arthrofibrosis in the knee is very common to experience after arthroscopic knee surgery or replacement procedures.
What Is Knee Scar Tissue
Arthrofibrosis, also called stiff knee syndrome, occurs when too much scar tissue develops around the knee.â
This condition can occur in any joint. It makes daily movement, like walking or standing up, difficult and painful. People of all ages develop arthrofibrosis, though it’s less common in children.
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Reasons For Needing Arthroscopic Knee Surgery
Candidates for arthroscopic surgery range from someone who has gradually worsening pain with knee crepitus or knee grinding to someone with ligament or cartilage damage needing to be repaired or removed.
Common complaints from patients are my knee hurts when I bend it and straighten it or I have a sharp pain in my knee.
For the purposes of this article, we will discuss the recovery process of common and less involved surgeries of arthroscopic debridement and partial meniscectomy knee surgeries, sometimes referred to as knee scopes.
The goal of this article is to talk about the recovery of a routine debridement or meniscectomy, however its worth taking a second to explain why they differ from more involved procedures.
When The Scar Heals
- Push & Pull: Imagine that you have divided the scar into sections two finger widths apart. Place two fingers in the leftmost section and move it in all directions of a clock . Where ever the scar feels stuck hold this position for 60 seconds. You will feel a strong pulling or light burning. Then move to the next section until you have massaged the whole length of the scar. When the top layers of skin move more freely try to press a little deeper to get to a deeper layer of the scar.
- Skin Rolling: Pinch the skin on either side of the scar, lifting the skin up. Start at either end and move forward and backward, rolling and raising the skin as you move. A free scar bulges upward, a stuck scar will dimple.
- Stroking along the Scar: Massage the scar tissue by working it with a rubbing motion along the grain. You can move your fingers apart along the length of the scar as if you are trying to make the scar longer.
- Plucking: Put your index finger on one side and thumb on the other side of the scar. Try and lift scar up, separating it from the underlying tissues. If the skin slips out of your hands, you may not be ready for this stage.
Massage Tips
The sensation you feel when you massage your scar is one of strong pulling or light burning, NOT sharp pain. Sharp pain is as if you cut your fingers with a knife. Scar massage should NOT feel like that.
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How Long Does It Take To Recover From Lysis Of Adhesions Surgery
Patients treated with lysis of adhesions go home the day of surgery. Range of motion exercises should be started the day following the procedure physical therapy starts 3-5 days after surgery and continues 2-3 times per week for approximately eight weeks. After six weeks, improved range of motion and patella excursion should be observed. Pain medications, such as narcotics as well as NSAIDs medications will be necessary immediately following surgery. Crutches are recommended for the first three days after the procedure for swelling reduction and stability.
For additional resources on knee arthroscopy lysis of adhesions or to have your knee pain evaluated, please contact the office of Dr. Riley J. Williams, MD, orthopedic knee surgeon serving Manhattan, New York City and the surrounding New York boroughs.
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How To Break Up Scar Tissue After Knee Surgery
If you have mild cases of arthrofibrosis, intensive physical therapy may be all that is required. In addition, in cases of scar tissue, a physician can break up the scar tissue with a controlled procedure under anesthesia. Some patients may benefit from surgery.
When the bodys natural defenses against injury fail, scar tissue can be produced to repair an injury or damaged area. Scarred skin is less flexible than healthy skin, which can inhibit movement and cause pain when it is irritated. Scar tissue pain and scarring are treated in a variety of ways. Fibrous tissue beneath the skin can cause long-term pain. An excessive amount of fat and excess tissue can cause joint and soft tissue damage as a result of fibrosis. People with minor scars can take several at-home methods to break up scar tissue. Surgery is typically used as a last resort to treat scar tissue pain caused by an injury or problem in which the scarred area is excessive and deep. There is no risk of infection or recovery downtime with Shockwave Therapy because it is a non-invasive treatment. A surgeon may be able to perform a skin transplant or remove damaged skin from another part of the body.
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How To Spot A Problem With An Incision
The signs to look out for when inspecting an incision suspected of having a healing problem include:
- Persistent or worsening drainage from the incision
- Grey or dusky tissues around the incision
- Broken sutures or skin staples that have come out of the scar area
The most common signs of a wound healing problem are persistent or worsening drainage after surgery. It is normal for a surgical wound to have some drainage immediately following surgery, but drainage beyond 72 hours after wound closure is not considered normal.
While some spotting on a bandage after 72 hours may not be a cause for concern, more than 2 centimeters of drainage on a gauze bandage is not considered normal and should be monitored by your surgeon.
Your surgeon will need to determine if the drainage is coming from around the incision or from deeper around the knee replacement implant. In addition, he or she will need to determine if the drainage shows signs of infection. If the drainage is from the deeper part of the wound or potentially infectious, then surgery will likely be necessary for treatment.
How Long Does It Take To Recover From Scar Tissue Removal In Knee
You should be able to resume normal activities in about 6 weeks. If your doctor repaired damaged tissue, your recovery will take longer. Depending on how long it takes for your knee to recover, you may be required to limit your activity. If you have a physical disability, you may be eligible for rehabilitation programs.
When recovering from knee surgery, how long does it take? The procedure is explained by Dr. Dan Albright. The surgeons goal is to remove scar tissue so that it can be returned to its original position. The doctor will be able to see the operation on the patient if a fiber-optic cable is inserted into the joint. Depending on the type of arthroscopic knee surgery, a patients recovery period may range from two to six weeks. Scar tissue is removed from the knee joint, resulting in a more stable joint. A typical patient can return to normal knee movement after 4-6 weeks of walking and leg strengthening exercises. Three to four months after surgery, swelling, pain, and limited movement are no longer present.
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Revision Or Removal Surgeries
Scar tissue on the skin may be corrected via cosmetic surgery techniques, such as excisions or skin grafting. These may be viable options if you have significant aesthetic concerns along with pain. This may be the case with third degree burns, severe wounds from an accident, or other injuries.
The downside to corrective surgery is that the process could lead to additional scarring, such as keloid scars. Therefore, your plastic surgeon will determine whether the new scar would be far less significant than the original scar tissue. If the answer is yes, then revision or removal techniques could bring more relief that can outweigh the risk of additional scarring.
If the scar tissue youre wanting to treat is from a recent surgery, the Cleveland Clinic recommends waiting at least a year before considering revision surgery. This is because the initial scar tissue could go away on its own without needing additional procedures.