Post-surgical edema, or swelling, is an expected and normal reaction following a total hip arthroplasty, the medical name for a hip replacement. This swelling represents the body’s immediate inflammatory response to the tissue manipulation and trauma that occurs during the procedure. The surgical process involves cutting through muscle and soft tissue, which prompts the body to send fluids, including blood and lymph, to the area to initiate the healing and repair process. This influx of fluid causes the visible enlargement of the limb.
The Typical Swelling Timeline After Hip Replacement
The progression of post-surgical swelling follows a predictable pattern. Swelling often increases during the initial days after the operation, typically peaking around the third to fifth day, though sometimes this peak can extend up to seven or even ten days. This is when the acute inflammatory response is at its strongest, and the amount of fluid accumulation is at its maximum.
Following the peak, the swelling should begin a gradual and steady decline over the next few weeks. Many patients notice a significant reduction in the edema by the two-week mark, and a substantial decrease by six weeks post-surgery. It is important to note that the total resolution of swelling is a slow process, and mild, residual edema is common.
For most individuals, the noticeable swelling diminishes greatly by the six-week to two-month point. However, some degree of mild swelling can persist for a few months, commonly three to six months, especially after increased physical activity or prolonged periods of standing. This lingering, mild swelling is normal as the soft tissues continue to adapt and fully heal around the new joint.
Where Swelling Is Expected and What It Looks Like
The swelling that occurs after hip replacement is often not confined to the immediate incision site but can be observed throughout the entire operated leg. Due to the effects of gravity, the fluid naturally tracks downward, making the swelling particularly noticeable in the lower extremities. This means edema is frequently seen in the thigh, around the knee, the calf, and most prominently in the ankle and foot.
Normal post-operative swelling presents as a soft, pliable enlargement of the limb. The operated leg will be visibly larger than the non-operated leg, but the swelling should not feel rock-hard or unbearably tight. Bruising, or ecchymosis, is also common, with discoloration ranging from purple to green that can extend from the hip down toward the toes.
Practical Strategies for Reducing Post-Surgical Edema
Patients can actively participate in managing and reducing this expected edema through several supportive measures:
- Elevation: Raise the leg above the level of the heart for 15 to 30 minutes several times a day to encourage fluid drainage. When resting, ensure the ankle is higher than the knee and the knee is higher than the heart for optimal gravitational assistance.
- Controlled movement: Gentle, prescribed exercises, such as ankle pumps and short walks within physical therapy guidelines, help prevent stagnation and promote circulation, as the contraction of leg muscles acts as a pump.
- Compression: Compression garments, such as stockings or wraps, may be prescribed to provide external pressure that helps control fluid accumulation in the lower limb.
- Icing: Apply ice packs to the surgical area for 15 to 20 minutes at a time, several times a day, always wrapped in a towel to protect the skin. Icing helps reduce inflammation and constrict blood vessels, which can minimize swelling and offer pain relief.
- Avoidance: Consistent application of these techniques is key, along with avoiding prolonged periods of standing or sitting.
Key Warning Signs Indicating a Problem
While some swelling is normal, certain characteristics suggest a complication and require immediate medical attention. One serious concern is Deep Vein Thrombosis (DVT), a blood clot in the deep veins of the leg, with symptoms including sudden, severe swelling in just one leg. This DVT-related swelling is often accompanied by persistent pain or cramping unrelated to the incision, along with skin that feels warm or is noticeably red in the affected area.
Signs of a possible infection at the surgical site also manifest as abnormal swelling. Swelling that is highly localized at the incision, is rapidly worsening, or is accompanied by a high fever is concerning. Other infection signs include the skin becoming intensely hot to the touch and bright red, or the presence of excessive, foul-smelling drainage from the wound.
Another serious complication is a large hematoma or compartment syndrome, indicated by swelling that causes severe, unrelenting pain disproportionate to the surgery. This is especially concerning if the pain is accompanied by numbness or tingling in the foot or toes, suggesting potential nerve or circulation compromise. Any sudden, dramatic increase in swelling after the initial peak, or new symptoms like difficulty breathing or chest pain, should prompt an immediate call to the surgeon or emergency services.