Joint replacement of any joint causes controlled surgical trauma to the soft tissues around a joint. As a reaction to this, tissue swelling is normal after surgery and can vary between patients based on many factors. Because the soft tissues around the joint are what restrict motion, excessive swelling can lead to stiffness and increased pain. This is especially true for total knee replacement where early recovery of range of motion is critical to outcome. Therefore, swelling control is a very important part of the postoperative recovery from joint replacement and should be modelled into the recovery plan. Key components to swelling control include:
1. Elevation of the joint above the level of the heart. Water flows downhill so in order to drain fluid out of a leg, it needs to be elevated enough to create a downhill gradient allowing fluid to flow back to the body and away from the limb. Several pillows can be used for this purpose or patients can purchase leg elevation pillows online.
2. Aggressive use of ice. Ice restricts blood flow which increases swelling. It should be applied for 20 minutes at a time with at least 10-20 minutes rest in between so as not to overcool the skin and cause fros bite.
3. Soft tissue massage: massage techniques can be used to milk fluid away from the joint and back to the body. This can be done with the palms of the hands. Massaging the tissue also keeps it supple and prevents stiffness
4. Range of motion: early motion actually helps pump fluid out of tissues. This is particularly true to knees where use of the CPM (continuous passive motion) machine squeezes fluid out when the knee is in full flexion. Continuous motion prevents the fluid from building back up.
5. Compression: compressive wraps such as ACE bandages or compression socks can help reduce swelling and can be used early after surgery. They are most helpful on the knee and harder to use on hips and shoulders.
6. NSAIDS (nonsteroidal anti-inflammatory medications): These include ibuprofen, Aleve, Naproxen, Motrin, Advil and other prescription drugs. For patients who are able to take these, regular scheduled use may help reduce inflammation which also increases swelling. They also help reduce pain which is helpful to allow range of motion.
Swelling management is very important as part of the active recovery after joint replacement. Understanding how to control and reduce swelling can expedite recovery, improve range of motion and reduce pain after surgery. Some swelling in a joint replacement can persist for several months after surgery and patients should continue to implement these techniques as needed throughout their recovery to maximize outcomes.
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