Managing Postoperative Pain, Swelling, And Bruising After Knee ...

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Key takeaways

Managing pain after knee replacement can involve both short-term prescription medications like opioids and longer-term over-the-counter options, complemented by physical therapy techniques.
Reducing swelling can be achieved through consistent elevation of the leg, the use of compression stockings, and regular application of ice packs to the affected knee.
Bruising is a normal post-operative symptom that typically subsides within a couple of weeks and can be managed by elevating the leg to reduce inflammation and tenderness.

Postoperative symptoms

Having some pain, swelling, and bruising is a normal part of the recovery process following knee surgery. That said, there are many ways to manage postoperative symptoms and ease your recovery.

After the initial pain and swelling, most people will notice a dramatic improvement in their knee problems within weeks of having total knee replacement surgery.

Keep reading for tips to help you deal with these common side effects of surgery.

Understanding side effects

General pain may occur for up to several weeks following a total knee replacement.
Swelling typically lasts for 2 to 3 weeks after surgery, but may persist for as long as 3 to 6 months.
Bruising may last for 1 to 2 weeks following surgery.

Immediately after the operation

Doctors have made big advances in pain management after total knee replacement over the last 10 to 15 years due to advancements in using regional nerve blocks, spinal blocks, and other methods of pain control.

During knee surgery, your healthcare team might either use a general anesthetic, where you will be fully asleep, or a localized anesthetic, where you’re numb from the waist down but still awake.

After the surgery anesthesia wears off, your healthcare team can provide pain medication either orally or through an intravenous tube.

These medications may include a strong opiate or opioid such as morphine, fentanyl, or oxycodone, and are intended only for short-term use. It’s important to note that larger doses over time can lead to physical dependence and addiction. Follow your doctor’s instructions to avoid adverse effects.

Managing swelling

Swelling is a normal part of the healing process.

According to the American Academy of Orthopaedic Surgeons, many people experience moderate to severe swelling in the first few days or weeks after surgery and mild to moderate swelling for 3 to 6 months after surgery.

You can reduce swelling by doing the postoperative exercises provided by your healthcare team. Elevating your leg on a pillow in bed for several hours each afternoon and using compression stockings will also help.

It may be worth investing in an ice pack. Ice packs or cold compresses are very effective for reducing swelling and inflammation in your knee joint and the surrounding tissue.

Your healthcare provider may recommend using an ice pack 3 to 4 times a day for about 20 minutes each time. Talk to your physical therapist or doctor if you see no improvement or if you think using an ice pack for longer might help. After several weeks, applying heat can also help.

Talk to your doctor if you have new or severe swelling, as this can signal a blood clot or an infection of the knee joint.

Pain medication

Some pain is normal after knee surgery. This will reduce over time.

Most people will take oral pain medication for up to several weeks. These include prescription-strength nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve).

If severe pain persists, your doctor might prescribe stronger pain relievers such as tramadol (Ultram) or oxycodone (OxyContin).

You may need over-the-counter (OTC) medication to help reduce temporary pain and inflammation later on. These medications may include acetaminophen (Tylenol) and NSAIDs such as ibuprofen or naproxen.

Your physical therapist may provide massages and prescribe exercises to help reduce inflammation. The pain will likely diminish over several weeks.

Dealing with bruising

Bruising around your knee may last 1 to 2 weeks following surgery. Bruising is a purplish discoloration that indicates blood gathering under the skin.

In the hospital, your healthcare team may give you a blood thinner to prevent deep vein thrombosis, which may add to the bruising.

Some bruising is normal and will subside over time, but it can come with additional tenderness. You can reduce inflammation and bruising by elevating your leg.

Read more about the recovery timeline after a total knee replacement here.

Home treatments

You’ll most likely wear compression stockings while you’re in the hospital, and a doctor may also recommend that you wear them for at least 2 weeks afterward. These socks can help reduce the risk of developing a blood clot and may help reduce aching in the leg.

Elevating the affected leg above the level of the heart periodically during the day may help with pain and swelling.

Applying topical creams and patches to the knee can also help reduce pain and make it easier for you to sleep at night. These usually include active ingredients such as capsaicin, menthol, or salicylates. People commonly use these ingredients on the skin to ease pain.

Physical therapy

Your physical therapist may use a transcutaneous electrical nerve stimulation (TENS) unit to stimulate blood flow and reduce pain in your knee and the surrounding area. These devices deliver electrical currents to the skin and aim to reduce nerve pain.

However, the American College of Rheumatology’s 2019 guidelines recommend against using TENS units in people with knee osteoarthritis. (Note that if your knee is swollen after a total knee replacement, this is an indication that you no longer have knee osteoarthritis.)

According to a 2014 study published in the journal Pain, TENS isn’t effective for everyone. People with high levels of anxiety or pain catastrophizing were less likely to benefit from TENS.

Your physical therapist may also provide massages or show you how to stimulate the muscles and tissue surrounding your knee.

Follow your exercises

Your physical therapist will recommend exercises to help strengthen your muscles, increase your range of motion, and increase blood flow around your knee. This promotes healing and helps drain fluid away from painful tissue.

While exercising can help postoperative pain, it’s important to avoid certain actions or positions that can cause damage. People may want to avoid squatting, jumping, twisting, or kneeling after surgery.

Takeaway

A total knee replacement will affect each person differently. Most people will experience some pain, swelling, and bruising after surgery.

Discuss your level of pain and inflammation with your healthcare team and report any abrupt changes. Using medication, ice packs, elevation, and physical therapy can all help to reduce discomfort and speed up recovery.

How we reviewed this article:

SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Box HN, et al. (2018). Venous thromboembolism prophylaxis after total knee arthroplasty. DOI:https://doi.org/10.1055/s-0038-1636907
Foran JRH. (2018). Activities after knee replacement.https://orthoinfo.aaos.org/en/recovery/activities-after-knee-replacement/
Foran JRH. (2020). Total knee replacement.https://hipknee.aahks.org/total-knee-replacement/
Hart ES, et al. (n.d.). Arthroscopic knee surgery: Common questions & post-operative instructions.https://www.massgeneral.org/orthopaedics/children/conditions-and-treatments/arthroscopic-knee-surgery
Kolasinski SL, et al. (2020). 2019 American College of Rheumatology/Arthritis foundation guideline for the management of osteoarthritis of the hand, hip, and knee.https://onlinelibrary.wiley.com/doi/full/10.1002/art.41142
Leung L. (2012). Pain catastrophizing: An updated review. DOI:https://doi.org/10.4103/0253-7176.106012
Rakel BA, et al. (2014). Transcutaneous electrical nerve stimulation for the control of pain during rehabilitation after total knee arthroplasty: A randomized, blinded, placebo-controlled trial.http://journals.lww.com/pain/Fulltext/2014/12000/Transcutaneous_electrical_nerve_stimulation_for.23.aspx
Total knee replacement. (2015).https://orthoinfo.aaos.org/en/treatment/total-knee-replacement/

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Medically reviewed by Timothy Gossett, M.D. — Written by Samuel Greengard and Tricia Kinman — Updated on May 19, 2023

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Key takeaways

Postoperative symptoms

Understanding side effects

Immediately after the operation

Managing swelling

Pain medication

Dealing with bruising

Home treatments

Physical therapy

Follow your exercises

Takeaway

How we reviewed this article:

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