How to Manage Pain, Swelling, and Bruising After a Total Knee Replacement

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.

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.)

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.

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