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[TKR] Purple swollen leg 5 days post-replacement

nell41

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Hello,
I'm 5 days after an otherwise successful total knee. I'm wondering how I know if my swelling is too much for my tissue? Compartment syndrome? I called my phys. assisant on call this morning, as I woke up to see a surprise of new purple and swelling, up to the groin and down near ankle, on the inside. The leg is pretty tight, but I can feel all over, and wiggle toes and all parts. The provider said it's normal, as the incision site looks clean and dry. Burning all over the purple bruising, and of course I can't do the bending I did last few days, due to swelling, but my helper was able to get my TedHose on. I'm icing and elevating almost all day, no change. I can always call them to ask if I'm worried, and I see the PT for the first time tomorrow. What should I look for to make sure I'm not getting compartment syndrome? Thanks! nell41.
 

Pumpkln

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Nell41,
Welcome to BoneSmart, glad you joined us!
Please post your surgery date, a moderator will add it to your signature for you. Having the exact date will allow us to properly advise you. Thanks!

Swelling and bruising are common after joint replacement. Here are some articles from our library you may find helpful to answer your questions.
Bruising after surgery ,
Swelling in the leg; or is it a clot?
Swelling: controlling swelling with compression
Swelling/pain comparisons
Compartment syndrome is excruciating, way beyond TKR pain.

I see the PT for the first time tomorrow.
You will want to work with a gentle PT, right now you need reassurance your recovery is normal, and that you are walking and getting around your house OK, they should also help you with pain control.

Here is your copy of the recovery guidelines, the articles are short and will not take long to read.

Knee Recovery: The Guidelines

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.
4. PT or exercise can be useful BUT take note of these
5. At week 4 and after you should follow this

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?

Energy drain for TKRs
Elevation is the key

Ice to control pain and swelling
Heel slides and how to do them properly

Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds


We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 
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nell41

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Thank you!
TKA date Jan. 30, 2019. I spoke with the PA on call just now, and his assurance plus your saying compartment syndrome is excruciating, both help. This pain is super “tight and tender” from huge swelling, bruising, which is worse not better after a day of ice, elevate, doing the Rxed exercises gently. I appreciate this forum. Good advices, I’ll look at your links, and my surg. team has educated me well too. I’ll call them tomorrow, keep elevating meantime.
 
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nell41

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Thanks, sistersinhim.
Yes, got cushions placed diagonally to get the foot 10-18 inches above my heart, certainly toes above the nose. Hope it will drain on its time, pretty much elevating all day between gentled exercises.
On hindsight, I had easy days 1-4, on day 4, yesterday, my helper took me to a grocery and I did do more walking, felt OK. Then bam! awoke day 5, this morning, shocked to see the bright purple balloon groin to ankle. It helped a lot to see those photos of similar legs, just knowing I don’t have to worry goes a long way! And of course it’s a (delayed) signal to slow down.
 

Pumpkln

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Nell41,
You are right in the middle of the very angry knee stage :tantrum2:, try to do too much and your knee will let you know.
"Just because you can, does not mean you should".
 
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nell41

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Pumpkin,
Thanks, learning this lesson quickly! I like your tantrum emoji, spot on.
Poor knee and innocent tissues all around it....;-(.
I just wish it would have told me that before I went to the grocery not after, but that’s how these go.
I’ve had total R hip 2001, total L hip 2005, lots arthritis multi-joint, so I get the delay is the way.
 
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nell41

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Well, Pumpkin, I actually do know the anatomy, which is the reason I’ve been freaking out over possible compartment syndrome. I do know how seriously acute that would be, so I’ve been very scared today.
The PA who called me back said this complication was almost unheard of in their clinic, he did not think I have signs of it (I can feel, wiggle and move all parts), so he thought I was safe to sleep and check with my team in the morning.
That’s a different statistic from Josephine’s article, so hers saying it’s a big hazard leaves me quite unsettled again, back to my original fear. I’m going to resolve it for the moment in that it is not worse in the last several hours, keep it very elevated, keep the Ted on while I sleep and do little activity beyond gentled exercises. Hopefully this will be enough, til I check with my team and meet the PT tomorrow.

Thanks for chatting, it helps to have people out there!
 

Lindylee

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I don't think I would go grocery shopping now and I'm 2 weeks today, so not really surprised that going out on Day 4 has caused increased swelling etc. I did a bit more yesterday and my leg was quite swollen last night and has been more painful than the past few days so I shall rest it a bit more today even though the swelling has gone down a lot already. This is such a helpful site isn't it? I hope you get reassurance tomorrow.
 

Jaycey

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@nell41 What you are experiencing is post op pain. Ice, elevate, take your medication around the clock as prescribed and most important rest! All this will ease if you just give it a chance. The grocery store was totally too much so early out. Let that knee recover!
 

SusieShoes

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So much bruising is alarming to see. I think I’d be concerned, too. Mine was only below the knee and it was quite scary enough. Bruising like you describe does happen, though, and so it’s probably nothing to worry about. It sounds like your surgical team is on top of things and will help you decide if it needs more attention.

Your swelling will likely go down before your bruising fades. The good news is so will your pain. You’re doing all the right things. :console2:
 

sistersinhim

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on day 4, yesterday, my helper took me to a grocery and I did do more walking, felt OK. Then bam! awoke day 5, this morning, shocked to see the bright purple balloon groin to ankle.
Oh my goodness, on day 4 all you should be doing is walking in the house just enough to do your daily activities. Your number one job is to heal that knee for the next few months.
 

skigirl

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It is distressing to have a bruised and swollen leg---and I am sure you have remorse for doing too much at the grocery store---this rehab takes a lot out of us. I had a fairly easy recovery, and really, was in bed 80% of the time for the first two weeks, doing just what you are doing, icing, elevating and compressing!! It is just going to take time to recover from the over doing it. Your knee does not want to bear your weight right now!

It is hard to let go and acknowledge that you are going to have to rest and limit your activity for weeks, but once you do, it is a little easier to face this long rehab!
 

Zommom

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Swelling is normal but sometimes for no rhyme or reason it reappears! I was doing fine doing nothing but RICE . On day 3 I was instructed to get labs done for my INR blood levels. This was not directed by my OS but by the anti coagulation team assigned to me after my stroke. So 3 days from surgery I had to get in a car be driven 10 miles wait in line to sign in and then another 1/2 hr of waiting for the lab tech and then the reverse to get home! It was way to soon to be out with that knee! I was ok that night but the following day I swelled up from my ankles to mid upper thigh. Today is day 6 and still have all this swelling. They wanted me to come in for labs again today but I put my good foot down and said no! We had a winter storm last night and this morning and I am not going to fight my way in to endure more days of swelling ! Ok I’ll probably go in tomorrow but geez how do they expect us to heal chasing around like this! :groan:
 

Celle

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That’s a different statistic from Josephine’s article, so hers saying it’s a big hazard leaves me quite unsettled again, back to my original fear.
When Josephine said that compartment syndrome was a big hazard after a knee replacement, she didn't mean it was the most common hazard. She meant it was the most serious hazard.

I've been on BoneSmart for 8 years now, about 5 of them as a Forum Adviser. In those 8 years, I haven't read of even one person who developed compartment syndrome after a knee replacement. Not one.

Believe me, if you had compartment syndrome, you would know all about it. You would be in screaming agony and by now the circulation to your lower leg would probably have been cut off.

On hindsight, I had easy days 1-4, on day 4, yesterday, my helper took me to a grocery and I did do more walking, felt OK. Then bam! awoke day 5, this morning, shocked to see the bright purple balloon groin to ankle.
What you wrote, above, is probably your answer. Going to the grocery store on day 4 post-op was definitely a bad thing to do. You should have made a list and asked your helper to do the shopping for you.

It's an example of cause and effect - you grossly overdid things on a brand new knee and it has responded by swelling dramatically. The purple colour is probably also bruising, which sometimes takes a while to show up and will take a long time to go away.
Bruising after surgery

You didn't have the BoneSmart articles then, but now you do.
Re-read this article: Activity progression for TKRs
You'll see that going to the shops isn't recommended until Week 6 post-op, not Day 4.

Weeks 6 and onward - add to all the previous
Start taking car trips to the shops but keep them short and sweet at the start, no longer than 15-20 minutes
Take at least one 5 minute rest while you are out
 

Jamie

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@Smokey253 .... I suggest you contact your GP and try to arrange an order for a Home Health nurse to come to your house to take blood for those INR checks. You might not get it, but it wouldn't hurt to push them for that service. You should be "home bound" for at least several weeks after your surgery.
 
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nell41

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Hi everyone,
Thanks for all the caring and comments. Thanks Celle for clarifying Josephine's article on the compartment syndrome, so now it's clear we agree: extremely rare, but bad news if it happened.
The swelling was down from elevating it all night, and I don't have excess bleeding, so I'm very pleased.
My team's Phys. Assistant called me up right away this morning on getting the message I'd called Sunday, and his conclusion made a lot of sense, that the TedHose sometimes are so tight they work against good blood flow, so he stopped them early, day 6 now. He agreed with continuing on the Aspirin, which I'm fine with. He warned me PT today will increase swelling.
I don't have any worries about pain, I just had not known how to handle the "tight as a drum" situation, but now I do.
The PT went great, she's pleased with my angles and strength, and I got my new exercsises. I'm so glad to be able to shower without following that with any stockings or bandage anymore.
Yes, elevate is key, and now that I am familiar with the swelling, and now have seen pictures of normal bruising, I'm good.
I wasn't disobeying any instructions, by the way; my D/C instructions were "weight bearing, ambulation, as tolerated," and I tolerated that grocery store visit fine at the time. Like we know, the delayed message from my knee being angry of course teaches me on hindsight that was too soon.

It's really nice to have this forum, and thank you all so much for your support. I'll sure be back if there are any more surprises, or I just need a "virtual hug." While friends call and visit and send flowers at first, we know they can get depleted by how long our needs go on.

Good luck to all of you as well, in your recoveries!
<3
Nell41.
 

Celle

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I'm glad things are working out better now and I'm glad we've been able to reassure you. That's what we're here for - help and support.

Please keep coming back, so we know how you're getting on.
 

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