Pain, Swelling and Stiffness After Revision Surgery: When It is Normal and When It is Not

Pain, Swelling & Stiffness After Revision Surgery-When It’s Normal — and When It’s Not
Orthopaedics and Joint Replacement

Medicine Made Simple Summary

After revision hip or knee surgery, it is normal to experience pain, swelling, and stiffness. But knowing what is expected and what could signal a complication is important for safe recovery. This article explains why these symptoms happen, how long they usually last, and when patients should seek medical help. By understanding the difference between normal healing and warning signs, patients and families can feel more confident, avoid unnecessary worry, and ensure problems are treated early if they arise.

Introduction: Why These Symptoms Matter

Hip and knee revision surgeries are complex, and recovery can be longer than after first-time replacements. Pain, swelling, and stiffness are almost universal experiences, but not all symptoms are created equal. Some are part of the normal healing process, while others may indicate infection, implant failure, or other complications. Understanding what’s normal versus concerning can help patients recover safely without unnecessary anxiety.

Why Pain Happens After Revision Surgery

Pain after revision surgery comes from several sources: surgical incisions, tissue healing, bone adjustments, and the body’s natural inflammatory response. Unlike first-time surgery, revisions often involve more extensive work, which can increase initial pain. Patients should expect discomfort, especially in the first few weeks, but pain should gradually improve with time, physiotherapy, and medications.

Types of Pain: What to Expect

  • Incisional Pain:   Felt around the surgical cut, usually improves within weeks.
  • Deep Joint Pain:   From bone and soft tissue healing; should decrease steadily.
  • Referred Pain:   Sometimes felt in nearby areas like the thigh, calf, or buttock.
  • Chronic or Sharp Pain:   If persistent beyond recovery, this may signal loosening, infection, or misalignment.

Recognizing different types of pain helps patients describe their symptoms clearly to doctors.

Normal Pain Timeline

1.   First 2 Weeks:   Pain is strongest, managed with medication, ice, and rest.
2.   Weeks 3–6:   Pain should reduce, though stiffness may persist. Walking aids are often still needed.
3.   Months 2–3:   Pain is mild and mostly after long activity sessions.
4.   Beyond 3 Months:   Significant pain should not be present. Persistent or worsening pain is abnormal.

Why Swelling Happens After Revision Surgery

Swelling occurs because surgery triggers inflammation and fluid accumulation. Blood flow increases in the area to aid healing, causing puffiness and warmth. In revision surgeries, swelling may be greater because of longer operation times and more tissue trauma. While expected, swelling should gradually decrease with proper care.

Normal Swelling Timeline

1.   First 2 Weeks:   Moderate to severe swelling around the joint and leg.
2.   Weeks 3–6:   Swelling should begin to reduce with elevation, compression, and activity.
3.   Months 2–3:   Mild swelling may persist, especially after exercise or long walks.
4.   Beyond 3 Months:   Minimal swelling is expected. New or increasing swelling after this point is a warning sign.

Why Stiffness Happens After Revision Surgery

Stiffness is a common complaint, especially in knees. Scar tissue forms naturally after surgery, and if not addressed with physiotherapy, it may limit movement. Revision surgeries, involving more scar tissue and bone adjustments, often carry a higher risk of stiffness. Gentle exercises, supervised physiotherapy, and persistence are key to regaining motion.

Normal Stiffness Timeline

1.   Weeks 1–2:   Very limited movement due to pain and swelling.
2.   Weeks 3–6:   Gradual improvement with physiotherapy; patients may bend knees or rotate hips further.
3.   Months 2–3:   Stiffness should be reducing noticeably. Daily activities become easier.
4.   Beyond 3 Months:   Persistent stiffness may signal complications like scar tissue buildup (arthrofibrosis) or implant malalignment.

When Pain Is Not Normal

Warning signs include:

  • Severe pain not improving with medication.
  • Sudden sharp pain during walking or at rest.
  • Night pain that worsens over time.
  • Pain accompanied by fever, redness, or drainage (possible infection).
  • Persistent pain beyond 3 months without improvement.

When Swelling Is Not Normal

Seek medical attention if:

  • Swelling increases suddenly after initial improvement.
  • The leg feels hot, red, or has pus discharge.
  • Swelling is accompanied by shortness of breath (possible blood clot).
  • Swelling persists beyond 3–4 months despite care.

When Stiffness Is Not Normal

Concerning stiffness signs include:

  • Inability to bend the knee more than 90 degrees by 2–3 months.
  • Loss of hip rotation or sudden restriction of movement.
  • Stiffness accompanied by severe pain and swelling.
  • Gradual worsening instead of steady improvement.

How to Manage Pain, Swelling & Stiffness at Home

1.   Pain:   Take prescribed medications, use ice therapy, and practice relaxation techniques.
2.  Swelling:   Elevate the leg, use compression stockings, and avoid prolonged standing.
3.  Stiffness:   Do physiotherapy exercises daily, even if uncomfortable, to prevent scar tissue buildup.
4.  Lifestyle:   Maintain a healthy diet and hydration to support healing.

Consistency is key in managing these symptoms effectively.

The Role of Physiotherapy

Physiotherapy is essential for reducing stiffness, managing pain, and restoring movement. Skipping sessions or doing exercises incorrectly can lead to long-term problems. In India, patients sometimes stop therapy early due to cost or distance. Investing in proper rehabilitation is critical for successful outcomes.

Emotional Impact of Pain and Stiffness

Chronic discomfort can lead to frustration, anxiety, and even depression. Patients may feel recovery is too slow. Family support, counseling, and patient support groups can help individuals cope mentally while their body heals physically.

The Indian Context: Access and Awareness

In India, access to good rehabilitation varies between metro cities and rural areas. Patients in smaller towns may have fewer physiotherapy centers, leading to prolonged stiffness. Education on home exercises, cost planning for physiotherapy, and proactive follow-ups are especially important in this context.

Checklist for Patients and Families

1. Track pain, swelling, and stiffness daily.
2. Ensure exercises are done correctly.
3. Watch for warning signs like fever or worsening pain.
4. Keep follow-up appointments with the surgeon.
5. Stay patient — recovery is slow but steady.

Conclusion

If you are recovering from revision hip or knee surgery and notice unusual pain, swelling, or stiffness, don’t ignore it. Early consultation with your surgeon can prevent complications and speed recovery. Trust the process, stick to physiotherapy, and remember that improvement takes time — but it does come.

*******Information contained in this article / newsletter is not intended or designed to be a substitute for professional medical advice, diagnosis, or treatment. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other professional health care provider with any questions you may have regarding a medical condition or advice in relation thereto. Any costs, charges, or financial references mentioned are provided solely for illustrative and informational purposes, are strictly indicative and directional in nature, and do not constitute price suggestions, offers, or guarantees; actual costs may vary significantly based on individual medical conditions, case complexity, and other relevant factors.

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