Post-Surgery Fever and Swelling After Knee Replacement: What to Know

Postoperative Fever After Joint Replacement Surgery

Hello, doctor! My mother (60 years old) underwent a total knee arthroplasty on July 8th of this year, and it has been about a month and a half since the surgery.
Her rehabilitation is going well; she can walk without crutches and uses a stationary bike for therapy (not exceeding five minutes).
However, in the past week or two, she has been experiencing a sensation of swelling in her knee post-surgery.
The outer side appears swollen and slightly reddened, with an ear temperature ranging from 37.0 to 37.6 degrees Celsius (with a maximum of 38 degrees).
She feels slightly warm all over and has mild sweating, but her feet are cold, and she occasionally feels nauseous.
Aside from these symptoms, she does not experience pain or discomfort at the surgical site (could it be possible that the pain medication is masking any pain?).
Last week, she visited the emergency room and followed up with her surgeon, and both doctors said there were no issues.
However, my mother has a lack of trust in her original surgeon (she was repeatedly reminded before surgery about self-paying items, but later found out they were covered by insurance), which has caused her a lot of worry.
Many educational pamphlets state that if there is fever and redness post-surgery, one should return for a follow-up immediately, but after her follow-up, the doctor said there were no problems.
As a caregiver, it is difficult for us to determine whether this is an emergency or if there is truly an abnormal condition.
We would appreciate your assistance in clarifying this.
Thank you.

Miss Jiang, 20~29 year old female. Ask Date: 2017/08/19

Dr. Shi Guozheng reply Orthopedics

Mild warmth at the incision site after total knee arthroplasty may be normal, typically lasting for about two to three months.
If there is no drainage or purulent discharge from the wound, it is generally not a concern, and local ice application can help alleviate discomfort.
However, if an infection occurs, the area will become red, swollen, hot, and painful, leading to significant discomfort.
It is advisable to check the erythrocyte sedimentation rate and C-reactive protein levels to assess for any elevation as a reference for infection.
Follow-up appointments after surgery are usually scheduled at one month, two months, and three months, and ongoing monitoring is essential.

Reply Date: 2017/08/19

More Info

Post-surgery fever and swelling after a knee replacement can be concerning for both patients and caregivers. It’s important to understand the typical recovery process, potential complications, and when to seek further medical attention.

Firstly, it’s not uncommon for patients to experience some degree of swelling and mild fever after knee replacement surgery. This is often a part of the normal healing process. After surgery, the body goes through a natural inflammatory response, which can lead to localized swelling around the surgical site. The swelling you described, particularly on the outer side of the knee, along with mild redness and a slight increase in temperature (37.0 to 38.0 degrees Celsius), can be indicative of this normal healing process.

However, there are certain signs that should raise concern. If the swelling becomes significantly worse, if the redness spreads, or if the fever persists or increases, these could be signs of infection or other complications. Infections can occur post-surgery, and they may present with symptoms such as increased pain, warmth, and discharge from the surgical site. The absence of pain at the incision site, as you mentioned, is somewhat reassuring, but it does not completely rule out the possibility of an infection, especially if other symptoms are present.

The fact that your mother is experiencing cold feet and occasional nausea could suggest a few things. Cold extremities might indicate poor circulation or a systemic response to infection or inflammation. Nausea can sometimes be a side effect of pain medications, particularly opioids, which are commonly prescribed after surgery. If she is taking pain medication, it’s worth discussing with her physician to see if adjustments can be made to alleviate these symptoms.

Given that you have already consulted with emergency services and her orthopedic surgeon, and they have indicated that everything appears normal, it may be beneficial to seek a second opinion if your mother continues to feel unwell or if her symptoms worsen. Trust in the medical team is crucial for recovery, and if there is a lack of confidence in the current physician, finding a healthcare provider who can address your concerns more thoroughly may be beneficial.

In terms of management at home, applying ice to the swollen area can help reduce inflammation. Elevating the leg and ensuring that she is engaging in gentle movement, as tolerated, can also promote circulation and healing. It’s essential to monitor her symptoms closely and keep a record of any changes, including temperature readings and the degree of swelling.

Lastly, it’s important to maintain open communication with her healthcare providers. If you feel that her symptoms are not being adequately addressed, do not hesitate to advocate for her needs. You might also consider discussing the possibility of further diagnostic tests, such as blood tests to check for markers of infection (like elevated white blood cell count or C-reactive protein), if her symptoms persist.

In summary, while some swelling and mild fever can be normal after knee replacement surgery, persistent or worsening symptoms warrant further investigation. Keeping a close watch on her condition and maintaining communication with her healthcare team will be key to ensuring a smooth recovery.

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