Post-Accident Knee Swelling: When to Consider Surgery and Recovery Tips

Swelling around the knee persists after a car accident, and remains swollen even after surgical debridement?

Hello Dr.
Chen, I was involved in a car accident at the end of January 2022, which resulted in a fracture of my kneecap and contusions in the surrounding tissues.
Since it was a minor fracture, the doctor recommended a cast and the use of crutches.
After the New Year, I noticed swelling and a numb sensation around my knee.
In mid-February, I sought medical attention, and the doctor used a 30ml syringe to aspirate about four and a half vials of bloody fluid (ranging from bright red to pink), then bandaged it and advised me to rest at home.

A week later, during a follow-up visit, the doctor used a 60ml syringe to aspirate one and a half vials of bloody fluid and recommended surgery for debridement.
I underwent surgery on March 15, with drainage tubes inserted, and was hospitalized until March 21, followed by a week of recovery.
After the surgery, the swelling significantly decreased (during this time, I experienced numbness around the knee).

Now, my kneecap fracture has healed, but the inner thigh area is swollen, and the skin feels somewhat hardened.
In the morning, the swollen area softens and reduces, but after a day of work (which involves prolonged sitting and minimal movement), it swells again and causes a painful sensation.
Currently, I feel that both the swelling and pain are progressively increasing.

Dr.
Chen, do you think I need another surgery for this condition? Can the hematoma be treated with topical medication to reduce the swelling? How long is it expected to take for this condition to heal? (I have a follow-up appointment scheduled for April 25.)

Mr. Luo, 30~39 year old female. Ask Date: 2022/04/20

Dr. Chen Bochen reply Orthopedics

Hello, based on your symptom description, there are two possible conditions (not excluding other possibilities): 1.
Lower extremity venous thrombosis 2.
Local congestion and poor circulation after fracture healing.
For both conditions, it is recommended to increase activity and perform ankle pump exercises (you can find videos by searching "ankle pump exercises" on Google).
For the first condition, it is advisable to consult a cardiologist to diagnose whether there is a thrombus and consider anticoagulant therapy.
For the second condition, simply applying heat and engaging in rehabilitation exercises should suffice for recovery.

Reply Date: 2022/04/20

More Info

Post-accident knee swelling, especially after a fracture and subsequent surgical intervention, can be a complex issue that requires careful evaluation and management. In your case, it seems that you have experienced significant swelling and discomfort following your initial injury and treatment. Here’s a comprehensive overview of your situation, along with recovery tips and considerations regarding the need for further surgical intervention.

Understanding Your Condition
After a knee injury, especially one involving fractures and soft tissue damage, it is common to experience swelling due to several factors, including:
1. Inflammation: The body’s natural response to injury involves inflammation, which can lead to swelling and pain.

2. Fluid Accumulation: Blood and other fluids can accumulate in the knee joint or surrounding tissues, leading to a condition known as a hemarthrosis (blood in the joint).

3. Scar Tissue Formation: Post-surgical healing can lead to the formation of scar tissue, which may contribute to swelling and discomfort.

Given that you have already undergone a procedure to drain excess fluid from the knee, it is essential to monitor the situation closely. The fact that you are experiencing swelling in the inner thigh area and that the skin feels hard could indicate ongoing inflammation or possibly the formation of a hematoma (a localized collection of blood outside of blood vessels).

When to Consider Surgery
Surgical intervention may be necessary if:
1. Persistent Swelling: If swelling continues to worsen despite conservative treatment, it may indicate an underlying issue that requires surgical evaluation.

2. Infection Signs: If you notice increased redness, warmth, or fever, these could be signs of infection, necessitating surgical intervention.

3. Limited Range of Motion: If swelling is significantly limiting your ability to move the knee or if you experience persistent pain that does not improve with rest and rehabilitation, further evaluation may be warranted.

4. Blood Clots: If you experience significant swelling in the thigh, it’s crucial to rule out deep vein thrombosis (DVT), which can occur after surgery or prolonged immobility.

Recovery Tips
1. Rest and Elevation: Ensure that you rest your knee and elevate it above heart level to reduce swelling.

2. Ice Therapy: Applying ice packs to the swollen area for 15-20 minutes several times a day can help reduce inflammation and pain.

3. Compression: Using a compression bandage can help control swelling. However, ensure it is not too tight, as this can impede circulation.

4. Gentle Movement: Engage in gentle range-of-motion exercises as tolerated to promote circulation and prevent stiffness. Consult with your physical therapist for appropriate exercises.

5. Medication: Over-the-counter anti-inflammatory medications (like ibuprofen) can help manage pain and swelling, but consult your doctor before taking any medication.

6. Follow-Up Care: Keep your scheduled follow-up appointments to monitor your recovery and address any concerns with your healthcare provider.

Prognosis
The healing time for knee injuries can vary widely based on the severity of the injury, the type of treatment received, and individual factors such as age and overall health. Generally, soft tissue injuries can take several weeks to months to heal completely. If you are experiencing persistent symptoms, it is crucial to communicate this with your healthcare provider during your next appointment on April 25.

In conclusion, while surgery may be necessary in some cases, many individuals can recover with appropriate conservative management. It is essential to maintain open communication with your healthcare team and follow their recommendations closely to optimize your recovery. If your symptoms continue to worsen or if you have any new concerns, do not hesitate to seek medical advice sooner than your scheduled appointment.

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