Knee replacement surgery complication

What are the complications of knee replacement surgery?

What are the signs of a blood clot after knee surgery?

How long after knee replacement do you have to worry about blood clots?

How common are blood clots after knee replacement?

What are the complications of knee replacement surgery?

Knee replacement surgery is one of the treatment options for a knee joint that osteoarthritis has damaged. Osteoarthritis develops due to a breakdown of joint cartilage and the underlying bone.

After knee replacement surgery

Before going back to the ward you’ll spend some time in the recovery room, where you may be given fluids and painkillers through a tube in your arm. This may include:

• patient-controlled analgesia (PCA) a system where you can control your own supply of painkiller going into a vein by pressing a button
• painkilling injections or tablets.

Oxygen therapy is likely to be given through a mask or through tubes into your nose.

There’s often no need to have a blood transfusion because your body can replace any blood lost during or after surgery. If the operation is more extensive you may need blood from a donor. An alternative is to recycle the blood which drains from your knee returning it into your body through a tube in a vein (auto-transfusion).

After the first day or so, the tubes giving you painkillers, fluids or oxygen therapy will be removed. You may have a tube (catheter) inserted for a few days to drain urine from your bladder, especially if both knees have been replaced at the same time.

Pain will usually be worse on the second or third day after surgery when the anaesthetic and strong medication wears off, and you’ll probably need painkillers to control this. Without them it’ll be difficult to do the exercises needed to strengthen your muscles and restore mobility.

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How quickly you get back to normal depends on many factors, including:

• your age
• your general health
• the strength of your muscles
• the condition of your other joints.

Complications from anesthesia

A surgeon may use general or regional anesthesia to put you into a deep sleep or numb your leg. This is so you won’t feel any pain during surgery. Modern anesthesia is generally safe, but it can cause side effects and negative reactions. It can be fatal in some rare cases. The most common side effects include:

• vomiting
• dizziness
• shivering
• sore throat
• aches and pains
• discomfort
• drowsiness

Adverse effects, or negative reactions, include:

• dental trauma
• croup (swelling of the windpipe)
• allergic reactions to latex
• wheezing
• vocal cord injury
• stomach problems
• injuries to arteries, veins, or nerves

The general anesthesia may also cause an irregular heartbeat in some people.

You should review your medical history before surgery to make sure that any prescriptions or over-the-counter medications you take don’t interfere with the surgery. Tell your anesthesiologist if you smoke, use recreational drugs, or heavily consume alcohol. These can put you at greater risk for problems related to anesthesia.

Blood clots

The medical term for blood clots when they occur in the legs is deep vein thrombosis (DVT). Clots in the lungs are called pulmonary embolism (PE). Surgery or an injury of any kind increases the risk of a blood clot. That’s because the clotting process is stimulated as your body attempts to stop the bleeding and close the surgical wound. A clot is normally formed by blood cells and clotting factors working together to create a protective scab over a healing wound. The surgical procedure may stimulate clots to form in error in blood vessels, which then may block the normal flow of blood.

Orthopedic surgeries like knee replacements are particularly likely to cause blood clots. Blood clots typically occur within two weeks of surgery, but they can also take place within a few hours or even in the operating room. Clots caused by DVT could delay your release from the hospital by a few days.

According to Healthline’s analysis of Medicare and private pay claims data, less than 3 percent of people reported DVT during their hospital stay. Less than 4 percent reported DVT within 90 days of surgery.

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Clots contained in the legs are a relatively minor risk. However, a clot that dislodges and travels through the body to the heart or lungs can cause serious health concerns. It can be fatal in rare cases. There are a few preventative measures that you and your doctor can discuss:

• Blood thinning medications. Your doctor will likely recommend that you take medications like warfarin (Coumadin), heparin, enoxaparin (Lovenox), fondaparinux (Arixtra), or aspirin to reduce the risk of clots after surgery. Talk with your doctor to understand any side effects caused by these medications.
• Techniques to improve circulation. Your doctor may suggest treatments like support stockings, lower leg exercises, calf pumps, or elevating your legs to help increase circulation and prevent clots from forming.

Be sure you discuss your risk factors for clots before your surgery. Some conditions, such as smoking or obesity, increase your risk.

Finally, talk to your surgeon about the signs and symptoms of a blood clot so you can monitor yourself after you leave the hospital. The AHRQ provides additional information on the prevention, symptoms, and treatment of blood clots.

Infection

The number of people who get an infection after a knee replacement is very low (rates for computer-assisted surgery are even lower). According to Healthline’s analysis of Medicare and private pay claims data, 1.8 percent of patients are reported to develop an infection within 90 days of surgery.

Because the knee joint is exposed during the procedure, the surgical team takes serious measures to prevent infections:

• Hospitals typically use special air filters for surgical rooms that limit particles in the air.
• Surgeons and their assistants follow a strict procedure of “scrubbing in” and dressing in protective wear in order to meet sterility standards of the operating room.
• The surgical instruments and the implants themselves are all sterilized before they enter the operating room.
• Your doctor will also likely prescribe antibiotics before, during, and after the operation to help prevent infection.

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knee replacement blood clot

Blood clots can occur during or after any type of surgery, but they are more common after orthopedic surgeries like knee replacements. Symptoms usually appear within 2 weeks of surgery, but clots can form within a few hours or even during the procedure.  About 1 in 100 patients who undergo knee replacement surgery and 1 in 200 patients who have hip replacement surgery will develop a blood clot called venous thromboembolism before leaving the hospital.

How to Avoid Blood Clots After Surgery

Anti-coagulation therapy:

Specific medications are used to help decrease the ability of your blood to form clots. The most common medication is Heparin, which is commonly taken via an IV. Usually, you are then transitioned to taking the medicine Warfarin (coumadin or similar), which can be taken orally.

Compression stockings:

These are stockings that are worn around the feet and lower legs and provide a constant moderate compression of the legs. This helps increase the movement of blood in the veins and its return to the heart.

Elevating the extremity:

Elevating the legs can help take advantage of the effects of gravity and increase venous blood flow to the heart.

Sequential compression devices:

These devices are sleeves that wrap around the lower legs and alternate between filling with air to compress the leg and then letting the air out to release the compression. This also helps improve blood flow within the legs.

Leg exercises:

When the muscles in your legs contract, they act as a pump that pushes the blood from your veins back towards your heart. Easy exercises to do while laying in bed after surgery include ankle pumps, heel slides, and supine marching.

Early mobility:

Arguably, the best way to prevent blood clots is limiting the amount of immobility and bed rest after surgery through early mobility. This includes sitting up, standing, and walking very early after your surgery (with the appropriate supervision and guidance).

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What are the signs of a blood clot after knee surgery?

• Pain or tenderness in your leg.
• Swelling or warmth in your leg.
• Red or discolored skin on your leg.
• Veins that stick out.
• Shortness of breath.
• Coughing up blood.
• Sudden chest pain.
• Painful breathing.

How long after knee replacement do you have to worry about blood clots?

The risk of blood clots is greatest two to five days after surgery; and a second peak development period occurs about 10 days after surgery, so be aware. You will be on pain medication, and your knee will be swollen.

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How common are blood clots after knee replacement?

Following any type of major surgery, including joint replacement surgery, you are at an increased risk for developing blood clots. A blood clot forms when the platelets in your blood clump together to form a gel-like mass. This occurs normally in the body if you are bleeding, such as from a cut or wound, but when clotting occurs within your blood vessels it can block the flow of blood.

The most common type of blood clot is called a deep vein thrombosis (DVT) and forms in the deep veins of your body, usually in the lower leg. A pulmonary embolism (PE) forms when a blood clot from somewhere in the body dislodges, travels to your lungs, and causes a blockage in one of the arteries of your lungs. This can cause serious complications and is life threatening.

Signs of a DVT in the lower leg include swelling, change in color, warmth, itching, and pain. Signs of a PE include shortness of breath and trouble breathing, chest pain, coughing, sweating, and dizziness.

After surgery, you are at an increased risk for blood clots because you are less mobile. Your legs and muscles are not working as much and a significant proportion of your time is spent lying in bed. This leads to stagnation of the blood in your veins. The flow of blood is slower and less blood is being pumped back to the heart. This makes it easier for blood clots to form.

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