Knee Surgery: Normal Bleeding, Bruising, and Swelling Explained

How much bleeding is normal after knee surgery?

Following knee surgery, it is normal to experience some degree of bleeding and bruising, particularly in the initial 24-72 hours, which typically manifests as red to pink drainage from the incision and widespread discoloration around the joint. However, excessive or sudden increases in bright red blood, or signs of infection, warrant immediate medical evaluation.

Understanding Post-Operative Bleeding

Knee surgery, whether it's an arthroscopy, ligament reconstruction, or total knee replacement, involves incisions and manipulation of tissues, blood vessels, and bone. This unavoidable trauma to the surgical site naturally leads to some degree of bleeding. This bleeding can be external, visible as drainage from the incision, or internal, contributing to swelling and bruising around the joint. Understanding what constitutes "normal" helps distinguish expected recovery signs from potential complications.

Expected Bleeding Characteristics

The characteristics of normal post-operative bleeding evolve as healing progresses:

• Initial Drainage (First 24-72 hours):
  • Color: The drainage from the incision site will typically be a bright red initially, gradually transitioning to pink, then a yellowish or clear serosanguinous fluid. This color change indicates the healing process is underway as blood clots and the body begins to resorb excess fluid.
  • Volume: Small to moderate amounts of drainage are expected. Your dressing may show a stain roughly the size of a 50-cent piece or slightly larger. Surgical drains, if used, will collect blood, and their output will decrease over the first few days.
  • Consistency: The fluid should be thin. Thick, pus-like, or foul-smelling discharge is not normal.
• Bruising (Ecchymosis):
  • It is very common to see extensive bruising around the knee, extending down the leg towards the ankle and foot. This is due to internal bleeding spreading through the tissues.
  • The color of bruising will change from deep purple/blue to green and yellow as it resolves, typically over 2-4 weeks.
• Swelling (Edema):
  • Significant swelling is almost universal after knee surgery. This is a combination of internal bleeding, inflammatory fluid, and lymphatic fluid accumulation. While not "bleeding" directly, it is often a result of fluid shifts post-surgery.
  • Swelling can persist for weeks to months, gradually subsiding as the body heals and rehabilitation progresses.

Managing Bleeding and Swelling

Effective management of post-operative bleeding and swelling is crucial for comfort and optimal recovery. Your surgical team will provide specific instructions, but general principles include:

• Rest: Limiting activity and avoiding excessive movement of the knee, especially in the initial days, helps prevent further bleeding and allows clots to form.
• Ice Application: Applying ice packs to the surgical site helps constrict blood vessels, reducing bleeding and inflammation. Use for 15-20 minutes at a time, several times a day, with a barrier between the ice and skin.
• Compression: Compression bandages or sleeves help provide external pressure to reduce swelling and support the healing tissues. Ensure they are snug but not overly tight to avoid compromising circulation.
• Elevation: Elevating the operated leg above heart level, particularly when resting, uses gravity to help drain fluid away from the surgical site, reducing swelling and discomfort.

When to Seek Medical Attention

While some bleeding is normal, certain signs indicate a potential complication and require immediate medical evaluation. Do not hesitate to contact your surgeon's office or seek emergency care if you experience:

• Excessive or Sudden Increase in Bleeding: If your dressing becomes saturated rapidly, or if there's a sudden gush of bright red blood that doesn't slow down.
• New or Worsening Severe Pain: Pain that is not controlled by prescribed medication or suddenly becomes much worse.
• Signs of Infection:
  • Pus or Foul-Smelling Discharge: Any thick, cloudy, or odorous fluid from the incision.
  • Increased Redness or Warmth: Redness spreading outward from the incision or the skin feeling excessively warm to the touch.
  • Fever and Chills: A temperature above 101°F (38.3°C) accompanied by chills.
• Numbness, Tingling, or Coldness: In the foot or toes, which could indicate a compromise in circulation or nerve function (e.g., compartment syndrome).
• Calf Pain or Swelling: Especially if accompanied by redness or warmth, which could be a sign of a deep vein thrombosis (DVT).

Factors Influencing Bleeding

Several factors can influence the amount and duration of bleeding after knee surgery:

• Type of Surgery: More invasive procedures, such as total knee replacement, generally result in more bleeding than arthroscopic procedures.
• Individual Physiology: Factors like blood clotting disorders, certain medications (e.g., blood thinners, NSAIDs, some herbal supplements), and overall health status can affect bleeding. Always disclose all medications and supplements to your surgical team.
• Activity Level: Overexertion or premature weight-bearing can increase bleeding and swelling. Adherence to post-operative activity restrictions is vital.

The Role of Rehabilitation in Recovery

While not directly managing acute bleeding, adhering to your prescribed rehabilitation program is fundamental for long-term recovery and minimizing complications. Proper, progressive exercise helps to:

• Improve circulation, which aids in the reabsorption of fluid and removal of waste products.
• Reduce chronic swelling.
• Restore range of motion and strength, leading to a more functional and less symptomatic knee.

Conclusion

A certain amount of bleeding, bruising, and swelling is an expected part of the recovery process after knee surgery. By understanding what is normal and diligently following your post-operative instructions, you can effectively manage these symptoms. Crucially, remain vigilant for any signs of excessive bleeding or infection and do not hesitate to contact your healthcare provider if you have concerns. Your surgical team is your primary resource for guidance throughout your recovery journey.