Severe Bruising After Total Knee Replacement

Foot Swelling After Knee Surgery

Any major surgery including your recent total knee replacement includes an incision and direct force by your surgeon.  When the surgery is complete and you are in recovery phase, naturally you would expect some pain and bruising of your knee and leg.

knee replacement xray

What happens when the bruising and redness is well beyond what you were expecting?  We’ve all had bruising in our lives however should you be concerned if your entire leg turns black and blue after your total knee replacement?

Evaluating and monitoring my patients in their home is one of my most important roles in the early recovery phase.  The easiest thing to monitor visually from day 1 is the color of the skin and any bruising that has occurred in the leg or knee.  

100% of my total knee replacement (TKR) clients have bruising in their legs after surgery.  The amount of bruising varies from person to person and I always warn my patients that the bruising can get worse even weeks after surgery.

So how much bruising is normal?  Any amount of color change including redness and dark spots is normal, including the entire leg potentially becoming black and blue.  However, normally there is not an increase in pain in those bruised areas appear as it might appear.

This is how to differentiate between normal and potential issues.  If along with your bruising you notice a sharp increase in pain, any seeping through the skin or temperature change of the skin you need further evaluation and call your surgeon.

Be sure to take pictures and show your physical therapist if seeping or severe pain or swelling occurs in your calf or groin regions.  Sharp pain in these regions could signal a possible blot clot or DVT forming which is a life threatening emergency.

To be clear:  Any amount of bruising, even severe ugly entire leg bruising, is normal after total knee replacement.  Bruising along with other changes such as sharp pains, seeping or temperature changes can signal potential issues.

How Long Does Bruising Last After TKR?

From my experience, bruising normally lasts anywhere from 4-6 weeks after knee replacement.  The amount and length of the bruising depends largely on the blood thinner medicine you are taking after surgery.

Surgeons vary on the type of blood thinners they have their patients take after total knee replacements.  Some require stronger forms of blood thinner meds such as Eliquis or Coumadin while others allow you to take only aspirin or baby aspirin after surgery.

For those on stronger blood thinners, you will notice larger amounts of bruising and your bruising will last longer.  Blood thinners help prevent clotting which is a potential complication after surgery.  However with this comes much easier bleeding even after basic activities which can appear as severe bruising.

Those on aspirin or baby aspirin should notice the bruising gone within a month after surgery barring any major setback.  Anything longer than 2 months of bruising after surgery is very abnormal and should be reassessed by your surgeon.

Areas of Bruising After Knee Replacement

Thigh Bruising After Knee Replacement 

The most common area you will notice bruising after knee replacement is the thigh or inner thigh region.  Thigh bruising can be caused by a few things during and after the surgery.  

During the surgery your doctor will use a tourniquet around the thigh region to cut off the blood flow and limit blood loss.  This tourniquet is very tight and puts strong pressure on your blood vessels in the area.

Because of this tourniquet often times you will develop significant bruising in the thigh muscle area after surgery.  In fact many patients complain of post-op pain in this specific area most often caused by the tourniquet.

Secondly, once you begin your therapy in the hospital and at home you will be using muscle and placing strain on the quadriceps or thigh area.  Along with this use you will have some micro tearing of the muscle fibers along with swelling, placing pressure on the blood vessels.  

This forced usage will likely cause some thigh bruising after your knee replacement.  This bruising is expected and normal.  Be sure to ice this area for 25-30 minutes 5-7 times per day to assist in the healing of this area.

Bruising Behind Knee After Knee Replacement

Your surgeon and physical therapist will both tell you that getting your knee straight after surgery is a very important goal.  You will only have 4-6 weeks to get the straightness or knee extension back so working hard on this is key.

Your PT regimen will include hamstring stretching and quad sets to help straighten the knee.  These type of exercises are designed to put strain behind the knee and will cause you some pain.

With this stretching of the muscles and ligaments behind the knee, you will also have bruising and swelling in this area.  Expect this bruising to occur after you knee replacement and know it will be temporary.

Be sure to ice this area for 25-30 minutes 5-7 times per day to assist in the healing of this area.  

Ankle & Foot Bruising And Swelling After Knee Replacement

The most confusing of the areas you will see bruising after TKR is your ankle and foot regions.  Especially since the bruising in this area does not come with any pain in the foot or ankle.  So why is this?

ankle foot bruising after knee replacement

Your bruising starts with irritation to the knee and thigh region from the surgery.  When you begin to walk and stand more with your rehab, gravity will begin to bring the bruising and swelling down your leg into your foot and ankle.

It may look like you have a sprained ankle or foot but clearly this is not the case.  Often times my patients cannot get their original shoe on the foot because of the swelling.  Foot swelling after knee surgery is normal and should not be of concern.

You will often see the leg bruising occur at night when your leg is more gravity dependent. Again, this is normal and should not cause any concern.

To help get rid of this bruising you should elevate the ankle above your heart level.  Lay flat on your back and place 2-3 pillows full length under your leg for 60-90 minutes.  You can also perform ankle pumps while elevating to help move the swelling.  Ankle swelling after knee surgery again is normal and expected.

Placing ice on the foot and ankle will NOT help with the bruising.  The reason for this is that the actual area of irritation is not the ankle but rather the knee.  You should only use ice on the area of injury or irritation.

How Do You Get Rid of Bruising After Knee Replacement?

Placing ice for 25-30 minutes on the knee and elevating the leg above heart level for 60-90 minutes will help reduce the bruising, swelling and pain after knee replacement.  Performing ankle pumps while elevating and using TED hose or compression socks can also assist in your recovery.

Final Thoughts of Severe Bruising After Total Knee Replacement

  • Bruising is Normal and Expected and Can Be Extreme After Knee Replacement
  • Look For Additional Symptoms Along With the Bruising For Potential Problems
  • Common Areas of Bruising After TKR Include Your Thigh, Inner Thigh, Behind the Knee and Your Ankle and Foot Regions
  • Using Ice, Elevation and Compression Can Assist With Reducing Your Bruising
About Jeffrey Roth MPT

Owner and operator of Roth Therapy Services in Pittsburgh, PA focusing on in home rehabilitation physical therapy services.

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