Following Total Knee Arthroplasty (TKA), recovery includes specific instructions for managing the lower extremities, often involving the use of compression garments. Wearing compression socks after knee replacement is standard protocol in orthopedic recovery. These specialized socks are prescribed to mitigate two significant complications that can arise following major joint surgery. Adherence to the surgeon’s specific instructions regarding the type, duration, and fit of these garments is crucial for a safe and successful recovery.
Preventing Deep Vein Thrombosis
Major orthopedic procedures, such as total knee replacement, increase the risk of developing blood clots. This heightened risk is due to surgical trauma and the necessary period of reduced mobility immediately following the operation. Slowed blood flow, known as venous stasis, makes it more likely for a Deep Vein Thrombosis (DVT) to form in the deep veins of the leg.
Compression socks counteract this risk through a mechanism called graduated compression. The garment applies the highest pressure around the ankle, gradually reducing it further up the leg. This external pressure gently squeezes the superficial veins, which helps narrow the diameter of the deeper veins in the calf.
By narrowing the deep veins, the socks increase the velocity of blood flow back toward the heart, preventing blood from pooling in the lower extremities. Maintaining this steady flow is a physical method of preventing the clumping of blood cells that leads to DVT formation. Preventing DVT is important because a clot can break free and travel to the lungs, resulting in a Pulmonary Embolism (PE).
Controlling Post-Surgical Swelling
Beyond preventing blood clots, compression socks manage post-operative edema, or swelling. Swelling in the lower leg is a natural response to tissue trauma and inflammation. This fluid buildup, consisting of lymph and interstitial fluid, can cause discomfort and restrict movement.
The consistent external pressure aids the body in pushing excess fluid back into the circulatory and lymphatic systems. Reducing swelling alleviates pain and supports greater comfort during recovery. Decreased edema also facilitates the necessary range of motion exercises required for physical rehabilitation.
Controlling swelling helps maintain the integrity of the skin around the incision site. Excessive, prolonged swelling can impede the delivery of nutrients to the healing wound. Managed fluid levels contribute to a more favorable environment for the surgical site to heal properly.
Proper Use and Duration Guidelines
Guidance on wearing compression socks is tailored by the surgical team, but general recommendations are commonly followed. In the first few days following TKA, the socks (often called TED hose or anti-embolism stockings) are frequently worn continuously, day and night. Continuous wear is advised until the patient is mobile enough to reduce the risk of venous stasis.
Once mobility improves, the recommendation shifts to wearing the socks during the day and removing them at night. Total duration ranges between two to six weeks post-surgery, or until mobility is near pre-surgical levels or swelling has decreased. The physician determines the exact end date based on individual risk factors and recovery progress.
It is important to ensure the sock is pulled up completely and smoothly, with no wrinkles or folds anywhere on the leg. A wrinkled sock creates uneven pressure points that can impair circulation. Patients must also follow instructions for washing and caring for the socks to maintain their prescribed compression level.
When to Immediately Contact Your Doctor
While compression socks are safe, recognizing signs of potential complications related to the surgery or the garment is important. Severe, sudden pain or tenderness, especially in the calf or thigh, that differs from expected surgical discomfort could signal a developing DVT. This may be accompanied by increased warmth or redness in one leg.
If symptoms suggest a pulmonary embolism, immediate medical attention is required, as this is a serious medical event. These signs indicate a possible clot has moved to the lungs:
- Sudden shortness of breath
- Chest pain that worsens with deep breathing
- Unexplained lightheadedness
Patients should monitor the lower leg for signs that the stocking is compromising circulation due to improper fit. The following warnings indicate the sock is too tight and must be immediately addressed:
- Numbness
- Tingling
- Blue or white discoloration of the toes
Any skin breakdown, open sores, or significant irritation under the sock should also prompt a call to the care team.