Scar Healing, Size & Treatment After Joint Replacement Surgery
This article was reviewed and co-authored by Dr. John Tiberi, M.D.,OS (board-certified orthopaedic surgeon).
Whether you consider your surgery scar a badge of honour, a marker of your new life, or something to be self-conscious about, this new addition may take some getting used to. For some, the adjustment to a “scarred life” is easy while others mourn the loss of their unmarked body. We hope that all joint replacement recipients can come to appreciate their scars and all that they represent.
Read on as discuss talk scar size, breakdown the different scars for hip and knee replacements, look at the scar healing process, and share tips on healing faster.
When it comes to the topic of surgery scars, nothing is discussed more than “size”. After all, size matters. Think about it: have you ever heard of anyone wishing for a larger scar?
A study in the Reconstructive Review, said that “a small incision has more importance psychologically than many physicians believe". In other words, patients are more mentally and emotionally affected by the length or their surgery scar than some physicians care to think.
Let’s break down incision size for the different types of knee and hip replacements.
Knee Replacement Incision
The length of the incision, which will become your scar, depends on the size of your knee--specifically the width of the femur and the width of the tibia. Other key factors are your BMI (body mass index), and whether or not this is a primary or revision surgery.
If you’re overweight, have larger bones or this is a second surgery on the same joint, your incision will be larger. This is why on average men have larger incisions and scars than women.
Minimally Invasive Knee Replacement
Minimally-invasive knee replacement surgery is gaining popularity. The main selling point for having a minimally-invasive surgery centers around incision size. “Minimally invasive” means a smaller incision, less muscle and tissue damage, and as some surgeon’s argue, a faster recovery process. Although there are positives and negatives to a minimally invasive surgery (like it being more complicated for the surgeon and only being an option for small patient groups) it will deliver a smaller scar to patients.
Average Scar Length: Approx. 4.1”-4.6”
“In a study that measured the incision length of 357 minimally-invasive knees", the shortest incision was 2.8 inches and the longest was 7.4 inches.
Traditional Knee Replacement
Traditional knee replacements are the catch-all knee replacement type that 80%+ of the population receives. In other words, if you’re reading this and getting a knee replacement, chances are this is the type you’re getting. This approach is the most common with the most highly-skilled surgeons performing it.
Average Scar Length: Approx. 7”-8”
Hip Replacement Incision
Dr. Tiberi shares that, "with a hip replacement, the approach, or method and direction your surgeon gets into your hip, may affect the location and size of your scar." With an anterior approach, the incision will be down the front of your thigh. With a posterior approach, the incision tends to be behind the hip, down the outer buttocks, or lateral. Overall incision-size has to do with the approach, as well as do your BMI, gender, bone size and abnormalities, and whether this is a revision or primary surgery.
Anterior Hip Replacement (Minimally-Invasive)
In the anterior hip replacement, an incision is made down the front of the thigh, starting at the pelvic bone. This approach will have 1 smaller incision. This approach is more technically challenging for the surgeon due to the limited view. This approach is only suitable for patients who are: average or low body weight, and who don’t have any bone abnormalities. Although not for everyone and not popular with all surgeons, the incision and scar will be smaller.
Average Scar Length: Approx. 3”-6”
Posterior Hip Replacement
Like a traditional knee replacement, the posterior approach can be thought of as the popular, "catch-all" hip replacement. In this approach, the incision is made behind the hip, along the buttock’s area. This surgery is performed with the patient on their side. In a traditional hip replacement, the gluteus maximus muscle (buttocks) is split, without a tendon being removed. This is the tried and true approach that is recommended for most patients.
Average Scar Length: Approx. 8-10”
Minimally-Invasive Posterior Hip Replacement (MIS Posterior)
The MIS posterior approach for a total hip replacement is a versatile option. It requires less soft tissue and muscle damage, but can also be adapted (with a larger incision) for those with more complex cases or deformities. There may be slightly reduced pain and recovery time. This is a more technically challenging and specialized procedure for your surgeon, and will not be an offered approach by all care teams.
Average Scar Length: Approx. 3”-5”
Incision Phases of Healing
Whether you’re having a posterior or minimally invasive hip or knee replacement, the bottom line is this: you will have a scar. In addition, your incision or wound will go through the same stages of healing.
3 Stages of Surgical Incision Healing
- Inflammatory Phase: Blood clotting begins and the scar appears to be red and inflamed. This is a brief phase, lasting only a few days after surgery.
- Proliferation Phase: New tissue is formed during this phase. It will look and feel “raised” from normal skin. Typically, your incision will be in this phase for 2-10 days after surgery. During this time, your incision will be bruised, swollen and red. There may be some spotty drainage, warmth and numbness over the area.
- Remodelling Phase: This is the last phase in wound healing and can last months after joint surgery. This is where your scar forms. As the wound becomes smaller, scar tissue forms. Nerves heal, feeling returns to the incision site, and the scar becomes more even-textured like regular skin. Swelling will go down around the 2 week mark, along with bruising and redness. Eventually, your purple scar will become white, and possibly even return to near skin color.
Since this post is all about the scar, not the incision, we won’t break down the best practices for incision care after surgery.
Note: Always call your surgeon if you have a fever; notice increased drainage coming from your incision or pus; there’s a foul-smell odor coming from site; a lot of swelling; blisters forming; surges of pain; and/or it’s difficult to move muscles around incision.
Tips to Heal Your Scar Faster
For the purpose of this article, we’ve assumed that the trials and tribulations of caring for your incision have past, and you’re in the “remodelling phase”. In other words, you’re infection-free, and your scar is healing. Once you’re in this stage, here’s how to care for your scar:
- Stay hydrated! This is crucial for all parts of recovery, but also helps with scar repair. Aim for 8 cups of water per day. Another test for hydration: urine colour. If your pee is lighter in color, chances are you’re more hydrated.
- Eat nutritious foods and food combinations that heal! Foods rich in calcium are excellent for wound repair. The Wound Repair and Regeneration Journal states that “calcium is integral in cell migration and regeneration patterns in later stages of healing”. Vitamin C is also a superhero when it comes to tissue growth and repair.
- Scar Tissue Massage: Massaging along the scar decreases scar tissue build-up and helps collagen fibers form. Massaging also drains fluid, helps with numbness, and increases blood circulation. Warning: Do not massage until incision has fully-healed and is a fully-formed scar (at least 2 weeks after surgery). Massage is effective for scars less than 2 years old.
- Vitamin E lotion: Rub Vitamin E into the scar daily. Vitamin E helps the formation of collagen. Do not use Vitamin E for the first month after surgery.
- Moisturize w/ SPF: Find a good moisturizer with sun protection that will keep your scar moist and protect against the sun. A cream with built-in SPF gives knee replacement recipients one less thing to think about during sunny shorts season!
Warnings About Your New Scar:
Lastly, we leave you with a few warnings about your scar. After all, scars are not the same as normal skin and require a little extra love and attention.
Here are a few important things to know about your new scar:
- Scars are easier to damage than regular, healthy skin.
- It’s crucial that you keep flexing your knee and hip to regain skin elasticity. Otherwise, that area of skin may always feel “tight” and sore.
- If you don’t flex and work your scar enough, scar tissue can build. If uncontrolled, a surgery can be required to reopen the incision and remove extra tissue.
- Scars get sunburned more easily than regular skin. Always keep protected in the sun. Sun-damaged scars are more likely to remain discolored.
Preparing for or recovering from joint replacement surgery? Sign-up for PeerWell today. Join the PeerWell blog for early access to content that affects your recovery! With PeerWell, you’re in the passenger seat, driving your own surgery outcome.
John Tiberi, M.D.,OS is a board-certified orthopaedic surgeon who specializes in minimally-invasive hip and knee replacement surgery and reconstructions. He attended medical school at the Harbor-UCLA Medical Center in Torrance, California. Dr. Tiberi completed his fellowship at Massachusetts General Hospital and Harvard Medical School in Boston, Massachusetts. He is a published orthopedic in journals such as The Journal of Arthroplasty, Journal of Bone Joint Surgery (JBJS), and Clinical Orthopaedics and Related Research. Dr. Tiberi is the winner of Dana M. Street Orthopaedic Research Award.