5 Signs of Complications After Joint Surgery: Beware of "WORST"

After a hip or knee replacement, it’s easy to second guess the process and how your body is recovering. This is especially true once you’ve been discharged home. Whether you had same-day outpatient surgery or more traditional inpatient surgery, majority of your recovery will be done at home. In all likelihood, neither you nor your at-home caretaker are medical professionals. As such, it’s super important to know the red flags that indicate something may be wrong in your recovery.

As your body heals from hip or knee replacement surgery, you will experience pain, bruising, swelling, inflammation, wound warmth alongside other symptoms like trouble sleeping, reduced appetite and even mild depression. With a wide range of ailments that are a part of normal healing, it can be hard to sift out warning signs that indicate a larger problem.

Although complications and infections are fairly low after joint surgery at a reputable hospital with a good orthopaedic surgeon, it can happen. In fact, “1.8 percent of patients reported an infection within 90 days of surgery”. Similarly, less than 2% of patients get blood clotting in their recovery. Despite serious complications and problems being quite rare, the faster you recognize the warning signs, the better you can steer clear of any potential issues.

Let’s breakdown the 5 key warning signs to watch out for after surgery. To make them easier to remember, we’ve created the acronym WORST.

Read on to learn the signs of infection after knee replacement surgery or hip replacement surgery.

5 Red Flags to Watch Out for After a Joint Replacement: W-O-R-S-T

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  • Worsening, discolored or foul smelling discharge from your wound/ excessive bleeding
  • Out of breath, chest pain or difficulty breathing
  • Red streaking down the leg from your incision
  • Sharp pain in the back of your surgical leg calf
  • Temperature of 100.5 degrees fahrenheit or greater

If you’re in recovery from a total or partial knee replacement (TKR, PKR, UKA, TKA) or a hip replacement (THR, THA) and are experiencing any of the above, contact your care team immediately. The above symptoms are warning signs that you may have an infection, blood clots, or are on the road to larger complications.

As a rule of thumb, your recovery should be on an upward swing of improvement. Some days may be tougher than others but on the whole, you should be progressing. Progress means less pain, less swelling, less inflammation, less stiffness, improved sleep etc. Read the recovery milestones you should be hitting in the days and weeks that follow your replacement.

1. Worsening, Discolored Discharge/ Bleeding

In the hospital or ambulatory center, your care team will be checking your wounds. They will also teach you how to properly change your wound dressing and care for your wound. It’s important that you pay close attention to your wound as it can tell you a whole lot about how you’re healing and whether or not you’re at risk for infection.

Drainage from your incision site past the 5 day mark after surgery is not normal. Drainage at any point that smells foul or is discolored also is not normal. If you are experiencing either, contact your medical team immediately.

The surgical site will remain warm and swollen for several weeks after surgery--this is a normal and part of the healing process. You must keep an eye out for drainage, discoloration, foul smells and excessive bleeding from your incision.

2. Out of Breath

It’s important that you get up and move after surgery. If you’ve had general anesthetic, you will need to move around to clear fluid from your lungs and to regain normal breathing. You want to avoid mucus from building-up in your lungs.

If you’ve just had local anesthetic or are having trouble breathing days or weeks after surgery this is cause for concern. Not being able to take deep, full breaths or developing a cough after surgery is a sign that you’re not healing properly. It can also indicate that you have blood clots or an infection. If you have chest pain, trouble breathing or a cough, contact your doctor or surgeon immediately.

3. Red Streaking Down Leg

Some general redness, heat and tenderness around your wound or incision site is normal. In fact, even your scar may retain some warmth and coloration many weeks (or months) after surgery. To treat normal redness, heat and tenderness, take your recommended pain meds and keep icing and elevating. This will help with inflammation.

You must look out for red blotchiness or streaking on your surgical leg. If there is red streaking down your leg from the incision this can indicate a serious issue. If your surgical leg redness looks streaky or is spreading, contact your care team.

4. Sharp Pain in the Back of Surgical Calf

This one can be tricky to pick out. Naturally, if you’ve had a knee replacement (or hip) that surgical leg will be in pain. Pain is normal and your body’s way of letting you know it’s been through trauma. However, if feels “sharp” and concentrated in the back of your calf this is an indication that something may be wrong. If pain feels like it’s “shooting” or “spiking” through the back of your leg, this is not normal pain. If you’re experiencing sharp pain through your calf on your surgical side, contact your care team immediately.

This is what normal pain is after joint replacement surgery. Read this article.

5. Temperature of 100.5°F+

A normal body temperature is between 97-99°F (36.1 - 37.2°C). If you’re above this level it could be cause for concern, indicating that you have a fever. A fever is a sign that you are not recovering normally and that you may have an infection or other complications. You should be closely monitoring your temperature and should keep a thermometer at-hand after surgery.

If your temperature is over 100.5° F, especially after taking medication, contact your care team.

Let’s Recap:

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Contact your care team if you are experiencing any of the WORST symptoms. To drill it in one last time, WORST stand for:

  • Worsening, discolored or foul smelling discharge from your wound/ excessive bleeding
  • Out of breath, chest pain or difficulty breathing
  • Red streaking down the leg from your incision
  • Sharp pain in the back of your surgical leg calf
  • Temperature of 100.5 degrees fahrenheit or greater

Hip and knee replacement recovery is filled with ups and downs. As a whole, a joint replacement is a very successful surgery. Although you should be progressing week over week, some parts of the healing process are tougher than others. Remember to pay close attention to what your body is trying to tell you and avoid any WORST case scenarios.


Are you having joint replacement surgery? Did you know that the decisions you make can affect your surgery outcome? Get matched with a top surgeon in your area and PeerWell PreHab before surgery for a better hip or knee replacement.

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Hi, I'm Grace. I write all things surgery for the PeerWell blog. You may remember me from such titles as: "Diabetes & Joint Replacement 101" & "Sex After a Joint Replacement".

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