Bleeding around a hip replacement

There is always some measure of bleeding during a hip replacement operation. Each specific bleeding point will be cauterized with an electric device as part of standard surgical technique. Despite meticulous technique there may still be some ooze from the exposed tissues.

In the vast majority of patients the body will breakdown and re-absorb any blood around the joint or in the wound. The breakdown of blood produces discolouration "bruising" which often spreads downwards with gravity. In addition to "the colours of the rainbow" the breakdown of blood draws in fluid and causes swelling in the wound. This may lead to some leakage, or ooze, from the wound[Wound Oozing After Total Hip Arthroplasty James J Wood, Paul M Bevis, Gordon C Bannister. Ann R Coll Surg Engl. 2007 March; 89(2): 140–142. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1964560/].

Leg Swelling

A gradual increase in leg swelling over 3-5 days is normal after a total hip replacement. This post-operative swelling responds well to elevation and tends to diminish overnight. As mobility improves the swelling is likely to go down. Patients with pre-existing ankle swelling may find the affected ankle will be more swollen than normal for 6-8 weeks.

Any leg with swelling that develops very quickly, causes calf pain or fails to respond to elevation should be reviewed to exclude deep venous thrombosis.

Wound Leakage

After the first 36 hours there should not be significant wound leakage (dressings should last 24-48 hours). Drain sites occasionally produce straw coloured leakage for 3-4 days. Wound that leak for longer should be reviewed, if there is a collection of blood under the wound (Haematoma) then this should be evacuated.

Drainage of haematoma

Sometimes a small haematoma can be expressed by gentle pressure on the wound (with sterile gloves!). For larger collections a visit to the operating theatre, removal of a few clips or sutures, and suction to remove the clotted blood is required. This can usually to done under local anaesthetic.

Wound washout

On rare occasions there may be secondary bleeding into the tissues around the hip replacement causing a large collection of blood. The swelling associated with a large collection may stretch the skin causing blistering. The use of anticoagulants increases the frequency of this complication, however these drug do reduce the risk of symptomatic deep venous thrombosis.

When there is a large collection a full anaesthetic is required for the wound to be opened for a thorough clean out.