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Warning Signs After Orthopedic Surgery: When to Call the Doctor and When to Go Straight to Emergency

One of the most consistent patterns in orthopedic post-operative care is this: patients who develop complications often knew something was wrong before they reported it. They waited a day, then two days, then a week — assuming the symptom was normal, not wanting to bother the doctor, or hoping it would resolve on its own.

Sometimes it did resolve. Sometimes it became a complication that was far harder to manage than it would have been if caught earlier.

This guide exists to close that gap. It tells you specifically — for knee replacement, hip replacement, shoulder surgery, ACL reconstruction, and fracture fixation — which symptoms are expected and manageable, which need a call to the clinic, and which need you to stop reading and go to A&E immediately.

The rule is simple: when in doubt, call. Dr. Ankur Singh's team at Renew Orthopedic Clinic, Sector 47 Noida, would always rather receive a call that turns out to be nothing than miss a call about something that needed urgent attention. No surgeon counts it as a bother.

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The Three-Level Framework

Before going into specific symptoms, a framework for decision-making:

Green — Expected and manageable at home:

Normal recovery symptoms that are uncomfortable but not dangerous. Manage with the tools you have been given (ice, elevation, medication) and report at your scheduled follow-up.

Amber — Call the clinic:

Symptoms that are outside normal recovery parameters but are not immediately life-threatening. Require medical assessment within 24 to 48 hours. Call the clinic number and describe what you are experiencing.

Red — Go to A&E immediately:

Symptoms that suggest a serious complication requiring urgent assessment and possible emergency treatment. Do not wait for a clinic appointment. Do not drive yourself. Go to A&E, or call for emergency transport.

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General Post-Operative Symptoms: What Is Normal

Before listing the warning signs, it helps to establish what normal recovery looks like — because patients who know what to expect are less likely to panic about normal symptoms and more likely to recognise when something genuinely needs attention.

Normal in the first 1 to 2 weeks:

• Pain at the surgical site, managed with prescribed medication
• Swelling of the operated joint and sometimes the foot and ankle (for knee and hip surgery)
• Bruising spreading away from the wound — sometimes tracking significantly down the leg for knee surgery. The bruising follows gravity and can appear in places that seem far from the incision.
• Fatigue — surgery is a significant physiological event. Feeling exhausted for the first 2 to 3 weeks is entirely normal.
• Low-grade temperature up to 38°C in the first 48 to 72 hours — a normal inflammatory response to surgery
• Night sweating in the first week
• Numbness or altered sensation around the wound — caused by minor nerve disturbance during surgery, usually resolves over weeks to months

Normal through the first 6 weeks:

• Variable pain — some days better, some days worse. This is not a sign of failure.
• Clicking or popping sensations in the joint (particularly knee) — usually the components settling or soft tissue adjusting
• Stiffness that is worst in the morning and improves with movement
• Swelling that worsens after activity and improves with rest and elevation

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Wound Warning Signs

The wound is the most accessible indicator of what is happening at the surgical site.

Green — Normal:

• The wound edges are closed, dry, and progressively less angry-looking over the first week
• Mild pinkness immediately around the suture line
• Small amount of dried blood or serous (clear/yellow-tinged) fluid on the dressing in the first 24 to 48 hours

Amber — Call the clinic:

• Any continued wetness or discharge from the wound beyond 72 hours
• The wound edges have separated slightly (dehiscence)
• A blister forming directly over or adjacent to the wound
• Redness that is confined to the wound area but seems to be not improving after day 5

Red — Go to A&E immediately:

• Active discharge that is yellow, green, or smells offensive — this suggests infection and needs assessment the same day
• Redness that is spreading outward from the wound in a visible front (streaking) — this is cellulitis spreading and can progress to systemic infection rapidly
• The wound has opened and tissue is visible — go immediately

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Blood Clot Warning Signs (DVT and Pulmonary Embolism)

Deep vein thrombosis (DVT) — a clot forming in the deep veins of the leg — is the most feared early complication of lower limb joint replacement surgery. It is why you are prescribed blood thinning medication after surgery and why walking from day one is so important.

DVT typically forms in the first 2 to 4 weeks after surgery, though the risk continues for up to 3 months.

Green — Normal:

• Generalised aching and swelling in the calf — this is common after knee and hip surgery and is usually due to post-operative inflammation, not clot

Amber — Call the clinic same day:

• Calf pain that is unilateral (one calf more than the other) and is a new, distinct aching
• Warmth and tenderness specifically in the calf
• Mild lower leg swelling that seems asymmetric between the two legs

Note: if calling out of hours and calf symptoms are present, go to A&E rather than waiting for the clinic to open.

Red — Go to A&E immediately:

• Sudden, severe calf pain — particularly if the calf feels significantly harder and warmer than before
• Calf or leg swelling that has developed rapidly over a few hours
• Breathlessness that is new or has developed suddenly (possible pulmonary embolism — a clot that has traveled to the lung)
• Chest pain combined with breathlessness
• Feeling faint, dizzy, or racing heartbeat alongside breathlessness

A pulmonary embolism is a medical emergency. Do not wait.

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Infection Warning Signs (Periprosthetic Joint Infection)

Infection around a joint implant — periprosthetic joint infection (PJI) — is rare but serious. It can present early (within weeks of surgery) or late (months or even years later). The Indian orthopedic context adds a specific risk: untreated dental disease, urinary tract infections, and skin infections can spread bacteria to a joint implant through the bloodstream.

Early infection (first 6 weeks):

Amber — Call the clinic:

• Wound warmth that is increasing rather than decreasing after day 5
• Fever persisting above 38°C beyond 72 hours
• Increasing pain in the joint that was improving — pain that reverses its improving trend

Red — Go to A&E:

• High fever (above 39°C) with joint pain and wound discharge simultaneously
• Rapidly increasing redness and warmth of the entire joint area

Late infection (after 6 weeks, or months to years later):

Late-onset infection is more insidious. The warning sign is a joint that was functioning well and starts to become persistently painful again, often without obvious cause.

Amber — Call the clinic:

• Recurrence of joint pain after a period of good, pain-free function
• New swelling in a previously well-functioning joint
• Pain that wakes you from sleep in a joint that was not doing this before
• Any significant infection elsewhere in the body (dental abscess, UTI, skin abscess, chest infection) — inform Dr. Ankur Singh's clinic so they can assess whether the joint needs monitoring

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Hip Dislocation Warning Signs (Hip Replacement Patients)

Hip dislocation — where the ball of the prosthesis comes out of the socket — is one of the most dramatic early complications of hip replacement. The risk is highest in the first 6 weeks while the soft tissues heal around the new joint.

Red — Go to A&E immediately:

• Sudden, severe hip pain after a movement (particularly hip flexion beyond 90 degrees, crossing the legs, or internal rotation)
• The leg looks shorter on the operated side
• The leg is rotated in an abnormal position
• You cannot move the hip at all

Hip dislocation is an orthopaedic emergency that requires urgent reduction (putting the joint back). Do not attempt to move the leg into a normal position. Call emergency transport.

This is why hip precautions in the first 6 weeks — no bending beyond 90 degrees, no crossing legs, no internal rotation — exist. They protect you during the period when dislocation risk is highest.

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Nerve and Circulation Warning Signs

After any lower limb surgery, the nerves and blood vessels around the operated area can be affected.

Amber — Call the clinic:

• Increasing numbness or altered sensation in the foot or lower leg that is worsening rather than improving
• New weakness in the foot (difficulty lifting the foot when walking — footdrop)
• Tingling or electric pain shooting down the leg from the operation area

Red — Go to A&E immediately:

• The foot is cold, pale, or blue compared to the other foot
• No feeling at all in the foot or lower leg
• Extremely tight, painful swelling that feels like the limb is bursting — this can indicate compartment syndrome, an emergency where pressure inside the muscle compartment is cutting off blood supply

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Specific Procedure Warning Signs

After ACL Reconstruction

Amber: Knee that becomes progressively more swollen in the days 5 to 10 (haemarthrosis — bleeding into the joint — occasionally requires aspiration)

Amber: Knee that feels completely unstable when standing — the graft should provide some stability from day one even if weaker than normal

Red: Complete failure of the knee to bear weight that was improving and then suddenly stops — possible graft failure

After Shoulder Surgery (Arthroscopy or Replacement)

Amber: Shoulder that becomes progressively more painful rather than improving after the first week despite medication

Amber: Loss of all sensation in the arm or hand (nerve monitoring is important after shoulder surgery)

Red: Rapidly expanding swelling at the shoulder within 24 to 48 hours (rare haematoma)

After Fracture Fixation

Amber: Wound discharge or fever after fracture surgery in the first 2 weeks

Red: Increasing severe pain in the plastered limb — if you have a plaster cast and the pain inside it is becoming severe and unrelenting, this is a potential compartment syndrome emergency. Cut the cast padding (not the cast) if possible to relieve pressure and go to A&E.

Red: The fingers or toes of a plastered limb are becoming cold, blue, or numb — circulation may be compromised.

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The Indian Context: Why Patients Delay and Why This Matters

In Dr. Ankur Singh's experience, Indian patients — and their families — tend to delay reporting warning signs for several specific reasons:

"We don't want to bother the doctor." Indian cultural deference to authority figures often means patients minimise their own symptoms. This is the wrong approach after surgery. You have every right to call the clinic with a concern, and it is the right thing to do.

"It's probably normal." It might be. But the ones who assume this and wait a week when they had a developing DVT or early wound infection are the patients who end up requiring much more complex management.

"We'll wait and see if it improves." A 24-hour "wait and see" on a non-emergency symptom is reasonable. A week of waiting is not.

"The pain is bad but we don't want to go to the hospital at night." Red flag symptoms — breathlessness, sudden severe calf pain, hip dislocation — require A&E regardless of the hour. KDSG Superspeciality Hospital in Greater Noida provides 24-hour emergency orthopaedic cover.

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Frequently Asked Questions

How do I tell the difference between normal post-op swelling and a DVT?

Normal post-op swelling is usually diffuse — both legs may be somewhat swollen, particularly the ankle and foot. DVT swelling is often asymmetric (one calf significantly more swollen than the other), and is accompanied by warmth and specific tenderness in the calf. When in doubt, call the clinic.

My wound is itching. Is that normal?

Yes. Itching around the wound is a normal sign of healing tissue. Do not scratch over the wound. If the itch is accompanied by rash or spreading redness, that changes the picture — call the clinic.

Can I take extra painkillers if the pain is very bad?

Take only the medications prescribed and at the doses specified. If pain is not controlled with the prescribed medication, call the clinic — additional prescription options may be appropriate, and uncontrolled pain can also be a signal that something needs assessment.

How do I contact Dr. Ankur Singh's clinic if I have a concern?

Call the number listed on this website. For emergencies outside clinic hours, go directly to KDSG Superspeciality Hospital Emergency Department in Greater Noida.

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Dr. Ankur Singh | Best Orthopedic Surgeon in Noida | Post-Surgery Safety Guide | KDSG Superspeciality Hospital Greater Noida | Renew Orthopedic Clinic Sector 47 Noida