Post surgical swelling in the lower limb.

An answer to queries under “comments”, 11 November 2011.

1. X-rays are very limited in what they show, and very “observer dependent”, which means some are better than others in interpreting what is shown. Even complex visualization, such as MRI will not necessarily give answers. Diagnosis depends upon a number of skills, such as the history, clinical examination, and other factors such as experience and intuition. All these qualities need to be combined and correlated if high diagnostic accuracy is sought. Matters often go very wrong when the patient takes the attitude of believing (sometimes insisting) that “all will be shown” by an x-ray and similar. Indeed x-rays can show apparent abnormalities, “red herrings”, and mislead completely. In spinal surgery one of the most dangerous instruments is the MRI. It shows so much that apparent abnormalities can mislead the treatment in a hazardous way.  Therefore it is not possible to say “no fault is found”. All that can be said is that that observer found no abnormality.
2. Swelling in the lower limbs is often treated by diuretics, which dehydrate the individual.  That means giving almost every cell in the body a dose of an abnormal chemical. There are other hazards of dehydration, which I will not labour here. Far better is to treat the parts which need treatment. A good start would be to try elasticised stockings. If the problem is a hydrodynamic one the stockings will work.
3. Another benefit of elasticised stockings is that an undiagnosed or preventable deep vein thrombosis can be treated with (properly designed and fitted) elasticised stockings.
4. If lower limb swelling is also present in the uninjured limb, then an entirely different group of diagnoses must be considered.
5. But it must be remembered that infection and problems with the blood vessels also produce swelling in the lower limbs. An entirely normal limb can be made to swell by inactivating it by walking with crutches.
6. If your swelling is localize to only some of the hardware, then local infection must be considered.
7. At this stage a few days wait is unlikely to make any difference. Rather use the time to ensure an accurate diagnosis and reduce the swelling with stockings. In any event you should use the stockings from immediately after the surgery (see earlier posts).
8. No surgery is entirely exempt from complications. However if the tissues are handled gently the chance of infection are considerably reduced. See earlier page on “Painless surgery”. There is a direct correlation between painful surgery (and for that men injurious surgery) and complications.
9. Discuss the method of removal with your surgeon. It is possible to do “subcutaneous” removal of plates and screws through small puncture wounds.