Wound care after joint replacement: protect the incision, protect the implant

Your incision is the barrier between the outside world and your new joint. Deep infection after hip or knee replacement is uncommon — roughly 0.5% — but it is the complication surgeons work hardest to prevent, because treating an infected implant can mean additional surgery. Nearly every deep infection starts at the skin, which makes the incision the highest-value real estate in your entire recovery.

The encouraging part: most wound problems are preventable, and prevention is split evenly between what happens before surgery and what you do in the weeks after. Dr. Morton's side of the bargain is a layered, watertight closure and a dressing designed to stay sealed; your side is optimization beforehand and disciplined care afterward. This page covers both halves.

How your incision heals is largely decided before the incision exists. Four modifiable factors dominate wound-healing risk, and Dr. Morton addresses each one as part of surgical planning rather than leaving them to chance:

You will leave surgery with a waterproof dressing designed to stay on — usually for one to two weeks, per your specific instructions. Resist the urge to peel it back and peek; every time a dressing comes off early, bacteria get a fresh chance at skin that hasn't sealed.

The everyday rules are simple. Showering is usually allowed early with the waterproof dressing in place — let water run over it, pat dry, no scrubbing. Do not soak the incision: no baths, hot tubs, pools, or ocean until the wound is fully healed and you have been cleared. Skip lotions, creams, and ointments on the incision unless the office tells you otherwise, wash your hands before touching anything near it, and keep pets off the surgical leg. Loose, clean clothing over the site beats anything that rubs.

A few things that look alarming but usually aren't: bruising around the incision, mild swelling, and a small edge of the dressing lifting are all common. Elevation and ice control swelling, and less swelling means less tension on the healing skin — the quiet reason the early exercises help your wound as much as your joint. If the dressing lifts enough to expose the incision or fills with fluid, call before improvising a fix.

Call early. A wound concern evaluated promptly is usually a small problem; the same concern a week later may not be. Call (808) 439-6201 — and if it is after hours and you feel seriously unwell, go to the emergency department. Watch for:

Once the incision is fully sealed and dry — typically around two weeks — normal showering resumes, and swimming follows once you are cleared. Protect the new scar from sun for the first year, and moisturize once healing is complete if the skin feels tight. Itching is a normal part of healing, and a patch of numbness next to the scar is common — small skin nerves are unavoidably crossed by any incision, and the area usually shrinks over months.

One rule lasts a lifetime: a joint replacement incision that becomes red, swollen, or starts draining months or years later is never normal — it needs prompt evaluation, and the revision clinic is built for exactly that workup. Dental work is a related long-term question — see antibiotics and dental work. And if you are still in the planning stage, an orthopedic consultation is where risk optimization starts.