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Postoperative Orthopedic Incision Monitoring Guide

SNF Reference · Normal Healing vs. Infection Concern

Normal Healing vs. Infection Concern
Sign ✓ Normal ⚠ Infection Concern
Redness Mild pink line along incision Expanding redness >1–2 cm beyond incision
Swelling Mild swelling that improves daily Increasing, tense, shiny swelling
Warmth Slight warmth during first few postoperative days Hot to touch compared to surrounding skin
Pain Gradually improving Worsening pain or pain out of proportion
Drainage Small amount of clear or light pink drainage Thick yellow or green (purulent), foul odor
Bleeding Minimal spotting Sudden increase or persistent bleeding
Incision Edges Well-approximated and closed Separation (dehiscence) or gapping
Systemic No fever Fever >100.4°F (38°C), chills, confusion
Rehab Gradual improvement in mobility and ROM Loss of ROM, increasing stiffness, inability to bear weight
Local Incision Red Flags

Increasing Redness

  • Expanding erythema (>1–2 cm beyond incision)
  • Streaking redness (possible lymphangitis)

Worsening Swelling

  • New or rapidly increasing swelling
  • Tense swelling with shiny skin

Drainage Changes

  • New drainage after previously being dry
  • Thick yellow or green drainage
  • Foul odor
  • Sudden increase in bloody drainage
  • Persistent drainage beyond 5–7 days postoperatively

Wound Dehiscence

  • Separation of incision edges
  • Visible underlying tissue
  • Staples or sutures pulling apart

Skin Changes

  • Warmth significantly greater than surrounding tissue
  • Skin necrosis (black or gray tissue)
  • Blistering around incision
Systemic Red Flags

Fever

  • Temperature ≥100.4°F (38°C), especially if persistent
  • Low-grade fever with additional symptoms

Increasing Pain

  • Pain worsening instead of improving
  • Pain out of proportion to exam
  • Severe deep joint pain (concern for prosthetic joint infection)

Altered Mental Status

  • New confusion in elderly patients (may be early sign of infection)

Hemodynamic Changes

  • Tachycardia or hypotension
  • Possible early sepsis
Orthopedic-Specific Red Flags

🦴 After Joint Replacement (Hip / Knee / Shoulder)

🔩 After Spine Surgery

🔧 After Fracture Fixation

DVT / PE Warning Signs

Common in SNF orthopedic patients — monitor closely.

DVT Signs

  • Calf pain
  • Unilateral leg swelling

PE Signs

  • Sudden shortness of breath
  • Chest pain
  • Oxygen desaturation

🚨 Notify Surgeon Immediately If: