A patient who has just had total hip replacement complains of significant leg swelling on the affected side. There is no calf or posterior knee pain. What is the appropriate response?
—Michael Flosi, PA-C, Jensen Beach, Fla.
Some degree of leg swelling is normal following surgery. Your patient simply may be relatively immobile or may not be elevating the leg. Make sure the patient does not have a deep venous thrombosis (DVT). It is important to remember that the Homans sign, which is frequently used to assess for a DVT, is not very accurate. Not all patients have the classic symptoms of DVT and may not have pain associated with the swelling. A Doppler ultrasound would be useful to rule out DVT. Some other differential diagnoses should also be considered, including cellulitis, superficial thrombophlebitis, or lymphedema. Barring a DVT, the patient should be mobilized according to the surgeon’s protocol.
—Michael E. Zychowicz, DNP, NP-C (124-1)
