5 months out and my new knee is STILL puffy every evening, is this normal or did something go wrong

Left total knee back in January, I'm 66, and on paper I'm doing fine. I walk, I drive, I did all my PT. But nobody told me the SWELLING would still be here in June. Every morning the knee looks almost normal, and by evening it's puffed up again, warm to the touch, and the skin feels tight and shiny. If I've been on my feet at a cookout or walking the grandkids around, forget it, it's like a grapefruit by bedtime.

My worry is the warm part. I keep reading online that warmth means infection and now I've half convinced myself something is brewing in there. No fever, no redness spreading, the incision healed up nice months ago. But warm and swollen five months out?? Is this just how it goes or should I be on the phone to the surgeon's office? I feel silly calling about something that goes away overnight, but I also don't want to be the woman who ignored a real problem.

Bev I'm 14 months out now and I remember the evening grapefruit knee so well. Mine did exactly that, fine in the morning, puffy and warm by night, worst after any big day on my feet. It scared me too because everything you google about a warm knee is terrifying.

What my surgeon's PA explained to me is that some warmth and swelling for months is the joint still settling and the healing still going, and that it being worse in the evening and better after a night flat is actually the reassuring pattern. Mine kept easing off slowly and by about a year it mostly stopped doing it. Ice and getting my foot up in the evening made a real difference, more than I expected.

The thing that finally got mine down was being honest about how much I was overdoing it and then paying for it that night. A "good day" where I was on my feet for hours was always the puffiest night. Not saying stop moving, just that the swelling is partly the knee keeping score.

Bev, first the reassuring part, then the line I don't want you to cross without a phone call.

Swelling and some warmth months after a knee replacement is genuinely common, and the pattern you're describing, better in the morning, puffy and warm by evening, worse after a big day on your feet, is the ordinary one. It's the joint still healing and the fluid pooling with gravity and activity, and for a lot of women it carries on to some degree for six months to a full year, sometimes a bit beyond, before it truly quiets down. Warm to the touch on its own, in a knee that otherwise looks and feels like yours does, is usually part of that and not a sign of infection by itself. Elevation above heart level, an ice pack for 15 to 20 minutes, and easing off on the days you've clearly overdone it are the boring things that actually work, and pacing so you don't get the "good day, terrible night" whiplash Carol described. The week-by-week recovery guide has more on why the swelling drags on this long.

Now the part that is not a forum question. Warmth that comes with any of these is different and gets a same-day call to your surgeon's office, not a wait-and-see: a fever, redness that is spreading or hot streaking, the knee suddenly much more swollen or painful than it has been, fluid or anything draining from the incision, or new calf pain, calf swelling, or breathlessness (those last ones because a clot is the thing nobody wants to miss). None of that is what you've described, but you asked when to pick up the phone, and that's the list. Calling about swelling that resolves overnight is never silly. They would much rather hear from you.

Four years out and I'll add the annoying long-view: mine would still puff up a little after a long travel day or a lot of standing well into year two, then one day I realized it hadn't done it in months. It fades so gradually you don't notice it leaving. The evening puff is not forever.

Thank you all, this settled me right down. I did call the office like Diane said, described the whole thing, and the nurse said the same, no fever no spreading redness means keep icing and elevating and let it ride, but call straight back if any of the red-flag stuff shows up. She said five months with an evening puff is very much on the normal map.

Three weeks on and I've been religious about getting my foot up after supper instead of parking on the couch with it down, and the grapefruit is more of a plum now. Pacing the big days helped too, hard to admit Carol was right about me overdoing it. Feeling a lot less like I broke my own knee.