If you’re waiting for knee replacement surgery – or considering it – you may have heard people talk about compression stockings.
Compression socks / stockings are – let’s be honest here – not many people’s idea of an entertaining wardrobe option. They stir considerable debate in online surgery forums, and plenty of questions. What do they actually do? Are they effective in doing what they do? And how long do you need to wear them for?
All excellent points – especially if you’re new to knee replacement details and looking for some clarity around when and how you’ll need to wear them. With that in mind, we’ve put together a brief guide to answer some of the common questions…
What’s the difference between compression socks and stockings?
They usually mean the same thing. Technically, a stocking refers to the thigh–high, open–toed versions you see on NHS wards, while a sock is often used for the knee–high versions that look more like athletic gear. But, in reality, they’re fairly interchangeable. In hospital settings, you may also hear them called TED stockings or TEDs (TED stands for thrombo–embolic deterrent) and sometimes compression hoses or hosiery.
Why is compression so important after knee surgery?
The main reason is that it reduces the risk of deep vein thrombosis (DVT), where a blood clot (embolism) forms after surgery. Big operations like knee replacement increase the chances of DVT for a couple of reasons. First, lack of movement: lying still slows down your circulation, which can cause blood to settle as it passes through the deeper veins (this is also why the nurses will encourage you to start moving soon after surgery). Second, tissue damage: the incisions during surgery can damage veins, releasing tiny particles into the bloodstream that blood can potentially clot around.
How do compression socks actually work?
Compression stockings are designed to put graduated pressure on your legs. Essentially, the sock is tightest at the ankle and looser towards the upper end of your leg. This upward pressure gently squeezes the tissues and veins in your legs, encouraging venous return (blood going back to your heart), improving circulation and reducing swelling. There are three different grades or “classes” of pressure. The lowest – Class 1 – starts at 18mmHg, while the highest – Class 3 – can provide up to 46mmHg. But you won’t need to worry about this; the hospital team will tell you which stockings will be best for you.
How effective are compression stockings at preventing blood clots?
There’s good evidence to suggest they can make a big difference. One high–quality study by the Cochrane network found that wearing graduated compression stockings reduced the risk of developing a DVT by approximately 60%. The benefits aren’t solely about clots, either. Other research has found compression helps to manage the “interstitial fluid” that causes swelling after surgery, reducing the overall extent of inflammation. Less swelling usually means less pain and a faster rehab.
Why do I have to wear a stocking on my “good” leg?
It feels counter–intuitive, but the risk of a blood clot isn’t just in the leg that’s being operated on. Because you’re moving around less than usual during your recovery, the blood flow slows down in both legs. Your surgeon wants to make sure both limbs are working at full capacity so blood can move freely around your body and help you recover safely.
Will I be given compression socks in hospital?
In most cases, yes. Before you go to theatre, the nurses will measure and fit you for a pair of stockings and show you how to put them on. They’ll normally ask you to wear one on your “good” leg first – the one that isn’t being operated on. The other compression sock will go on after you’ve had the operation. Most patients are given two pairs, so they have a spare set to wear if the others are being washed. Keep in mind that, occasionally, swelling can change the shape of the legs and make the socks more uncomfortable to wear. If this happens, you may need to get re–measured for a new pair.
Can I swap the hospital stockings for my own pair?
You normally can – but check with your surgeon first. If you dip into knee replacement forums online, you’ll notice that not everybody gets on well with the hospital–issue stockings. Patients occasionally say they feel itchy or are prone to rolling down. But, if your consultant recommends it, you can experiment with other commercial, medical–grade versions. Daylong is one well–established brand that supplies stockings to the NHS on prescriptions. But the larger high–street pharmacies like Boots provide specialist compression socks too.
How do I put on compression stockings?
This may take some practice at first! But don’t worry – the nurses will show you how to wear them when you’re in hospital. For stockings with a toe section (closed toe), this is how the process works:
- Reach inside the stocking and find the heel
- Pull the stocking inside out, as far as the heel
- Place your foot carefully into the opening (be sure to line up your heel with the stocking heel)
- Gently pull the stocking over your ankle and up your leg (avoid twisting or overstretching the material)
- Nuffield Health has a useful application guide for stockings, which you can download here: Anti–Embolism Stockings A Patient Guide on Discharge (downloads as a PDF)
What if I can’t get the stockings on?
There’s no two ways about it: medical stockings can be difficult to put on, especially when you’ve just been through a major operation and are struggling to get mobile. There are devices you can buy to make the process easier; search online for “compression stockings” and “application aids” to see some of the options. Sprinkling a little talcum powder on your skin can also make it easier to pull the stockings up, particularly if the skin is moist or sweaty. The best option, though, is to ask a partner or close friend to help you. If you live alone, you may want to find someone ahead of time who can check in with you on a daily basis, at least in the early days. This is something we recommend more generally. The first days after surgery can be challenging; it’s good to have someone around you can talk to and who can support you around the home.
Can I take my compression stockings off to sleep?
Different hospitals have different protocols for when (or if) you can remove your stockings after knee surgery. Most patients wear their stockings day and night for the first two weeks. But, even then, the nurses will recommend you roll down your socks once a day, temporarily, to inspect your skin. Soreness, redness and skin discolouration are things to keep an eye out for; if you’re concerned, contact your GP or hospital for further advice. Avoid letting the socks roll down your legs; this can create a tighter band further down that could cause constriction.
How long will I have to wear them?
This is actually one of our most–frequently–asked questions! In truth, it varies from patient to patient. Everyone’s rehab journey is different; some people recover much more quickly than others. Patients are often keen to get rid of the stockings as soon as they can, and that’s understandable. But because they confer benefits for at least six weeks after surgery, the general advice is to keep wearing them for that time period. So it’s important to stick with the specific timeline you’re given in hospital. Ultimately, compression socks are a necessary evil (if “evil” isn’t too strong a word!) – a temporary inconvenience that keeps you safe and encourages a good, strong recovery.
Are you struggling with knee pain – or worried about knee replacement and what comes afterwards? We’ll be glad to help you find out more about the process and how we can support you. Just drop our friendly team a line on 01962 826107 or use the online form and email addresses to send us a message.
