How do I know if the wound on my knee is infected?

It depends on how the wound happened: a closed incision, an open surgical wound, and an ordinary cut each have their own signs, with different fever numbers. Because a knee keeps bending, a wound that comes open or stitches that come out too soon is its own reason to call.

There’s no warning-sign list just for the knee. It isn’t one of the bony spots where pressure sores usually form, or one of the places venous or arterial leg ulcers usually appear. So what decides which signs apply to a knee wound is not where it is, but how it happened.

If it is a surgical incision that was closed, contact your surgeon for more redness or pain; swelling or bleeding; the wound is larger or deeper; or the wound looks dried out or dark. Also call if the drainage increases or becomes thick, tan, green, or yellow, or smells bad (pus), or if your temperature is above 100°F (37.7°C) for more than 4 hours.

If it is a surgical wound being allowed to heal open, there is a separate list. Contact your provider if there is more redness, pain, swelling, or bleeding at the wound site; if the wound is larger or deeper, or it looks dried out or dark; if drainage increases or becomes thick, tan, green, or yellow, or smells bad (which indicates pus); or if your temperature is 100.5°F (38°C) or higher. The two temperature thresholds are not the same, and which applies depends on your wound, not on your preference.

If the wound is not surgical — a fall, a graze, a cut — the general signs apply. Redness, increased pain, or yellow or green pus, or excessive clear fluid around the injury are signs of infection. Black edges around the injury are a sign of dead tissue.

What’s special about a knee is that the wound sits across a joint you can’t stop using. Two things follow from that. Do not wear tight clothing that rubs against the incision while it is healing, and do not pull at your stitches or try to remove them on your own. And one reason to contact your provider right away matters wherever a wound crosses a joint: a wound that has come open or the stitches or staples have come out too soon.

On washing, showers are better than baths because the wound doesn’t soak in the water. Soaking the wound could cause it to reopen or become infected.

What to watch for

Contact your provider right away if you have redness, increased pain, or yellow or green pus, or excessive clear fluid around the injury; black edges around the injury, which is a sign of dead tissue; bleeding that will not stop after 10 minutes of direct pressure; fever of 100°F (37.7°C) or higher for more than 4 hours; pain at the wound that will not go away, even after taking pain medicine; or a wound that has come open or the stitches or staples have come out too soon.

First, settle whether this is a surgical wound, and if so whether it was closed or left open. The surgical wounds above have their own temperature thresholds, and they differ. Then watch the wound as you move, not only at rest: look at it bent and straight, and report any point where the edges part. Do not test how far it will open.

What we look at

  • How the wound came about, and whether it is a closed or open surgical wound
  • Which infection signs are present, and when each appeared
  • Whether any part of the wound has separated with movement
  • Whether sutures or staples are intact
  • Temperature, and how long it has been raised

Sources

  1. MedlinePlus — How wounds heal: https://medlineplus.gov/ency/patientinstructions/000741.htm
  2. MedlinePlus — Surgical wound care, closed: https://medlineplus.gov/ency/patientinstructions/000738.htm
  3. MedlinePlus — Surgical wound care, open: https://medlineplus.gov/ency/patientinstructions/000040.htm