Illustration of woman after joint surgery with scarring
Credit: Tatiana Ayazo

If you’re considering joint replacement surgery, it’s understandable to be concerned about scarring. However, with the right preventive and treatment efforts, scarring can fade over time.  

According to Bryan Springer, MD, Fellowship Director of OrthoCarolina Hip & Knee Center, the appearance of the scar should not be a deterrent for patients to have joint replacement surgery. “The majority of the time, scars heal uneventfully and leave a minimal longitudinal mark,” says Dr. Springer. 

Plus, try to think of all the benefits you’ll enjoy from having more pain-free days and mobility — and a potential scar may not seem so bad. 

“The benefits far outweigh the concerns over the appearance of the scar,” adds Dr. Springer.  

What Impacts Scarring After Surgery

The process of healing after surgery can result in the formation of scars, and while scarring is a natural part of the healing process, there are several factors that can impact the appearance and severity of scars, including being prone to keloid scars, the location of your surgery, and being prone to scarring in general. 

Keloid Scars

Speak to your doctor or a dermatologist if you’re prone to keloid scars. Keloid scars are a type of raised scar that can form on the skin after surgery. Unlike other types of scars, keloids tend to be larger and thicker and can extend beyond the boundaries of the original wound. They may also have a shiny or lumpy appearance and can feel tender or itchy. 

While a keloid scar isn’t detrimental to your health, you may not like how it looks or feels. Early treatment can help minimize its growth.  

Know your risk factors, which include:  

  • Having brown or Black skin: Although it’s unclear why, keloids are most common in these patients.
  • Having a family or personal history of keloids: They can run in families — and if you’ve already had one keloid, you’re at risk for developing others.
  • Being under the age of 30: Those between the ages of 20 and 30 are more likely to develop a keloid. 

In some cases, a keloid located on a joint might develop hard and tight tissue that restricts full movement. However, skin scarring is usually a cosmetic issue. 

Surgery Location

If you’re getting a joint replaced, the scar may enlarge over time, simply due to where it’s located. “Joint surgery scars tend to be on areas of the skin that stretch — like around the knees or shoulders,” says Tina Alster, MD, Director of the Washington Institute of Dermatologic Laser Surgery and Clinical Professor at Georgetown University. “Those scars are more prone to get a little larger because of the mobility in those areas.” 

Dr. Alster says she tells patients who have a scar tendency to come in as soon as possible after the sutures are removed (even on the same day) to get started on treatment. The earlier you do so, the faster the scars can heal and resemble more normal skin. 

How to Minimize Your Scar After Surgery

There are many remedies for scarring that you’ll find online, but it can be easy to waste money on things that don’t actually work. Here are the action steps experts recommend, but always check with your own doctor first.  

Scar Cream or Vitamin E

Once the incision is through its initial phase of healing, generally four weeks, Dr. Springer recommends applying a scar cream or vitamin E to diminish the appearance of the scar. Apply daily for two to four weeks, he says. 

Topical Cortisone Cream

Hydrocortisone cream can be applied as soon as the sutures are removed (or when itching starts) — twice per day until the itch resolves, says Dr. Alster. “This can be helpful to reduce itchiness, as well as the inflammation in the area,” he explains. It’s important to keep the incision area moist and covered so it doesn’t dry out and has optimal healing. 

Laser Surgery

According to Dr. Alster, scars on the skin’s surface can be treated with a vascular laser known as Pulsed Dye Laser (PDL). This laser targets the blood vessels in the scar and helps to reduce redness, bulk, and improve the flexibility of the scar tissue.  

“We can make those scars virtually disappear with a treatment using a PDL,” says Dr. Alster.  

“You can get it to match pretty close to the normal skin, depending on how big and red the scar is.”  

Each laser treatment (at monthly or bimonthly intervals) range in cost from $250-$1,000, depending on the size and number of scar(s). Some insurance companies will bear the cost, says Dr. Alster. 

What Not to Do

Before surgery, avoid getting a tan on the skin around your joint replacement. 

“If you have any sun exposure on the areas that will be operated on, it’s best to lose the tan before you have surgery,” says Dr. Alster. “When you cut through skin that has active melanocytes — pigment-producing cells — from being exposed to sunlight, that increases the risk of hyperpigmentation. This is darkening of the skin and can make scars look worse.”  

It’s also a good best practice to avoid sun exposure after surgery: If you have a wound, that area is more prone to sun damage. Exposure can darken the skin, which slows down the wound healing response. In this case, it can take months for the darkening to fade.  

Also avoid unnecessary movement (beyond your physical therapy and doctor-approved exercise, of course) that will stretch the skin around the scar. And while home remedies like aloe vera may hydrate the skin, it won’t necessarily make a difference in your scar, says Dr. Alster.  

The Bottom Line

When it comes to treating scars, it’s important to discuss with your doctor or dermatologist which treatments will work best for you. Talk to your physician about the incision and closure type, as well as any recommended scar creams, says Dr. Springer.  

It’s also important to be aware of risk factors that can worsen scarring or make you more prone to keloids, such as having Black or brown skin and being between the ages of 20 and 30. To minimize the risk of scarring, try to avoid sun exposure before and after your surgery. 

Remember, the sooner you address your scar, the better your chances of successful healing.  

Be a More Proactive Patient with ArthritisPower

ArthritisPower is a patient-led, patient-centered research registry for joint, bone, and inflammatory skin conditions. You can participate in voluntary research studies about your health conditions and use the app to track your symptoms, disease activity, and medications — and share with your doctor. Learn more and sign up here.

Interview with Bryan Springer, MD, fellowship director of OrthoCarolina Hip & Knee Center. 

Interview with Tina Alster, MD, Director of the Washington Institute of Dermatologic Laser Surgery and Clinical Professor at Georgetown University. 

Keloid scar. Mayo Clinic. October 11, 2022.

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