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A stiff total knee replacement can be extremely frustrating for patients and surgeons. The best way to manage a still total knee is prevention. I have written many articles on this website focusing on how to rehabilitate your knee replacement effectively. Unfortunately, some patients will experience stiffness in spite of their best efforts. The management pathway I have outlined below is how I recommend dealing with this problem. For a bit more explanation, check out the video posted below.  Stiff total knee replacement management algorithm
9 Comments
Holly
3/26/2021 05:32:29 pm
May I ask your thoughts on icing and elevation after TKR? She has been told to ice every three hours for 45 minutes and elevate every time she is laying down and all night. 3/28/2021 11:16:21 am
Ice and elevation is helpful after knee replacement surgery. This, alone, will not result in good range of motion. I would encourage her to stretch on a routine basis, every day, as recommended throughout this website. If hip pain is interfering with her ability to rehabilitate- this is not normal. She should be evaluated by her surgeon.
Holly
4/26/2021 12:56:13 am
I appreciate your reply. She went back to the surgeon who stated she should not be having this pain because everything is fine. We went for a second opinion and this doctor has ordered an MRI. He said it appears that there is extensive damage to the veins possibly due to the tourniquet used during surgery and she was not in good enough health for the surgery to begin with. He said his mentor in Med School taught him that it is of utmost importance to know when NOT to do surgery and to look at the entire person and not just the knee itself. I wish more doctors would follow your example of no tourniquet. Thank you! 4/24/2021 01:42:13 am
I do agree that when looking for an orthopedic surgeon, we need to ensure they are qualified and experienced. The other day my dad mentioned he needs to have his knees replaced. I will remind him to look for a trusted and reliable surgeon to have his knees replaced.
Holly
4/26/2021 01:03:46 am
From my experience with my mom, I would say to make sure you find a doctor who does NOT use a tourniquet. In addition, I would ask if they use a CPM device. My father-in-law in Italy had his knee replaced at 82 and his best friend at 83 and their knees are absolutely perfect, as if it were their own knees. NO tourniquet and CPM immediately. Kind regards. 5/11/2021 05:18:12 pm
While CPM will not likely cause any harm, it also will not help with terminal extension or deep flexion. In my experience, these devices were best used when patients stayed in the hospital for several days following surgery. Now, most patients are able to be discharged safely the day following surgery. This is why I strongly recommend slow, long duration stretching to regain terminal extension and deep flexion ASAP. Everyone regains mid-range of motion (which is what CPM helps with) without difficult.
Holly
5/12/2021 10:03:18 am
Thank you for your response. My father-in-law spent several days in the hospital after his knee surgery, which is standard protocol for knee replacements in Italy. So the CPM makes perfect sense. I wish they had used it on my mom when she was readmitted to the hospital within 24 hours of being sent home. I’m 63, male. Bone on bone Knee replacement 5/3/21. PT increased flexion from 35 to 53 degrees in first 2 weeks. Very stiff. Question: past compound commuted fracture of femur 4 inches above knee. Casted 6 months. Max flexion about 105 prior to surgery due to frozen knee and adhesion mid thigh where bone came through. Could a new knee and release of adhesion give me more flexion? 5/26/2021 10:26:46 pm
I would expect you to regain additional range of motion (beyond 105) as a result of your knee replacement (and proper post-op rehabilitation). Your comment will be posted after it is approved.
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