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Stiff knee replacement

5/20/2016

214 Comments

 
Bandaged knee after total knee replacement
So you finally decided to have your arthritic knee replaced. You got through the surgery just fine. As expected, you had some surgical pain, but almost immediately you realized that your arthritic pain was gone. Awesome! Things seemed to be going very nicely, and now you are home...

Your knee may begin feeling tight and warm. This is normal and expected. Healing occurs in part through an inflammatory process. Inflammation shows up as swelling, warmth, and pain. You have been told to stretch, but may be questioning this recommendation now. You may be concerned that because it hurts you could be damaging yourself or your new knee. This is a very common concern. Please resist the urge to stop stretching.

The knee is a complex joint. There several moving parts and potential spaces (otherwise known as tissue planes). During total knee replacement these parts are moved around , the tissue planes are opened. I think it makes sense to patients when they have some pain after surgery. But as the wound is healing on the outside, why does it feel like things are getting worse on the inside?

As the healing process proceeds, the tissue planes that have been opened begin sticking together. Gradually adhesions, or scar tissue, may form between these planes preventing them from gliding properly. Initially this scar tissue is weak, but it will get stronger every day. For this reason, there is some urgency to regain range of motion as soon as possible. This is because after about 6 weeks or so from surgery this scar tissue becomes strong enough that a patient is unlikely to be able to stretch it out any more. The range of motion you have achieved at this point will be how far your knee will move permanently...without additional intervention. 

To better understand knee range of motion lets begin with a couple of definitions. Flexion of the knee means bending. When you sit in a chair and your feet are flat on the floor, your knee is bent, or flexed. Extension of the knee means straightened. When you stand up and your knee is straight it is extended. 

Now lets discuss these tissue planes a bit.

Tissue layers that must glide following total knee replacementTissue layers in the knee that must be stretched following total knee replacement.
The skin must be able to slide over the kneecap (patella). The body achieves this by only loosely attaching the skin to the patella. This loose connective tissue allows motion to occur. Under abnormal conditions, fluid can collect here and create swelling. A potential space such as this is referred to as a bursa. The loose connective tissue found here is called bursal tissue. The specific space, or tissue plane, between the skin and the kneecap is called the pre-patellar bursa. It is shown in purple in my sketch. 

The kneecap (patella) is embedded within the tendon that attaches your thigh muscles (quadriceps) to your shin bone (tibia). A tendon is the tissue that attaches muscle to bone. The quadriceps tendon must be able to slide relative to the thigh bone (femur). The area above the patella shown in my sketch as orange is called the supra-patellar pouch.

If either of these tissue planes  sticks together, the knee will not be able to bend completely. 

In the back of the knee there is a sheet of tissue called the posterior capsule. This is green in my sketch. ​This tissue is irritated during surgery and will gradually tighten as it heals. If this is allowed to happen, the knee will not fully extend. 

So, how do you prevent a stiff total knee? It is not by walking around a lot. It is not by cycling the knee back and forth a lot. It is by gently and progressively stretching. Even though it hurts. The longer you are from surgery, the longer these stretching sessions must be because the scar tissue becomes stronger each day. Gentle progressive stretching works by taking advantage of the viscoelastic nature of biologic tissues. 

My basic recommendations:
  1. Extension: Place your heel on something. Make sure your toes are pointing straight up. Leave your knee completely unsupported. Gradually relax your muscles to allow gravity to pull your knee straight. You can assist by trying to gently force the back of your knee down. Maintain this stretch for as long as you can. Longer is better. Try to measure the duration of stretch in minutes as opposed to seconds.
  2. Flexion: Progressively bend your knee. It is very important to relax your quadriceps muscle while doing so. You can use your other leg to help. Place your good foot in front of your ankle and pull back attempting to bend the knees together. Again, do this slowly but progressively. Hold the endpoint for as long as you can. Although it will hurt, do your very best to relax your body. Measure the duration of stretch in minutes as opposed to seconds. 
  3. You do not need to repeatedly swing your knee back and forth from full extension to full flexion. In my experience, all of the mid-range range of motion done will not help increase end range of motion, and could actually cause swelling and inflammation which will slow down your progress. It is much better to slowly and progressively focus on one motion at a time.



214 Comments
Beverly Stephens link
1/8/2018 10:11:59 pm

I fx my Patella wired and screwed together 6 weeks ago. Currently passive flexion 90, active around 55-60 lots of pain. My surgeon said I should be at 90 plus by now. He said he has done all he can for now He said come back in 8 weeks. Should I get a second opinion? Can I do more. Currently CPM 6 hours a day PT once a day for 1 hour, ambulating as much as possible.

Reply
Christopher Gorczynski, MD
1/8/2018 10:48:21 pm

I would also like to see 90 degrees of flexion at the 6 week mark after open reduction internal fixation of a patella fracture. This is not always the case-for a variety of reasons.

First of all- don’t worry- you will make progress for many months yet to come- with the appropriate exercises.

A couple of your comments are consistent with those I hear from patients with a stiff knee- “I’m doing a lot of walking”, and “I’m using continuous passive motion for many hours.” Unfortunately, neither of these things will make a stiff knee loosen up.

Another thing I hear quite often is - I am doing xxxx strengthening exercises all the time.”

Walking simply does not require much knee range of motion. While it is good for many other reasons, it will not help you to regain knee range of motion. The benefits of walking include improvement in bone density, improvement in muscle tone and strength, reduction in risk for deep venous thrombosis (DVT), otherwise know as blood clots. So it isn’t inappropriate to walk when your surgeon allows you to.

Continuous passive motion (CPM) is a machine that gently pushes a joint back and forth, but doesn’t force endpoints very much. These machines were utilized extensively in the past, and for certain conditions can be quite helpful. I have abandoned their use after knee replacements as the majority of my patients are usually up, out of bed, ranging their knees through a 90 degree arc, waking up and down the hall and stairs and are back home within 24-48 hours of admission. These devices were great when hospital stays were 5-7 days or more and patients spent most of the time laying in bed. Using a modern multimodality pain control regimen including regional anesthesia and intra-articular local anesthetics I found CPM was holding patients back.

Strengthening is great for muscle development and is important, but this is only effective after range of motion is restored. Strengthening will not cause joint range of motion to improve.

Getting back to your question- improvement in joint range of motion requires stretching. I have found sustained stretching (holding the endpoint for many minutes as opposed to a few seconds) is much more effective for a postoperatively stiff joint than the 10-15 second stretches most therapists suggest.

As long as your surgeon has allowed you to progress your range of motion without limits at this time, I would recommend stretching for a cumulative minimum of 1 hour each day, with no days off, and for a minimum of 10-15 minutes each session. Only a single maneuver is required: when trying to regain flexion, flex the knee until it stops, try to use your thigh muscles (hamstrings) to bend it more, and apply additional flexion force manually by gently pulling your ankle toward your buttocks. Simply hold this stretch for as long as possible.

Another method is to lie on your back on a sofa. Let your legs hand over the arm. Slide your butt to one end of the couch- right against the arm of the couch. Your hip should be flexed to 90 degrees. This should allow your knee to be dangling in the air. Relax in this position and gravity will be pulling down on your knee. Stay in this position for as long as possible. If desired- wear a boot or use an ankle weight to apply additional flexion force.

Remember- cycling your knee back and forth will not result in improved motion- sustained endpoint stretching will.

In this blog are articles on the viscoelastic nature of biological tissues as well as articles supporting this sustained stretching technique- which is also very helpful for adhesive capsulitis (frozen shoulder).

You are spending lots of time and effort attempting to rehabilitate. Just refocus your efforts toward more effective techniques and I think you will see progress.

I hope this information is helpful.

Reply
jacqueline davey
11/26/2018 03:52:15 pm

1 yr po, 90° bend, surgeon said it's functional?

Christopher Gorczynski, MD link
11/26/2018 05:55:22 pm

@ jacqueline davey 90 degrees is marginally functional in my opinion. I would expect you to have difficulty going up and down stairs normally, and to have difficulty standing up from a low chair using your affected knee. If it is otherwise pain-free and trustworthy, you may decide to leave it along. If, however, you do find it functionally limiting, you would be a candidate for arthroscopic lysis of adhesions with a manipulation under anesthesia. This is very likely to help you regain a truly functional range of motion if you work diligently on maintaining the range of motion your surgeon gets. It is worth discussing this with your surgeon if you are not satisfied with your level of function.

Caroline
1/19/2020 09:27:32 pm

I am 5 wks post op TRKR. My range of motion is from 68-80. My knee is tightening up so much my bend is not getting better. Would you suggest a MUA at this point or do I still have time to really push for better ROM. It is so terribly uncomfortable and extremely tight.

Christopher Gorczynski, MD link
1/22/2020 06:01:27 pm

@Caroline... You are facing a difficult situation. If I am interpreting your question correctly, it sounds like you are stuck with a bent knee. We call that a flexion contracture. That makes walking extremely difficult.

It is a very challenging situation.

I do not think a manipulation is likely to help much with a flexion contracture. The best plan is prevention, by avoiding this from the beginning, always forcing the knee straight from the day of surgery.

At this stage we are unfortunately beyond prevention. My best recommendation at this point is to begin using a static stretching brace that will help you to gradually force your knee straight again. The brace I use when this problem happens is called JAS (joint active systems). I would recommend you get in touch with your orthopedic surgeon immediately and discuss this option.

Lissette Lopez
1/29/2020 10:52:12 pm

I had my surgery 11 weeks ago and my knee only bend 80 my surgery just bend my knee for on January 24 but while I was in surgery on November 4 they pinched my nerve so it’s traveling all the way from my leg to my back I’m in so much pain and today the spine surgery put injection on my back so I’m praying that it works because having a pinched nerve you really can’t do the things you want to do for your knee

Yvonne
2/16/2020 07:11:17 pm

I had knee surgery and I go to therapy when they bend my knee and measure it’s measure 100 and they say that not good enough and if I don’t get up up 125 I well have problems walking is that true

Christopher Gorczynski, MD link
2/17/2020 07:42:35 pm

@Yvonne: I addressed this exact question in a recent blog entry.

https://www.yourorthomd.com/orthopedic-knowledge/stretching-is-more-important-than-walking-after-knee-replacement

Basically- you do not need very much range of motion to walk reasonably well. Increased range of motion does help your knee to function normally. Getting up from sitting, climbing and descending stairs, getting into and out of the car, and trimming your toenails are all activities that require much more range of motion than walking. I think your therapists were trying to explain that 100 degrees of flexion is not optimal for a normally functioning knee. If your only goal to to walk, you have plenty of motion. Most people will do better with range of motion of 120 degrees or more.

Robert Mahlstedt
7/26/2020 11:11:59 am

I am 3 weeks past my total knee replacement. I worked all day yesterday in stretching and bending my knee as far as pain would allow. I iced, I walked, I exercised all day. By the end of the day I felt my knee was quite flexible. But overnight it seems like I am right back at ground zero. Is this normal?

Christopher Gorczynski, MD link
7/26/2020 10:38:41 pm

@Robert Mahlstedt - what you describe is quite common early on after knee replacement surgery. You get it loosened up and feeling good, then you rest or sleep and it seems that you are right back where you started. This is normal, and it will be temporary. As the inflammatory process gradually winds down, I would expect you to feel less stiffness, and feel that you are making progressive gains. In the meantime, use ice to help with inflammation, and slow, long duration stretching every day. Best of luck!

Kaitlin
9/2/2020 10:52:01 pm

Hi! I’m 37. Had two scopes over the past year and a half, no medical meniscus causes me to go bone on bone coupled with localized OA on the anterior part of the knee.
I’m 11 weeks out of my total knee replacement and 5 weeks post manipulation procedure. I’m in two static braces for both flexion and extension. I can barely get to 100 and I’m -15 extension. My quads are just not activating and I’m get frustrated. I’m a mom of two boys and can’t even squat anymore. I was an active athlete and struggling to figure out what i can do to get this leg to bend and to feel normal again. I can’t walk normally at all let alone do stairs or move run around with my kids. The knee was a mess, i get that.... what else can i try to get rid of this terrible stiffness and get me to be flexion and full extension to be more normal? Compression stockings, cry therapy.... what else am i not trying. (Again, continuously in PT and using static splints). Any suggestions.

Christopher Gorczynski, MD link
9/3/2020 05:39:18 pm

@Kaitlin -

You are, unfortunately, facing a very difficult orthopedic problem. You have stiffness in both extension and flexion, and this has been resistant to stretching at home, PT, static bracing, and manipulation. This is more common in younger patients, and you are definitely a young total knee patient.

The flexion contracture (-15 extension) is particularly troublesome, since it will prevent normal walking.

I wish I had an easy answer for you. I do not. Some patients have an extremely difficult time rehabilitating. You need to compartmentalize pain. This means: observe that you are experiencing pain, but do not resist this pain by tightening your muscles. The longer you hold your stretches, the better. This is because your muscles can not resist forever. You need to understand that pain experienced with stretching in your situation does not indicate damage is occurring. Using ice, anti-inflammatory medicine, and even narcotic pain medication to facilitate LONG DURATION stretching is appropriate.

There is a chance you will experience improvement for up to a year or more from now, however, I think there is significant risk that revision surgery may be required. This is because of the severe flexion contracture you have. I recommend you focus on long duration extension stretching in an attempt to get your knee straight enough to walk with a reasonably normal gait.

You do not need 0-120+ degrees range of motion to have a pain-free, functional knee, but the closer you get to this, the better.

I am sorry to hear you are having such difficulty. Best of luck to you.

Pam Davey
9/5/2020 08:08:19 am

Thank you - the information you provided re stretching is extremely helpful. I an 66 years of age & generally fairly active. I am just over 5 weeks Post op after TKR I have an existing big scar on the inside of my femur from several osteomyelitis operations as a child then an op to remove the scar about 40 years ago & also an op to remove the infection in the scar tissue about 10 years ago I seemed to be progressing well but now have gotten very stiff & tight around my old scar closest to the knee joint I thought I was doing the right thing by cycling but now nearly overnight I can’t bend my knee enough to push the pedals around

Pam Davey
9/6/2020 01:01:16 am

Thankyou for you ideas & recommendations re stretching I am 66 years old have just had a tkr on my Right leg. I am currently 5.5 weeks post op. Seemed to be progressing well until 3 days ago when everything has stiffened seem to be limping more. As a child I had 3 operations on my inside femur for osteomyelitis 40 years ago I had the scar partially removed & 20 years ago had another op when there was an infection in the scar tissue The main pain I have now after the TKR is around the front of the old scar I can’t believe that my Physio & surgeon didn’t insist on the stretching for a considerable time

Jenn Kerr
10/24/2020 08:37:38 am

thank you sooo much for investing all the time and effort into this blog/website. I just know that the extended duration stretching is going to help me. I’m three weeks post-op, and I have almost full extension and i guess around 110 flexion - but pain and stiffness abound!

I want to try your method of minimum 1 hour per day in these stretch positions - in 10 minute intervals. My question is whether this means 1 hour for flexion and 1 hour for extension? I think I understand correctly that I don’t need to choose more than one exercise for each per session which means I can break up the monotony a bit!

I also am wondering......I have a spin bike at home......people talk about recumbent bikes, I’m using my spin bike but my question is whether to do after stretching or as warm-up before!

Again, thanks so soo much for all of this information, I was really getting quite worried and frustrated.

Oh.....related question.......I had a bad MVA many years ago and separated my S/I joint, and frequently have troubles with it - go to chiro, but pain comes and goes still. It is on the same side as my TKR. My question is this. My surgeon has apparently corrected my hyperextension.......in the operative leg obviously. And I’m worried it will be longer than the other in standing position.......also wondering if there could be impacts on my S/I joint?

Thanks again

Christopher Gorczynski, MD link
10/24/2020 04:40:09 pm

@Jenn Kerr

With stretching, more is better. If you can manage to do an hour of flexion and extension, that would be great. If you are only able to get to a single hour of stretching for both motions, that is likely adequate. Do not stretch your knee into hyperextension. In other words, get full extension, and then simply maintain that. There is no value in hyperextension of a total knee replacement. In fact, it will be quite counterproductive.

A spin bike would be ok for a warm-up. Spinning for long durations early after knee replacement could be irritating and would not inherently result in excellent range of motion. Stretching as I recommend throughout this website is the most efficient means to regain motion.

Unless your other knee is significantly malaligned, or you have a major flexion contracture, your new, straight replaced knee is unlikely to irritate your SI joint.

Jenn Kerr
10/24/2020 09:06:49 pm

Thanks again. And don’t worry, i have no intention of trying to force my hyperextension back into being.......just wondered if one being straight and the other not might make the leg lengths off kilter. :). Thanks for reassurance re S/I joint.

I tried today for an hour each flexion and extension, managed 40 minutes each, very painful, but I think helpful. And frankly that was going from 2 minute holds to 9 or 10 for each stretch, so not feeling too bad. I’ll keep working at it, I’m sure it is the key.

Thanks again.

Michael
10/29/2020 09:39:34 pm

In the last 2 months I have had 2 knee surgeries. I had an acl reconstruction/medial meniscus repair (stitching of the meniscus). 2 months after this surgery and after intense stretching and physio, I required a MUA and arthroscopy to clear out scar tissue which was stopping my ROM in my knee. Now 2 weeks after MUA and arthroscopy and I still can’t fully extend or flex my leg. I’m stretching everyday and going to physio 3 times a week. Do you think its too early to see results or should I be seeing better results by now? I am worried that my knee will be like this forever. Would love to hear your thoughts.

Christopher Gorczynski, MD link
11/8/2020 08:27:57 pm

@Michael

Generally, after ACL reconstruction, you have a bit more time to regain range of motion, relative to total knee replacement. This is because much less trauma is imparted to the knee to perform the operation. That being said, it appears you are dealing with arthrofibrosis. This is a condition that can occur after ligament surgery where the knee becomes very stiff and aggressive scar tissue envelops the knee. You have treated it appropriately thus far. The stretching exercises I describe throughout this website are appropriate. Using ice, anti-inflammatory medications, and potentially even undergoing a cortisone injection may be necessary to help you recover. I would expect improvement in motion for many months to come as long as you continue to focus on stretching and inflammation control.

If you are developing a flexion contracture (inability to fully extend)- check out my prone hang technique article:

https://www.yourorthomd.com/orthopedic-knowledge/the-best-total-knee-extension-stretch

Also consider asking your surgeon to prescribe a static extension brace.

Graham
12/15/2020 05:40:05 pm

Thanks for a very informative article, will definitely do what you suggest.

Trey Wilson
1/5/2021 04:28:40 pm

I am 7 1/2 weeks post op for a fractured patella. I had 1 screw and a figure 8 done during ORIF surgery. The scar has healed nicely and I have complete extension. However, my surgeon did not recommend moving the knee until about a week and a half ago, in which time I have went from about 40° flexion to 67° flexion. I visited my ortho today and he is recommending manipulation under anesthesia but I don’t want to have it done due to anesthesia concerns and scared of complications. Do you believe that your method of extended flexion could help me get to at least 90° or further without manipulation under anesthesia? I am not currently insured and money is also a concern for the MUA. I have 6 days to inform the surgeon if I want to have to procedure done or not. Thank you for your time.

Reply
Margaret Bartlett
9/5/2018 06:04:51 am

Thank you so much for this advice. I am 3 weeks post op tkr and nearly bought a small pedal machine last night and also went for a longish walk. Woke up this morning feeling very stiff then found your article. Also holding the knee bend for minutes rather than seconds has given me a breakthrough in my recovery.

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Christopher Gorczynski, MD link
11/5/2018 08:43:16 pm

Glad to hear that extended stretching is helping you. Consistency (no days off) and long duration, progressive stretching definitely seems to be the most effective, and least irritating method to rehabilitate total knee replacements.

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C M Allan
11/5/2018 06:45:08 pm

Thank you for this really helpful information. I'm finding the more lengthy stretches are making all the difference and I've stopped being quite so scared of splitting the scar when pushing further with the knee bends. The exercise involving hanging my knees over the side arm of the sofa is really helping get rid of the deep ache from where the tourniquet was positioned during surgery. Why is that?

Reply
Christopher Gorczynski, MD link
11/5/2018 08:44:08 pm

I am pleased to hear that extended the duration of stretching is helping you to make progress with your total knee rehabilitation. Stretching over the arm of the sofa allows your muscles to relax during the stretch. Because the tourniquet creates mild trauma to your thigh muscles, allowing them to relax while they are being stretched is probably why you find this helpful. All too often I hear about physical therapy sessions that sound like torture sessions, or strength contests. Gentle, progressive, long duration stretching makes this process much less unpleasant. Thank you for the comment, and keep up the good work!

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Bob McWilliams
11/16/2018 02:08:09 am

Dr. Gorczynski,
I’m 13 weeks out from my TKR. The best I can remember (lots of meds) I have had a tight band running just below my patella (front only) and another on the outside edge running at at 45 degree angle. They are tight and like a rubber band (I’m assuming it’s scar tissue).
Do you think that will that go away over time? I’m out of official PT but ride my recumbent bike daily and do strengthening and stretching exercises.
Now that the swelling has gone away and most of the pain I am very active outdoors and can do most everything I could before except get on my knee.
My last flexion measurement was 102. I’m not giving up though and am shooting for 120 hoping for at least 110.
I have lost a lot of weight prior to and after surgery and plan on keeping that off.
Thank you for taking my question about the band issue. I hsve not seen that addressed anywhere.

Reply
Christopher Gorczynski, MD link
11/26/2018 05:36:51 pm

This does sound like some scar tissue. To gain more range of motion at this point, you really need to focus on prolonged stretching exercises, maintaining stretches for 30 minutes or longer, multiple times per day if possible, and every day. Since scar tissue tends to contract over time, it is normal to feel the need to work at range of motions exercises sometimes for many months.

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Bob McWilliams
11/27/2018 08:30:17 am

Thank you for your reply. I’m clear on your advice for stretching a minimum of 1 hr several times a day if possible.
My question is is it ok to to keep riding my recumbent bike and do strengthening exercises along with these sustained stretches?
8/7/18 was my surgery date. My surgeon has released me and will not see me again unless I make an appointment. He said after 6 weeks he would not do a manipulation. We did not discuss removal of scar tissue. Should I seek further advice (2nd opinion) for removal of scar tissue OR rely totally on these stretching exercises? Thank you

Bob McWilliams
11/16/2018 02:18:56 am

Dr. Gorczynski, I’m sorry but I did want to add, when I exercise ( bike, stretching etc ) the band tightens a lot right afterwards. After a good nights rest it relaxes to its normal tightness which is tight enough it’s very aggravating and in a way dehabilitating.. Thank you

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Christopher Gorczynski, MD link
11/27/2018 09:05:28 pm

It is definitely ok to continue riding the recumbent bike as well as progressive strengthening exercises. A simple manipulation is unlikely to be very effective beyond 6-8 weeks maximum. I recommend that you continue doing exactly what you have been doing. Particularly working for long periods on regaining deep flexion. I have seen patients gradually improve their range of motion for up to an entire year from surgery. Persistence and patience will usually pay off. Ice and anti-inflammatory meds will assist you. If, at a year from surgery, you have not regained a range of motion that is acceptable to you, you could consider undergoing arthroscopic lysis of adhesions and manipulation. But, this is not something I would encourage you to do at this point because there is an excellent chance you will correct this on your own.

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Jenn Kerr
11/4/2020 11:20:12 am

Hi Dr. Gorczynski,

I am now 4.5 weeks post-TKR, and have a LOT of stiffness still, mainly in the purple and/or orange area of your diagram. I am trying very hard to do my flexion exercises in particular, I bike a lot and am trying to ratchet the seat lower and lower hoping it will help with the scar tissue.

My ROM is pretty good, about 120-125 passive at PT (extension 0 or close to it). But the stiffness is really painful for exercises, and just general living. :). So I’m trying to do the long-duration stretches for at least an hour a day. I find that when the knee is warm it seems to bend better......and am beginning to wonder if icing post-exercise is making things tighter, or whether you still recommend it??

I have a cryo-cuff, and I find the compression really helps. Or I think it does. To be honest, some times/days one thing helps and the next day/time it doesn’t at all, which makes knowing what to do a difficult proposition.

Also wondering if it is true that given my ROM is pretty good, nothing may get done about the scar tissue/pain? If I keep stretching can i just expect it to resolve?

Sorry for all the questions, just quite frustrated, and not seeing improvement except possibly minor (again, not sure).

Christopher Gorczynski, MD link
11/8/2020 07:57:25 pm

@ Jenn Kerr: At only 4.5 weeks, with 125 degrees of motion I think you are doing just fine. I would continue stretching and icing as you describe. Maybe ease back on the biking a bit and focus more on slow, gentle stretching to maximize your range of motion over the next few weeks. You will improve for many months yet to come. While it is easy to get frustrated, patience and persistence are the key to an optimal result.

Cathleen
1/3/2019 05:18:07 pm

I am 6 weeks post knee replacement. I achieved 115 deg. range of motion at 10 days post op. I now have 121 deg. ROM but don't seem to be progressing beyond that. I have been relatively pain free but my knee is very stiff. I am very flexible and do extensive stretching 5 times a week. I will begin stretching daily per your advice. I will begin holding my stretches longer.
I am not understanding why I seem to be stiffer and more uncomfortable than a week ago. I am using ankle weights on both legs for 2 exercises..1 1/2 lbs.weights each. The weight is causing lower shin minor bruising on my knee replacement leg. I ride my recumbent bike 30 minutes with resistance each exercise session to warm up before stretching.

Any ideas about why my knee stiffness is worsening? Thank you for your help.

Reply
Christopher Gorczynski, MD link
1/4/2019 11:51:02 am

A 121 degree arc of motion is excellent, and should be sufficient for all reasonable activities following total knee replacement. It is possible to regain even more motion, but this takes a great deal of work and is not a guarantee of better function. Scar tissue tends to thicken and contract over time. This could be why you are feeling a bit stiffer. Thankfully, this process does not last forever. I would expect this feeling of increasing stiffness to end over the next couple of months. Simply continue gentle, long duration stretching to maintain (or slightly improve) your already excellent range of motion. As for the 1.5 pound weights, if they are causing irritation, I would discontinue them. Simply walking, riding your resistance bike with low resistance, and time will help you to regain function. Gradually add double leg squats, then consider single leg squats, holding something to help with balance.

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Cathleen
1/3/2019 05:20:07 pm

Sorry I forgot to mention on my previous post that I am a 68 year old woman in excellent health.

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Cathleen
1/4/2019 01:55:09 pm

Dr., thank you very much for your encouraging reply. You have saved me worry and second guessing my progress. Very much appreciated!.
I am not sure if any of your patients cannot tolerate narcotics Since childhood I have been deathly allergic to all narcotics. I was naturally very concerned about pain after my knee replacement. I religiously did leg/knee strengthening exercises and stretches for 6 weeks prior to my surgery. I had a block during the surgery and was fully awake. I have had very little pain....just stiffness. I take Celebrex and tylenol for pain. I have not really needed anything else. I also used an ice therapy machine for 2 weeks after the surgery. My second knee replacement is February 25.
Cathleen

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Christopher Gorczynski, MD link
1/4/2019 02:29:08 pm

I do have patients that either don't want or don't tolerate narcotic medications and are similarly able to rehabilitate their total knee replacement using only ice, tylenol, and NSAIDS. The regional anesthetic block we use definitely makes a big difference for the first 20+ hours or so. Best of luck on your second knee replacement! The nice thing is that after this....you have no more knees to work on....

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Sharon
1/13/2019 11:37:24 pm

Dr., I'm only 5 days post op from my TKR surgery and have yet to have my follow-up appt. with my surgeon or my first PT session. I'd been improving daily... less pain and discomfort... easier to walk and stretch. I've been doing my exercises religiously and then suddenly today my swelling and stiffness increased. It actually feels like I have an invisible ace bandage stretched around my knee! I've continued with my stretching exercises and am actually even holding a stretch longer... but this stiffness continues. Is this temporary or should I be concerned about some longer lasting effect? Thank you so much for your reply.

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Christopher Gorczynski, MD link
1/14/2019 09:46:28 pm

Your experience is not unique. It is common for patients to feel that recovery is quite easy for the first few days following surgery and then feel that their progress becomes much more difficult. This is so common, in fact, that we tell our patients to expect the second week to be less pleasant than the first.

There is an inflammatory cascade that happens when your body is traumatized. Surgery causes injury to the body. This injury induces an inflammatory cascade. It takes your body a while to mount this inflammatory response. In general, I would expect this inflammatory cascade to peak around 10-14 days postoperatively.

Additionally, as your body begins to heal, tissue planes begin trying to "stick together." This early scar tissue makes stretching more challenging.

It is crucial not to discontinue stretching during this time. The mistake is to let the pain suggest you are doing something inappropriate. You only have a few weeks to regain a functional range of motion, and each day that goes by allows the scar tissue to become more robust. This means that delaying stretching only makes subsequent stretching attempts more difficult.

Do your very best to relax mentally and physically during stretching sessions. While you do not need to use high forces during stretching, it is usually better to extend the duration of stretching and to add multiple sessions throughout the day. Additionally, the use of ice can help reduce some pain and inflammation. If your surgeon allows it, anti-inflammatory pills can also be helpful during this time.

Once you have achieved a functional knee range of motion, and the inflammatory phase of the healing process is behind you, your knee will feel better and better, and should ultimately become pain-free.

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Reba Pierce link
1/17/2019 04:59:12 pm

I am 10 weeks post-op TKA. My flexion has varied of late from 125 to 127 with passive assistance. I have maintained a slight degree of swelling which my PT assures me is not impeding my progress. However, my walking has been consistently sub-par and in the last few days I've developed the that band that so many people have referened. I was very interested in your information about stretching, which my PT hasn't instructed me to do. Since reading your blog, I've been doing prolonged stretching for a couple of days and plan to continue. At times it seems to be helping, but I wonder if I've gotten to this information too late in my recovery and will need more aggressive treatment by my surgeon.

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Christopher Gorczynski, MD link
1/17/2019 08:39:12 pm

If you have achieved 127 degrees of flexion and have full extension, you should be in great shape. I would expect an excellent result. At this point I would recommend simply maintaining the range of motion you have achieved, and allow the inflammation to subside gradually as your knee heals. Patience is key. There is no reason for you to be anxious at this point, the hard work is behind you. At this point I would expect your knee to gradually settle down and feel better and better as months go by.

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Melissa C
5/11/2019 08:15:47 am

I cannot even imagine 127 degrees! Wow!! I am 10 days post op and have struggled to get to 70 degrees. I simply cannot believe how extremely tight the knee is, already. I have read through all of the emails and will continue to work at holding the flex position for a longer period of time. Thanks for all of the information!!

Christopher Gorczynski, MD link
5/12/2019 11:02:30 am

@Melissa C

In the first couple of weeks following total knee replacement, concentrate on reducing inflammation. Ice, anti-inflammatory medication, slow/sustained stretching.

Try to relax as much as possible during the stretch, keep the anxiety level low. Remember, you have 6 weeks to get a functional range of motion back. Stretch multiple times per day, for longer and longer periods of time.

Even a couple degrees of progress per day will give you an excellent range of motion.

Phyl
1/23/2019 01:29:33 am

I am a 70 year old female 7 weeks out from TKR. I had my right knee replaced in 2017 and now my left knee Dec 2018. I have that tight band that has been spoken about on here and only 90 flexion so far, it was stuck at 78 for 3 weeks. I’ve just started doing the longer stretches you recommended and already I can feel the difference. I think my Physio will be pleasantly surprised at my progress so far. I was too frightened to “push it” as I thought I would break something. Thank you for your suggestions they do help!
PS... I am only taking Osteo Panadol and Celebrex and have been since my op as I had adverse reactions to all other meds..even though I was on them for the other knee, I must admit I feel better without the stronger ones.

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Christopher Gorczynski, MD link
1/25/2019 10:49:30 am

It definitely sounds like you got off to a bit of a slow start. 90 degrees always seems to be a "sticky spot" with regard to range of motion.

If you have not done so already, check out the videos I posted using a yoga band to help stretch beyond 90 degrees of flexion.

At this stage following surgery you will really need to be persistent with long duration stretching to regain functional range of motion.

If you are still stuck around 90 degrees of motion at 7 weeks, I would strongly recommend discussing possible manipulation under anesthesia with your surgeon. This usually helps you get back on track with your range of motion.

The trouble is, most patients are unable to achieve much improvement in range of motion on their own beyond 6-8 weeks from surgery. A manipulation not only rapidly advances this range of motion, but buys the patient a few more weeks to make further gains in motion.

Beyond 8 weeks, if range of motion is inadequate, additional improvement usually requires an invasive procedure (arthroscopic lysis of adhesions prior to manipulation.) This obviously entails additional risk and ideally is avoided.

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Cheryl
1/23/2019 11:29:05 am

I had my first total knee replacement on 11/14/18 and the second one in 12/26/18. The first one was a breeze - the second one, not so much. Four weeks post surgery, I am having trouble even reaching 110 range of motion. My incision is healed yet, the sensitivity is nearly unbearable. I can’t tolerate even a light cloth touching it. I do the stretching exercises as recommended and still have therapy twice weekly. At the last visit, the therapist found an area that was extremely sore, to the right and back of my knee. He suggested I have damage to a tendon and recommended self massage. Could this be a barrier to healing?

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Christopher Gorczynski, MD link
1/25/2019 10:41:41 am

Every patient has a somewhat different experience when rehabilitating a joint replacement. A subsequent joint replacement can even feel different to the same patient. In my opinion, 110 degrees at 4 weeks is fine. I would recommend continuing to stretch for long periods of time as I recommend elsewhere in this website. The longer the better. I would expect another degree or 2 of improved range of motion for another couple of weeks time. That should allow you to regain at least 120 degrees of motion. This should be more than adequate for all desired activities.

Touching and massaging the knee along with ice should help reduce the hypersensitivity. Anti-inflammatory medication (oral or topical) can also be helpful, but I would discuss this with your surgeon. If there is a point-tender spot that does not improve with time, I recommend discussing this with your surgeon.

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Kevin
1/23/2019 08:17:06 pm

Dr. Gorczynski:

I am six weeks out from left TKR. 63yo male in excellent health. 5-11, 158 pounds. I came out of surgery well. PT initiated very aggressive therapy. I was 120 degrees flexion at 2 weeks and 130 degrees at 3 weeks, with less than 1 degree from straight. Still pushing both. PT has had me doing athletic therapies like running up and down stairs, body weight squats, wall sits, static and walking lunges and other drills. I have been riding a stationary bike for 30 minutes and have walked for 40 minutes. I have not used an assistive device since Day 10. However, I have also developed swelling above the kneecap and along the lateral side of the knee. It is always stiff and painful at this point. I have been pushing through it in PT and gym training of my own, which has included low-weight single leg presses. But it is becoming problematic. Feels like a tourniquet across the top of my knee. Very tight. While my gains in PT and gym have continued, I'm actually going backward in daily life. I am taking no meds. Sleep is problematic. Concentration level at work is low because of the pain. I saw my surgeon at 6 weeks and he was thrilled and said the swelling will subside. Implant looks good. But I am worried. The question is: Did I do too much? And what is the cost?

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Christopher Gorczynski, MD link
1/25/2019 10:35:38 am

It is very easy to become a bit impatient when rehabilitating after total joint replacement. It is important to understand that the healing process truly takes at least a year(and perhaps even longer) to be complete.

Swelling indicates inflammation. Some inflammation is expected and unavoidable after surgical trauma. Overuse also may cause inflammation.

My recommendation is: maintain your knee range of motion. Reduce the repetitive and higher impact exercises. Let your knee calm down.

As long as your knee range of motion is adequate, time will take care of everything else. When you are feeling better, and a few weeks have elapsed, gentle strengthening can be resumed. I would focus on hip and core strength. It is really too soon to be aggressively strengthening the muscles about your knee.

My sense from your message is that there will be no long-term consequence from the overuse your knee was subjected to. Let it calm down, and then gradually advance activities. Remember, this is a long-term process. Your patience will be rewarded.

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Karen
2/9/2019 02:37:55 pm

Hey Doc,
I had bilateral TKR’s last April. I have good range of motion and am finally walking well. ROM 125 in each. No real pain but stiffness on the knee surface, best described in your diagram as “purple”. I am happy to have straight legs, ability to stand for longer periods of time and to have ROM that allows for me to ride a bike. However stairs are still with discomfort due to this tightness? Scar tissue? How do I expedite or stretch this area? I have tried massage & shock wave therapy. Any ideas?

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Christopher Gorczynski, MD link
2/9/2019 08:03:19 pm

The purple in the diagram above represents the tissue plane between the skin/fat in the front of the knee and the kneecap (patella). These tissues must slide relative to each other to allow normal knee flexion. That being said, your 125 degrees of flexion suggests well done rehabilitation, and I doubt your range of motion is interfering with stairs.

The tissues around your entire knee are usually thickened a bit after surgery (permanently) as there is normal scarring expected. Long-term, this generally does not cause any significant discomfort.

Difficulty on stairs, particularly in the front of the knee often suggests hip weakness. Another common complaint associated with this is aching pain in the front of the knee with prolonged flexion (for example in a movie theater or back seat of a car.)

Thankfully, there are a few simple exercises that usually make a tremendous difference. I have an entire blog posting focused on this:

https://www.yourorthomd.com/orthopedic-knowledge/anterior-knee-pain

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Melisa Brubaker
2/9/2019 03:10:27 pm

I am 61 yrs young, I had both Osteo knees replaced using Conformis, 6 months ago 8/9/18..Before hand I started exersizing, riding a bike, & swimming to get in better shape before surgery..I had excellent exstension after surgery, everything went well, but my right knee more often that not is super tight at times, feels like a tight band around the knee, and up into my inner area & front of leg..like a pulling..I have continued with exer. 3 x a wk for 30 minutes, & I walk 15 to 30 min. every day on my treadmill as well as 15 min 3x a wk on my bike..Also my scar is darker on this knee..My left knee feels great other than a little stiffness if I sit too long..Can u suggest anything I might try? I also eat healthy to try and improve..I rarely do steps there are none in my home..could that be it? tks so very much!

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Christopher Gorczynski, MD link
2/9/2019 07:56:38 pm

From your comment, I presume both knees were done under the same anesthetic. Thus, both scars should have similar appearance. While I would expect continual improvement for up to an entire year or more from surgery, it is strange that your knees feel so different. If this is significantly irritating to you, it is worth discussing this with your surgeon to see if he/she recalls any differences intra-operatively, or if there is any soft tissue balance or range of motion difference between your knees. If your range of motion is not symmetric, I would focus on long duration stretching in an attempt to equalize and maximize your motion bilaterally.

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Melisa
2/11/2019 12:35:11 pm

Thank-you!

Miriam
2/9/2019 09:26:03 pm

My knee is so stiff and 8 weeks after surgery what can I do to help this. I stretch every day with no relief.

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Christopher Gorczynski, MD link
2/9/2019 10:03:14 pm

If you are not happy with your range of motion at 8 weeks postoperatively, you could be a candidate for manipulation under anesthesia. I consider this a way to "catch-up" to where you should be at this point. It is important not to delay. I usually perform this when needed at 6 weeks post-op. Much beyond this, the scar tissue has become too robust to make much gain...in this situation an arthroscopic procedure needs to be performed first to cut the scar tissue prior to manipulation. Obviously, an invasive procedure is much less desirable than a simple manipulation. Therefore....call your surgeon this week to discuss manipulation ASAP.

Here is a link to an article I wrote on this topic.

https://www.yourorthomd.com/orthopedic-knowledge/manipulation-under-anesthesia

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Shearon link
2/10/2019 05:41:59 am

I had right knee replaced jan 15 2018. I have had pain on left side of that knee since. Had arthroscopic sept 7 to break up scar tissue and bend. I was able to bend to 121 after that surgery but with great pain. My pain is worse and range of motion is too. I still go to gym twice a week. It usually takes me a few days to get over my work out which is not that strenuous. I did not have much pain prior to surgery unless I had to walk great distances (shopping, yard work). I have had a nerve block and nerve ablation (very painful). So far no relief. What do I do now? Live in pain with a stiff knee? Not what I planned when I retired. I am 69 and in great physical shape except for the knee. My mental state is suffering too.

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Christopher Gorczynski, MD link
2/10/2019 11:47:54 am

A stiff knee can be very frustrating- both to patients and to surgeons. Assuming the knee was properly balanced during surgery, a stiff knee suggests inadequate rehabilitation (stretching) in the early postoperative period. Once stiff, regaining normal motion without pain is very difficult. That is why I suggest the key is to regain full functional range of motion within the first 6 weeks postoperatively.

Once stiff, pain is a common complaint.

It is very important NOT to avoid stretching because of pain.

If your knee range of motion is inadequate for normal desired activities, and your pain level is unacceptable at this point, it is important to ensure your prosthesis is appropriately placed (all angles and rotation are correct), and that there is no evidence of infection.

It is possible (although far from ideal) to undergo revision knee replacement surgery under these circumstances. Clearly this entails risk. Most concerning is the risk of infection. Revision surgery is most predictable if the underlying problem can be clearly identified. If the problem is poorly positioned prosthetic components, this can be fixed. If no cause can be identified, then it is crucial to make up your mind that early rehabilitation will be done differently next time....regardless of pain level.

Long duration stretching is absolutely mandatory.

I would also plan on using a static stretching brace like a JAS (Joint Active System) brace to help facilitate extended progressive stretching.

https://jointactivesystems.com/products/jas-sps-knee/

I have found such braces quite helpful over the years. I would discuss this with your surgeon. In fact, I would obtain one of these (or similar) braces and use it diligently for several months before proceeding surgically. The long periods of time spent at the endpoint of motion will usually allow progressive range of motion improvement. Even if you do not achieve significant gains, you are training your self to endure the discomfort for long period of times and getting in the habit of stretching every day without any days off. This will be very helpful should you eventually decide to undergo revision surgery.

To summarize:

1- Ensure your prosthesis is implanted correctly. A second opinion is always reasonable. Additional imaging is often necessary.

2- Rule out infection.

3- Train your body to endure long duration stretching.

4- Consider the use of static bracing to help stretch for long durations.

5- Stretch every day for months prior to considering surgery.

6- If surgery is ultimately deemed necessary, make sure you stretch adequately immediately and consistently following surgery, every day, until your knee is cool, calm, and functional.

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Christopher Gorczynski, MD link
2/10/2019 11:55:25 am

The reason I focus so much on long duration stretching is that your tissues are viscoelastic. That means they will yield to long duration tension.

https://www.yourorthomd.com/orthopedic-knowledge/viscoelasticity

Early after surgery, no scar tissue has been able to develop. Stiffness at this point is due to the pain and swelling of acute inflammation. Nothing is physically blocking range of motion.

As weeks go by, actual scar tissue devleops between tissue planes and the undersurface of the quadricep tendon scars down to the anterior femur just above the knee. As this occurs, actual physical resistance to motion occurs.

Scar tissue starts out wispy and weak. It is easily stretched. This tissue becomes more robust with time, and ultimately quite rigid. The farther a patient gets from surgery, the more challenging it is to rehabilitate.

I can not emphasize this enough: the time to regain range of motion is immediately after surgery. A functional range of motion needs to be obtained by 6 -8 weeks from surgery. Beyond this time, more aggressive/invasive management is usually necessary.


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Miriam Lunk
2/14/2019 08:07:34 pm

I am 8 weeks out of total knee replacement. Rangeof motion is 127 . But I am in more pain and tne knee feels stiffer. I stretch every day. What can help this.

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Christopher Gorczynski, MD link
2/27/2019 09:53:22 pm

Time, ice, anti-inflammatory medication, continued stretching, and patience.

I would expect you to "turn the corner" soon, and begin feeling better. If this does not happen in the next couple of weeks, I recommend you discuss this with your surgeon.

Remember, assuming your surgery was properly performed, and you have properly rehabilitated it, you are expected to improve for an entire year.

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Nancy B
2/19/2019 12:01:54 am

I am 12 weeks post op after a patella fracture. I was in an immobilizer for the first 4 weeks. My rom was only 60 degrees at 5 weeks of PT so I had an MUA. It is now 2 weeks after the MUA and I am at 90 degrees. Do you think it is possible with your suggestions for stretching along with intensive PT to keep improving the rom or is it too late to have much of a change now? I really want to know the truth but no one seems to know the answer.

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Christopher Gorczynski, MD link
2/27/2019 09:57:07 pm

After an injury like you had, treated as yours was, I think you should expect progress with regard to range of motion for many months to come. Slow, steady, prolonged stretches are the best way to improve your range of motion. It is important do stretch as often as possible, for as long as possible, every day. Check out my article on use of a yoga strap to help.

https://www.yourorthomd.com/orthopedic-knowledge/another-way-to-stretch-your-knee-replacement

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Nancy B
3/3/2019 11:59:21 pm

Thank you for your reply and for a wonderful, caring website. It has helped me a lot. I am improving with your suggestions of stretches and am now at 118 degrees 3 wks after MUA and PT 5x wk. It has been a long and painful road so far. Could you tell me what I should expect going forward? How long it will take and what I can hope my knee to get back to? Besides the pain, the not knowing is really messing with my emotions.

Christopher Gorczynski, MD link
3/4/2019 07:10:41 am

I am pleased to hear that this website has been helpful to you.

You are clearly working very hard and consistently to rehabilitate your knee. This effort should pay dividends for you long-term.

It is somewhat difficult to predict precisely how any individual will ultimately do, however, in general, and if you continue your consistent efforts, I would expect your knee range of motion to gradually increase over the next several months, and your pain to gradually improve for up to an entire year. This prolonged course reflects the inflammatory process that occurs following trauma (surgical or accidental). Unfortunately, you might permanently lose some deep flexion, but you have already regained a good functional arc of motion. Over the very long-term, a patella fracture increases the risk of developing arthritis in the knee joint. This is because the cartilage coating the undersurface of the patella was also injured when the bone was broken. Overall, it appears you have healed nicely, and are now on the right track to regaining acceptable knee function. I predict your knee will serve you well for a long time in spite of the injury. Best of luck to you!

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Nancy
2/27/2019 01:25:23 am

I had tkr right knee in July 2017, no problems with the surgery, not much pain through any of it. Went back to work as a florist in 3 months. Lots of standing, lifting, bending, walking, heavy work. Still no pain but just in the last few months the swelling is horrible. I come from work and can hardly walk. My surgeon took x rays and everything looked good, my flexion is good and my bend is 120. I need to have my left knee done soon but not sure if I want to go ahead with it if my right knee is so swollen all the time. Wondering why the stiffness and swelling is getting worse. Thank you for any comments.

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Christopher Gorczynski, MD link
2/27/2019 10:05:09 pm

Swelling without trauma in a knee replacement that had been functioning properly is concerning.

If it is getting worse, it is important to be evaluated by an orthopedic surgeon. If the x-rays look good (as you reported), I would recommend some blood work (CBC, ESR, CRP). These labs are useful to help rule out infection. I would also consider lab work to rule out tick borne illness (Lyme, Ehrlichiosis, etc.) It is also important to make sure your knee is properly balanced (that there is no instability). This is done by history (feeling unstable or giving out) and by physical examination loose side to side or front to back when stressed by your surgeon. Lastly, adverse reaction or allergy to materials should be considered and evaluated.

I agree with your plan to wait on the next knee replacement until the problem with your first knee has been figured out and resolved.

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Brenda
3/15/2019 07:30:50 pm

Hello,
I had a TKR of my right knee on 11/20/18. I have been in PT ever since. The fist 3 weeks were torture sessions in which I cried every tim, 5 days a week. Then the dr sent me to a PT he uses for a month. My range of motion was only 105. Dr said he wants to do an MUA. I’m trying to avoid that. I have been at a different PT now since 2/15/19. My ROM is 114, but it is very painful to bend it to that degree. The knee isn’t as stiff as in the beginning, but it is still difficult to flatten it due to a lot of pain behind my knee. I am in PT 4 days a week and just started going to a massage therapist last week. She works on the whole leg for an hour to soften the tissue and relax the muscles. I have no pain after her therapy which is great for several hours. Then the pain behind the knee recurs and bending is difficult. Do you think I should have the MUA? I’m nervous and discouraged.

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Christopher Gorczynski, MD link
5/12/2019 10:56:51 am

My experience is that manipulation needs to be done within 8 weeks of surgery. Beyond this point the soft tissue contractors/scar tissue will not yield to a reasonable force.

If range of motion is unacceptable beyond 3 months from surgery arthroscopic lysis of adhesions (cutting of scar tissue) must be done prior to manipulation.

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Neil Coleman
4/6/2019 05:53:31 pm

I am 66 yrs old , and I am fit and active . I had TKR 11 months ago , for arthritus . After 6months I had 0 deg. ext and 95deg .flex , and was making good progress . I was playing social doubles tennis , but not quite able to road bike . Generally feeling positive , back at gym and doing regular stretching exercises . 8 months post.op , I had discomfort in knee , with swelling and heat . Had to ease off on physical activity . Weight bearing after sitting was a problem , as well as a very clicky knee . I revisited my surgeon who x-rayed and declared the new joint "pristine " but suggested there had been some tissue damage , and keep up the exercise . My Physio has given me specific quad strengthening work , and I am currently using your excellent "flexing with strap" regime to increase my flex to about 100deg . I also have regular massage , and have been taking low dose antiflam medication.
After 11 months , while I don't have pain , my knee is often clicky and wobbly after sitting or lying . I now limp more , and find activities harder I am concerned with my reversal of progress . While I am doing everything I can do to recover my knee health , can you tell me if it possible to "overdo" these exercises ? , or suggest any thing else that may help? Your blog is extremely helpful , I wish my surgeon and physiotherapist had explained TKR as well as you do .

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Christopher Gorczynski, MD link
5/12/2019 11:13:01 am

It sounds like you have a bit less range of motion than would be ideal for your desired level of activity.

The wobbly sensation you describe accompanied with difficult flexion could suggest slight soft tissue imbalance in extension relative to flexion.

Some total knees will loosen up with time, and in the absence of pain do not require treatment.

In my opinion, simply stretching harder or for for longer durations is unlikely to help at this point.

I would consider getting a second opinion on your knee. While an x-ray might be "pristine",the soft tissue balance may not be ideal.

In your case, your knee may be improved by regaining deeper flexion. This unfortunately would likely involve an arthroscopic lysis of adhesions and manipulation. If there is instability in extension and tightness in flexion, this would require revision surgery at this point.

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Denise link
4/30/2019 06:00:54 pm

Surgery for complete left knee replacement March 6, 2019. The first 2 weeks I did the recommended physio at home. After the two weeks I started physio up to the day before I saw my surgeon at 7 weeks. I’ve been to pt 12 times. Very and extremely painful every time. Since the fourth week I have felt a piercing hook on the left side every step I make, preventing me from doing them properly. As a result, it makes me afraid of what i will feel when my foot touch the floor.
Surgeon was happy with the X-rays. Bend 90/95, flex minus 7.
I describe that as a large “cup hook”. It is excruciating. I read the comments and recommendations. But none addressed mine.
I’m looking forward to your reply.

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Christopher Gorczynski, MD link
4/30/2019 08:29:41 pm

I am sorry, I do not understand what is meany by a "cup hook." If you can clarify this in other words, perhaps I can help.

Much of this website has been focused on helping patients avoid knee stiffness following surgery. This is crucial to a good knee replacement result.

Unfortunately, when a total knee replacement is allowed to get stiff in the early post-operative period, the usual result is pain. The mistake most patients make at this time is to do less stretching because it hurts. The best thing to do is to do long duration stretching, more times per day. Using ice on the uncomfortable soft tissues and being generous with anti-inflammatory and pain medication is also appropriate.

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Jo
6/26/2019 08:03:15 am

10 months post total knee replacement. I have at least 115 bend and completely straight leg but I still have an awful tight feeling across the top of my knee when walking. I'm hoping it will wear off in time??

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Christopher Gorczynski, MD link
7/22/2019 08:31:52 pm

Following total knee replacement, your body will lay down new, thicker scar tissue. This may feel stiff for a long time. Although this tissue will always be present, it should gradually loosen up for a long time. Additionally, the lateral aspect of the knee (outside aspect) is often partly numb, this can feel abnormal, some may describe this as "stiff." With the range of motion you have achieved, I would expect you to feel better and better as months go by.

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John Cranias link
1/16/2021 08:26:03 pm

I’m 4 months out from TKR. 65 yrs old male 150 Ibs. Knee flex 0 to 115 with help 120. I still have swelling real bad painful stiffness across knee where meniscus once was. Similar to what others mention, riding stationary bike to warm it up helps before I stretch for a hour. I can’t stand on it for longer then 15 minutes at a time. I can walk heal to toe on it with minor limp but painful after 20 minutes. Doctor had recent CT scan showing implant was aligned perfectly and no other issues appears to be scar tissue getting worst daily due thickening. Did a allergy study for metal and came back negative. Do you recommend I have the lysis arthroscopic surgery with MUA at this point?

Thank you

Christopher Gorczynski, MD link
1/16/2021 09:17:58 pm

@John Cranias:

If this was my knee, I would not undergo an invasive procedure (arthroscopic lysis of adhesions with manipulation) with range of motion 0-115 plus. I would expect you to improve for many more months. At this point, I personally would continue using ice, anti-inflammatory medications, and stretching for long durations of time. The potential to undergo this surgery does not diminish with time, so it is always there as a backup plan. I think patience here is your best bet. To give you some perspective. If you only had 95- degrees of flexion, I think potential benefit with regard to improved function would justify the risk of surgery. With motion like you have right now, there is no reason your knee should not simply get better with time as it heals, and the few extra degrees that you may obtain at surgery would not be expected to make a significant difference in your function. And it comes with surgical risk.

Nancy B
7/17/2019 11:00:31 pm

Hi Dr G, I am still recovering from a patella fracture on Nov 2018.
I will always be grateful for your suggestion of long duration stretching. I was stuck at 60 degrees and had to get a MUA. It was terrifying. My ROM is great now, almost the same as my NON OP knee. At around 140 degrees! I still do the stretching everyday.
There is still some swelling, stiffness and pain though. I wonder if this may be due to having the MUA late at 10 weeks post op??

Now I am going to have surgery in 2 weeks to remove the metal and am hoping that this will help to fix these problems and that I will eventually feel better.
My questions are:
Re this surgery,
1. do I risk to get that “rare” stiffness again that doesn’t usually happen to others?
2. How soon can you usually do the long duration stretches after this surgery? I’m so scared to start it all over again. It really was a nightmare.
3. Is this surgery recovery going to be as painful as the original surgery recovery?

Also, can you suggest some ways to increase my quad size/strength? My quad is still looking scrawny.

Thank you for your help!

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Christopher Gorczynski, MD link
7/22/2019 08:39:30 pm

Outstanding job on regaining motion! Unfortunately, after a fracture, your knee may never feel perfect. It is common to find the hardware used to repair the fracture irritating, and I would expect improvement in symptoms once this is removed.

Assuming your fracture is solidly healed, I would begin range of motion exercises immediately, certainly once the wound has healed.

I highly doubt you will experience significant stiffness after this procedure, and now that you are an expert on regaining motion, I think this should seem relatively easy to you.

I would recommend avoiding open chain quadricep strengthening exercises (open chain is where your ankle swings through an arc). The most common example of this is the leg extension machine. This should be avoided. This is particularly important with your history of patellar fracture. Doing single leg squats is an excellent way to build your leg strength in a physiologically normal way. It is also important to build your hip strength.

Please check out my article on anterior knee pain for a demonstration on how to build up your hips.

https://www.yourorthomd.com/orthopedic-knowledge/anterior-knee-pain

Best of luck with your procedure, I am sure you will do very well.

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Nancy B
9/1/2019 06:25:54 pm

Hi Dr G
I have really good relief with the hardware out (2 wks ago) ROM is still good too. I have a quick question re your advice on avoiding doing “open chain quad exercises”. I definitely have avoided using the leg extension machine at the gym but is a “long arc quad exercise” the same thing? (Gentle, no weight)
If so, how long should I avoid this move? Indefinitely?
PS: just a reminder, I had a patella fracture 9 mo ago

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Christopher Gorczynski, MD link
9/1/2019 11:26:13 pm

I am glad to hear you are feeling well. I think doing unweighted long arc quad exercises is fine to help regain full, active extension. I would definitely not recommend adding weight to this exercise though, as it could rapidly become irritating to your patella. And yes, I would recommend avoiding open chain strengthening forever. Single leg squat/leg press are better ways to strengthen.

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Deborah L Domenici link
9/2/2019 03:47:04 am

I broke my knee June 10th-fell on tile. Only hurt initially. I never had any swelling or mobility issue the 1st week. Was doing everything I normally do-including mowing my lawn with zero pain or problems. All my problems started when I fnd out I broke my knee 1 week later. And i only fnd this out. Because my GP sugg. I have it x-ray since i had broke a toe 10 days prior-and was going to Ortho to have that X-rayd. Found out broke my Patella. but Orthopedist sd it was in a good place. But if I would continue to bend it. I could possibly end up needing surgery. Since it should stay straight for 6 weeks to heal. ALL MY PROBLEMS started with the immobilization. I had horrible calf, ankle, and foot swelling. i got numbness, and my leg felt like glue was poured in there. This went on for 6 weeks. I was so uncomfortable -I called ask-a nurse 2 nights. I was told to go to ER.Since calf swelling could be blood clot. Waited till Monday-told my GP this. He tells me i don't have a blood clot. I sd how do you know. He says " I'm a Dr?" He agreed on my request to let me have ultrasound referral. Where blood clot was ruled out. But this continued. And 2 weeks later when I called Orthopedist upset.They recommended another Ultrasound. Where blood clot ruled out agn. Nothing else was ever suggested from my Orthopedist or GP for these symptoms. The immobilizer came off July 28-6 weeks from June 17th. 6 weeks of hell. When it came off- i asked the Orthopedist. " Is this swelling going to go away?" He says maybe? I had 2 physical therapy sessions. But I couldn't get more than 95 degree bend in the end. Due to my calf and behind knee swelling. Another P therapist told me I wouldn't till I got rid of the edema. So-here i am now-more than 1 month from immobilizer off. I am able to get enough rom to ride my recumbant road bike now-but that's it. And I've only ridden it 3x for about 10 min-because when i get off-10 min later-my lower leg feels worse than ever-stiff cement like. Numbness comes and goes. My ankle when I try to move it-feels like I'm trying to move burnt skin. A lot of the swelling has gone. But I still have some. I can't lift my right foot off the floor more than about 10 inches. And I can't safely walk my 2 big dogs. I'm not walking totally normal by any means. I have taught aerobics a good part of my life. And I happen to be very flxible. My left foot-at 65-I can still put to my mouth. And bend back and touch my butt easily. My right foot now. I can get facing a wall. I'm 1/2 way to the butt-that is a lot of lost rom. And I feel horrible-between the 3 symptoms. Do you suggest-static stretches for me also? I use the neighbors pool. And when i 1st get there. My calf is hard as a rock. I'm able to get fluidity to it in about 10 min. But after the 50- 60 min I'm there moving. As soon as I get home-20 min later-It's BACK-the stiffness. Tuesday I have an appointment with a chiropractor for a compression boot session. And last week I had the grad-forget correct spelling technique done by him. Not so sure that was a good thing. Felt fine agn for 15 min-stiffness back 15-20 min later. And the procedure painful. Common sense tells me pressing on my leg with a stainless steel instrument-to get fluid moving-may not be the best method. So- I need advice. I'm getting very depressed about all this, I feel half crippled from a simple break that required no surgery. Chiropractor sd i should have been offered massage during this 6 weeks of immobilization-to keep fluids moving. And I'm wondering if a brace that allowed minimal movement rather than none. Would have been much more common sensical. Now my patella is healed -But I'm half crippled?

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Christopher Gorczynski, MD link
9/16/2019 08:19:44 pm

Rehabilitation after a fracture can be frustrating. I would expect progress for an entire year of more following a patella fracture. Nonoperative treatment of a patella fracture does require immobilization. Now that you are healed, it is important to have patience and persistence. You should be stretching progressively every day. The stretching I recommend on this website for patients following total knee replacement will work for you as well.

Here is a shortcut to several articles explaining how to stretch in the most effective ways possible.

https://www.yourorthomd.com/orthopedic-knowledge/category/rehabilitation

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Verna Lister
9/16/2019 08:44:50 am

I had a TKR on Aug 15, 2019. Prior to TKR I had only a maximum of 93 degrees flexon due to prior injuries. Total tears in 1988 to ACL and i 2009 PCL..some Medal lateral damage, After 4 weeks post op of have about 80 degrees flexon, extension seems OK. What should I expect by 6 weeks and what should I do for stretching?

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Christopher Gorczynski link
9/16/2019 08:09:02 pm

In my opinion, you are a bit behind schedule in regaining your range of motion. My experience suggests it is very unlikely for patients to predictably regain much flexion beyond 6 weeks from surgery. I recommend long duration, slow steady stretching, as often as possible, for as long as possible.

In my practice, if a patient does not achieve a functional range of motion (0-110 degrees or so) by 6 weeks postoperatively, I recommend a manipulation under anesthesia.

The majority of articles that appear on the following link will provide further guidance.

https://www.yourorthomd.com/orthopedic-knowledge/category/rehabilitation

Close follow-up with your surgeon is crucial over the next few weeks to make sure you end up with a functional knee

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Verna Lister
9/30/2019 09:08:29 pm

I have been doing to prolonged stretches and making more progress. But to add further information for your consideration. My knee flexon was a maximum 0f 93 degrees for more than 4.5 years prior to surgery..so how would this change the rom by 6 weeks? Would further ROM and more weeks bring a more acceptable ie 115 degrees? I am seeing surgeon Wed. I will advise him of my progress. Any further incites to why I am experiencing lack of rom to date? I have done stretches and PT every day?

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Christopher Gorczynski, MD link
9/30/2019 09:16:59 pm

Poor range of motion prior to surgery definitely correlates with a more challenging rehabilitation process after surgery. This is in spite of the surgeon regaining full, unrestricted, range of motion at the time of surgery. It appears you are now around 6 weeks from surgery. In my practice, if you are still stuck around 90 degrees at this stage, I would recommend undergoing manipulation under anesthesia. This usually makes a huge difference for patients.


Here is an article I wrote about this procedure.

https://www.yourorthomd.com/orthopedic-knowledge/manipulation-under-anesthesia

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Patrick Shipley
10/3/2019 12:58:07 am

Hello,
I am a 54 yr old male professional bowler, at had my total knee replacement June 4, 2019 on my left knee which is my sliding leg. After seven weeks of physical therapy, I had a Manipulation Under Anesthesia on August 22nd due to be stuck at 75 degrees of flexion. Physical therapy has been tough. The day of my Manipulation procedure, I went directly to PT and was 90 degrees, then PT two straight every day ended September 6th. I am now back to two sessions a week and am at 103 degrees at 17 weeks. I have my 6 week post op appointment from my Manipulation procedure next Monday Oct 7th. I’m afraid I’m stuck now at 103 degrees. The last 3 PT sessions have been the same. I bought myself a recumbent bike about week 5 and am able to peddle completely forward and backwards and moving my seat up gradually, but only to the point that I just can’t do it anymore.
I’ve been seeing on these posts about the tight band that goes completely around the knee. I have that and it’s like a 2-3 inch band. Also, I want to add, when I am trying to get my flexion, the back of the knee hurts, like a squishing feeling.
I have returned to work at 8 weeks, and also started bowling again as of last week and half. My surgeon and therapist told me to get back out on the lanes as part of my therapy, so I did just that. I bowled league last week which was 16 weeks post op, and shit 225-214-183, better than I expected, but my knee bend is still stiff during my slide.
What should I expect from my doctors visit at my 6 week post op appointment from Manipulation procedure? They mention at my 2week appointment, that there is an option of arthroscopy to remove scar tissue, but I really don’t want to go backwards.

Thank you very and input. I need some encouraging words right now.

Patrick

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Christopher Gorczynski, MD link
10/7/2019 08:22:38 pm

Hopefully you are trying to stretch the way I recommend in this article. My experience with stiff knees really suggests that short, rapid stretches are ineffective. Check out the article I wrote on viscoelasticity.

https://www.yourorthomd.com/orthopedic-knowledge/viscoelasticity

It is important to find a way that allows you to hold the deep flexion stretch, WHILE RELAXING YOUR MUSCLES.

This is the crucial point, and a mistake I commonly see. You must completely relax your quadricep muscles to effectively stretch. This means not supporting your body weight.

The use of a non-elastic yoga strap is very effective.

https://www.yourorthomd.com/orthopedic-knowledge/another-way-to-stretch-your-knee-replacement

You can also discuss a prescription static stretching brace with your surgeon. I don't think you will gain much from this style of brace at this point as your motion is really not bad enough.

I would recommend working for several months on long duration static stretching before considering arthroscopic lysis of adhesions. This is for several reasons: that procedure really isn't any different or more effective if done now, or in the future, it involves risk of infection, it is no guarantee of improved results, it is much better to train yourself to be able to stretch appropriately now, and (most importantly) if your are stretching properly on a daily basis, you very well may not need any additional procedures.

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Patrick Shipley
10/3/2019 01:38:09 am

I’m sorry, I had my weeks messed up. My Manipulation procedure was on August 22nd which was 11 weeks from my total knee replacement surgery June 4th, 2019.

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Brenda Solomon
10/6/2019 05:12:50 pm

I had knee replacement surgery three months ago. My range of motion is good 126. I have completed PT. Now I use my stationary bike daily and try taking long walks. But my knee can still feel very stiff some days especially after standing or walking for long stretches. Does this stiffness eventually go away? Is there something else I should be doing? Everyone says it takes awhile. They told me that Medicare will not pay for more PT.

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Christopher Gorczynski, MD link
10/7/2019 08:08:34 pm

From my perspective you are doing great for this stage. While every patient has a somewhat unique experience following knee replacement surgery, I would expect stiffness to gradually improve for a whole year. At this stage I recommend progressively resuming your desired activities. It is ok to use ice if the knee gets swollen or sore. Be confident that the way your knee feels at 3 months is far from the final product. Congratulations on your excellent early rehabilitation.

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Amy T Lake
3/10/2020 04:30:35 pm

I had total knee oct. 2016 and then may 2017. It is now 2020 they still hurt when I stand 4 or more hours. Is this normal? Can they still swell even though the parts aren't bone? Some days they feel as big as boulders in the inside, but can't tell on the outside. I work 40 hrs a week medical assistant. I had them rechecked and had to pay big money for all the x rays but I'm still not convinced.

Christopher Gorczynski, MD link
3/11/2020 10:21:55 pm

It is not normal for total knee replacements to hurt as you describe. I can take a while for a patient to recover enough to stand for several hours at a time. If your knees swell, it is not the metal prosthesis or bone that is bigger, it is extra fluid contained within the knee joint. This fluid is made by the synovial tissue inside the knee. This is living tissue. I usually remove most of this tissue at the time of surgery, but not all surgeons do. Some patients will have recurrent swelling after knee replacement. This does require some investigation beyond simple X-rays if the swelling and discomfort are significant. Sometimes blood work is necessary. Sometimes additional radiographic testing is needed. Perhaps you should consider a second opinion if you are not satisfied with the explanation you were given by your surgeon.

Michael Treloar link
10/10/2019 10:32:10 am

Keep up the great work! Thank you so much for sharing a great posts.


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Christopher Gorczynski, MD link
10/14/2019 06:17:47 pm

It is my pleasure! I am glad to hear that you enjoy this website.

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Jim
10/12/2019 03:45:01 pm

I had bilateral tkr sept 5/19 and found your question and answers very helpful, thank you so much for doing this.

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Christopher Gorczynski, MD link
10/14/2019 06:16:16 pm

I am glad to hear you find this site helpful, thank you for the feedback!

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Christine
10/18/2019 02:17:44 pm

I had a total knee replacement over 4 years ago and had very little pain and recovered very quickly. The only slight issue was a small area of tightness on the outside of my leg just above my knee

A couple of weeks ago I went out wearing a pair of slip on shoes which had heavy soles and were quite loose. At the end of the day I felt a great deal of discomfort in the muscles around my knee and although there has been a slight improvement. It seems that shoes which have supportive, flexible soles cause discomfortaround my knee. Is there a reason for this.

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Christopher Gorczynski, MD link
10/28/2019 07:20:51 pm

It sounds like the combination of heavy shoes that fit loosely probably required more energy to walk. I would recommend supportive, properly fitting shoewear.

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Abinesh Jegatheesan
11/19/2019 10:23:36 am

Hey I had broke my lateral femoral condyle in a freak accident in April. After the internal fixation procedure I struggled a lot with my range of motion and my knee became extremely stiff and it was recommended that I undergo arthroscopic treatment to remove the scar tissue. I had that done last week on November 8th. Ever since I have been on my CPM machine, consistently doing my post op exercises, going to PT, but there hasn’t been much change in my ROM. My knee is still quite swollen, but I’m still quite discouraged with my progress so far. Is there anything I can do to improve my ROM?

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Terry
11/22/2019 02:47:47 pm

I am a 65 year old female who had a total knee replacement 3 weeks and 3 days ago. My flexion is 115 and the leg lies flat. I have the tight band sensation people are talking about. I am incredibly thankful I found your information and will begin the stretching exercises, holding the leg for some time, rather than seconds. Your information has given me peace of mind that I am doing okay, and has answered SO many questions I’ve had. I sincerely cannot thank you enough for taking the time to answer so many questions. Thank you.

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Christopher Gorczynski, MD link
11/22/2019 11:04:58 pm

I am glad you find this website helpful. It sounds like your total knee rehabilitation is right on track - your range of motion is perfect for this stage.

Keep up the good work!

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Sandy Perna
8/26/2020 10:24:00 am

This is me to a tee! I’m so discouraged with this tightness, which no one gave me straight answers about. I am actually 4 weeks post op and will now start the exercises mentioned here and hope it’s not too late.!

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Christopher Gorczynski, MD link
8/26/2020 07:41:46 pm

It is definitely not too late. Just keep stretching every day for long periods, and you should see progress.

Good Luck!

joyce stein
12/26/2019 02:13:38 pm

I am 5 and 1/2 months out from total knee replacement. I have good range of motion. Can't do stairs due to clunking and pain behind knee. I go to the gym every other day for strengthening exercises and recumbent bike. Can go upstairs fine no pain. Catching young clunking going downstairs. Mild clunking when I walk. Can minimize it if I keep my glutes tight while walking. He does get irritated from all this clunking. Wondering if there is any exercises that would minimize this. My Doctor says he could replace the plastic in my prosthesis with a different kind if I'm still having a lot of trouble in 3 months.

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Christopher Gorczynski, MD link
1/11/2020 10:22:53 am

This probably deserves an entire article, but I will attempt to answer your question briefly here. A total knee replacement is a mechanical device made of hard materials (metal and plastic). A variety of motions are possible between these components. Because the materials are hard, mechanical sensations are common and often quite normal and anticipated. A properly balanced knee will not have major catching and clunking, however. Severe clunking can indicate synovial tissue becoming caught between components, ligament imbalance, or mechanical debris caught between the moving prosthetic components. Exercises are not likely going to help. The fact that your surgeon suggested a polyethylene plastic exchange suggests that he/she is concerned about ligament instability. I would also suggest getting a second opinion from another surgeon before committing to a revision surgery.

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Jason Hancock
1/16/2020 07:36:23 pm

I'm a 47 year old man and I'm 9 days post op. I am really struggling like most with flexion and I'm currently at 90° my physiotherapist is making me go a little beyond what I can handle pain wise with her help and holding only 5 seconds. My progress seems to be creeping along and feel like this is brutality! Lol. My question is, when you say to hold these exercises longer using minutes instead of seconds, do I have to be at a point of almost agony when I hold? Or can it be a bit less so I can prolong the exercise? As I'm typing this I'm thinking the answer may be obvious! Thank you!!

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Christopher Gorczynski, MD link
1/17/2020 10:46:34 am

This is a very common question. The problem is that when you force range of motion for just a few seconds, your tight muscles will spasm and even the biggest, strongest physical therapist in the world will be unable to move your knee. Particularly at 9 days, there has not been enough healing yet to create any significant "scar tissue" that physical therapists love to talk about.

The resistance at this point is almost entirely muscular. If we put you under anesthesia at this point (so your muscles could not fight back) it would take minimal force to bend your knee so that your heel touches your buttocks.

So- this is why I recommend slow, gentle, long duration stretching. We need to convince your muscles to relax, and to fatigue them a bit so they will relax and actually let your knee bend. It is only at this point that the tissue planes will begin to slide/deform which is actually what gets your knee moving better. Most people will not see much progress with a few seconds of over-pressure.

If you are struggling with range of motion, I recommend significantly extending the duration of stretch. It should be uncomfortable, but does not have to be horrendously painful at this stage in your recovery.

To take the pressure off a bit...having achieved a 90 degree arc of motion at 9 days postop at age 47 is actually just fine, and if you continue working on motion on a daily basis, I would expect you to easily regain a 120+ degree arc by 6 weeks. Just keep with the stretching and try to relax your muscles as much as possible while doing so.

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Jason Hancock
1/17/2020 12:07:23 pm

Thank you so much for your quick response! My my therapist just left and I have achieved 97° which is a 7° improvement in 2 days. I definitely see that the morning PT is easier than the afternoon which I assume is because of less swelling and pain due to 8-10 hrs of rest. Thanks again.

Cami Gorsky link
1/25/2020 08:34:39 pm

I had my R TKR on June 5th 2019 and at 6 weeks was bending great, don't know the degree, but about half way up my thigh. I had my L TKR on Aug 5th and bending was the same. I was cut loose from PT that was done at home. I am 60 years old. I was a 5 day a week tennis player and am in good shape, not overweight and wondered why it has become so still.Seemed to be doing great but my R knee started getting stiff. I've tried ride the recumbent bike, but I know it's not bending as well as it should. I seem to be able to rotate but my right ankle is bending funny to accommodate the rotation. Now, on the Right side I can only bend it to the top of my calf. The Left (second surgery) still bends like it's supposed to. I can straighten them both flat. I called my ortho office and it's taking 3 weeks to get in for a appt. They both click when I walk. I have no problem walking. Just the Right bending. I've been trying to work with it but it's really not budging much at all. I've tried soaking in epsom salts and then stretching but I can't tell that it's helped at all. It's quite frustrating. I had rotator cuff repair in Dec of 2018 to repair 3 tears and it healed quite well without any scar tissue. Do you have any idea why the first surgery has adhesion's? I would appreciate any advice. Thank you so much, Cami Gorsky

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Christopher Gorczynski, MD link
2/1/2020 12:59:51 pm

Unfortunately, I do not have enough information to answer the question (why your right knee got stiff after "bending great" at 6 weeks.) I agree that this is not typical. Usually once rehabilitated, a normal knee replacement is expected to easily maintain functional range of motion for decades without having to constantly dedicate time to stretching.

I agree with your plan. It is crucial to have an orthopedic surgeon check out your knee. Anytime the function of a joint replacement deteriorates, it requires evaluation by an orthopedic surgeon.

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Gordon Fitzsimmons
1/31/2020 07:37:47 pm

Hi, I am pleased to have found your site and have spent time tonight reading through the posts and answers/advice given. I am particularly interested in the references to "tight", "tight band". I am 9 months post tkr on my right leg and 6 on my right. Of the two, my right has been more of a success to date. I have had a fair bit of I believe soft tissue issues with my right knee/leg . Thankfully this is settling down a bit. I have good ROM and straight legs; I followed my PT program and was discharged from my sessions and returned to work after a few months. What concerns me is this tightness/stiffness above both knees (lower quad/quad tendon). I can walk on the flat and go up hills (with slight awareness of it), use my excercise bike also, however walking down gradients/slopes is a problem. I feel I have to take baby steps due to this tight band/concrete band feeling above my knee. I have even at times gone down slopes sideways as it's much easier. My daughter thinks it's equivalent to a woman walking down hill in high heels. I feel I'm going to fall face down at times. I'm currently trying to take longer strides , but the tightness persists. Is this the scar tissue you refer to ? If so will this go away/settle down given more time ...I'm approaching 1 yr post op in April. I continue to do excercises given to me by my PT back last summer. I will try the longer stretches you mention. Thanks in advance for any advice on this.

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Christopher Gorczynski, MD link
2/1/2020 12:53:22 pm

You do not specify your range of motion, other than "good." I assume this to mean 120 degrees or so. I think your difficulty going down slopes is more likely due to relative leg weakness and should improve with time and strengthening of your hips, quadriceps, and hamstrings. There are some technical issues with regard to knee replacement design that can make them somewhat less forgiving going down hill. It is very important to work on strengthening to help you with this. This being said, I recommend that everyone avoid open chain quadriceps exercises (quadriceps extension machine) and instead focus on squats, lunges, etc. I hope this helps you.

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Gordon Fitzsimmons
2/3/2020 03:42:42 pm

Thanks for allowing and responding to my post. Your advice is much appreciated .

Julie High
2/7/2020 09:39:01 pm

Hi. I am a 60y/o female post LTKR December 18, 2019. Two weeks post-op my ROM was 117/0 and 125/0 at 6 weeks. I've had extreme nerve pain that stings, burns and becomes achey. That started about week 3 and I was told that sensitivity was normal and would go away. I started doing desensitization and the nerve pain was starting to subside at around 5 weeks.. I saw my surgeon at 6 weeks, 5 days and everything looked good. Prosthesis fit was good, x-ray looked good. I discussed the desensitizing with my Dr. and how the nerve pain was starting to subside. We also talked about using Palmer's cocoa butter over the incision site and massaging to break up scar tissue. I did that with his go ahead and I don't know if I massaged too deep but something has changed. I feel stiffness, like a band is being held over my knee. I have almost constant nerve pain, whereas before it only occurred late evening. I also feel a cord shape (vein?) palpable under the skin that extends mid-knee horizontally to the lateral side of my leg that ends at the bend. I've been actively involved in my PT before surgery and post-operatively without any issues. I was unable to complete full reps of my exercises yesterday because of the pain. Today I went for therapy and my PT did light massage, some light exercises and gentle movement of my knee. I'm so frustrated because everything seemed good, with the exception of the nerve pain which was actually resolving until I massaged my scar with the cocoa butter. It seems like it was a simple thing to do. Now I'm concerned that something has gone wrong. This new pain is excruciating and wearing me down. Thank you for your time.

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Christopher Gorczynski, MD link
2/8/2020 06:29:17 pm

I think you are only experiencing the normal thickening of the soft tissues around the knee as the healing process progresses. Scar tissue tends to toughen and contract over time. Ice, massage, stretching and (most importantly) time should take care of most of the sensitivity and tightness. As always, if there has been significant deterioration in your knee's appearance and/or function- have your surgeon check it out in person. Excruciating pain is not typical for this stage in your rehab.

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Lindsay
2/21/2020 08:56:14 pm

Hi there. I'm a 29 year old female, and I broke the distal head of my femur within my left knee playing soccer 11 years ago which appears to have healed nicely without surgery. Years later, I had increasing pain and last year an orthopedic surgeon found that I had significant wear and tear on the inside of that patella with some bone loss. About 10 weeks ago, I had a osteochondral allograft transplant from a donor placed onto the kneecap. PT was terrible after that due to a combination of problems (bad post-op pain that started PT off for about 5 days, a physical therapist who was too aggressive and never did the type of PT you've talked about on here, and the possibility that I scar quickly). Anyways, I could only get about 70 degree flexion with no progress for four weeks. So I had to have scar tissue removal surgery at 9 weeks (9 days ago) and my surgeon said I had extensive adhesions all over the place that were virtually "cementing" my knee down. He got 135 degree flexion during manual manipulation under anesthesia. After this surgery, my surgeon wanted 90 degrees flexion 3 days post-op, but I could only get about 40 and apparently my patella was already very stiff at that time. Right now on my CPM and at physical therapy, I can get to about 65 degrees with a lot of tension and pain. And my kneecap feels more stiff than last week. My thigh muscle and perhaps tendons/ligaments above my knee are insanely tight and feel so much pain when stretched. I have done well to learn to relax during PT and I'm even on valium and opioids to try to continue to relax these muscles. I know I could bend my knee more if these muscles would stop being so tight. They hardly feel like muscle anymore. And while I simply try to bend my knee outside of an actual PT session, these muscles are like tightropes and the knee bends maybe 15 degrees.

Sorry, this became long, And I suppose my questions are 1) I've been doing everything my doctor and PT has told me to and I'm otherwise very healthy and still young, why might I seem to be doing so poorly with rehab? 2) What can I do about my thigh muscles/tissues that are so tight and painful? My PT just says I need to keep practicing relaxation techniques and massage it.

Thank you so much for reading my long post, and your reply!

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Christopher Gorczynski, MD link
3/6/2020 02:34:30 pm

Unfortunately, I am unable to state why, exactly, you have become so stiff. It does happen sometimes. It is called arthrofibrosis. Some patients have a very difficult time relaxing into the stretch. If the response to pain is clenching the muscles, then stretching becomes very frustrating. The best thing to do is to be very gentle with the stretching, but to hold the stretches for a very long time. This allows the muscles to fatigue, and relax. Use some pain medication and ice or heat while stretching. Try to distract yourself during the stretch. Stretch for hours everyday, with no days off. Your hard work will pay off.

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Mita Vyas
3/2/2020 02:37:26 pm

Hi Doc,
I have TKR about 5 months a go. My bend is about 120 to 125. I would like to increase it to 135 (I had 140+ before surgery). Is it possible after 5 months? I do exercises for bending and stretching but it increases the stiffness a lot. Should I continue to exercise or be happy with what I have .

Thanks
Mita

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Christopher Gorczynski, MD link
3/6/2020 02:26:11 pm

It is possible to improve your range of motion for up to a year from surgery. This will take dedicated time and effort on your part. I would argue that 125 degrees of flexion is an excellent result, and should allow you to do just about anything necessary for a happy life. If there is a particular reason you need more flexion, then keep stretching, but if it is simply to get a "better" number, then I think you may have more pleasant things to do with your time.

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Tonya
3/6/2020 04:41:50 am

Hello,

I had left knee replacement surgery January 17, 2020. I've been going to therapy and am now able to stretch to 105 degrees. I'm still having some pain, but still do stretches in therapy and at home, but I still cannot get past 105. Doctor suggested manipulation under anesthesia or try to see if continued stretching will help down the road. I'm afraid of more surgery because when I had the knee replacement, the doctors could not wake me up for 12 hours after surgery and I experienced a stroke during surgery. I'm doing good with the 105 degrees but of course want more. I'm not able to fully straighten or bend my leg. Also, starting a couple of weeks ago, I now have that tight band feeling at the top of my knee cap along the length of my scar. What should I do? Do you think that I can eventually get my leg to a complete bend or completely straighten it out as time goes by? I definitely will try holding my stretches longer. Thank you.

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Christopher Gorczynski, MD link
3/6/2020 02:23:04 pm

I understand your reluctance to undergo more surgery. A manipulation is generally done using only IV sedation, and no incision is made. This usually must be done within 6-8 weeks of surgery for a reasonable chance of success.

Diligent stretching as I recommend may get you another 5-10 degrees at this stage, but I doubt it will ever be considered "normal." You don't state how far from full extension you are now. Manipulation will not generally help extension. The best bet there is long duration extension stretching.

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Tonya
3/8/2020 09:06:13 am

Thank you so much for responding!

Bill
3/25/2020 09:00:00 pm

Stats - Age 67 , TKR Oct 15 , MUA Dec 16 , Current ROM 90 (95) . Can you explain why it was necessary to perform MUA before week 8 vs your thinking of Long Duration Stretching even after a MUA has been completed . I thought that after week 8 or 9 the contras had formed and the only way to remove scar tissue was more surgery ?

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Christopher Gorczynski, MD link
3/25/2020 10:49:08 pm

After surgery scar tissue begins forming. This scar tissue becomes more robust over time. Early range of motion exercises are very important to regain a functional range of motion before this scar tissue becomes so dense that it will not yield to stretching exercises. Within 6-8 weeks this scar tissue can be gradually elongated by stretching it. It is dose dependent- meaning the longer the stretch is held, the more effective it will be.

After undergoing a manipulation procedure, this scar tissue is disrupted. The surgeon basically forces your knee to bend beyond the point the scar tissue allows. This requires anesthesia because the procedure hurts, and it relaxes your muscles which normally resist stretching when it is unpleasant.

Because manipulation disrupts the scar tissue, you now have a few more weeks to improve your range of motion.

Since you only had 90 degrees of flexion at 8 weeks, if you had not undergone that procedure, then it is unlikely you would have regained a functional range of motion. If you decided that a 90 degree arc of motion was unacceptable much beyond 8 weeks, then the scar tissue would have gotten so dense and strong that manipulation would require too much force to be effective- this could result in a fracture or injury to the extensor mechanism in your leg. This is why I do not recommend manipulation beyond 6-8 weeks, without first performing a lysis of adhesions arthroscopically. Here we cut the scar tissue and then manipulate.

I hope this clarifies things a bit.

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Matt B
4/6/2020 10:53:41 pm

Hey Doctor! Thanks for all the replies I’ve found them very helpful. I had surgery on my left knee February 11th, 2020 for my MCL (repair) and to remove Osgood Schlatters build up that had been causing me irritation. The Doctor who did my surgery put me in a knee immobilizer after the surgery for 4 weeks keeping my leg completely straight. I then started PT and my knee was completely stiff and could only bend about 5 degrees. The most we’ve seen it bend in therapy has been 65 degrees, but this is with they Physical Therapist pushing it down. Really 55-60 degrees is what we get it to by the end of our therapy session. I’ve now been in therapy for 4-5 weeks (3 days a week) and have been putting in the work to stretch it at home. I saw the Doctor again today and he was angry at the PT’s advising they weren’t being aggressive enough, although I’m yelling in my therapy sessions from the pain. He advised we may have to do another surgery due to the stiffness. Any advice for me? I’ve just started doing your recommended lengthy stretching sessions and will continue doing this daily. Thanks. Appreciate you and could really use the help.

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Christopher Gorczynski, MD link
4/16/2020 03:36:22 pm

The best bet for a very stiff knee is long duration stretching, as often as possible, for as long as possible. This is best done passively- meaning that you should not have to use any muscle strength to force the stretch to happen. You should try to relax your entire body while stretching. Ask your surgeon to consider a static stretching brace- for example - Joint Active Systems.

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Eli Joseph
4/13/2020 12:10:04 pm

Hey Dr. G!
Stats:
Make (23)
1st Surgery, April 8, 2019: patella-tendon graft and meniscus repair for torn ACL, MCL, and meniscus.
2nd Surgery, September 18, 2019: Knee debridement and MUA.

I tore three ligaments in my knee during a basketball accident, and it took about 3 weeks before I was able to get surgery. I tore my ACL, MCL, and had a bucket handle meniscus tear. After my first surgery, I waited about a week before going to therapy. I didn’t know how much of a delay that was for recovery until weeks later, and I’d only achieved about 80 - 90 degrees of flexion consistently. I had immense pain on the side of my knee where the largest incision was, and I could not completely straighten my leg. During the summer of 2019 I was able to get my flexion in my knee to about 120 degrees with much pain and help from my physical therapist. When the fall rolled around, my surgeon recommended a debridement and a MUA to get rid of the scar tissue. I did both, changed my therapist, and started therapy the day after surgery. After a couple weeks of therapy, my therapist was able to help me bend my leg to about 135 degrees of passive flexion, which is about 8 degrees short of my full ROM on my uninjured leg, though this was very painful too. On my own I had about 120 - 125 degrees of active flexion. However, I stopped seeing my therapist in January 2020, and since then my flexion and knee pain have gotten substantially worse. I’ve never quite been able to get back to where I was with my therapist on my own.

Is it too late to try and regain my ROM on my own with daily stretching and exercises? Do I have to get another MUA? I really don’t want to do invasive surgery again.

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Christopher Gorczynski, MD link
4/16/2020 03:41:31 pm

You do not quantify what you mean by "substantially worse," but I assume this to mean worse than 120 degrees of flexion. I would think you should be able to regain a decent range of motion on your own since you had excellent range of motion just a couple of months ago. I recommend focusing on long duration stretching, as often as possible, every day, for as long as you can tolerate. Try to make these stretches passive- meaning you should find a way to stretch that allows you to relax your entire body during the stretch. I demonstrate a variety of examples of this throughout this website. I doubt another MUA will be needed if you really dedicate yourself to a stretching regimen.

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Gloria Applegate
4/26/2020 08:38:15 pm

I am a 60 year old woman. October 28, 2019 (basically 6 months ago) I had double total knee replacement surgery because of severe pain from arthritis. I was in the hospital 4 days, then entered inpatient rehab for about 4.5 weeks. I had physical therapy each day from the day after surgery until i left rehab, with great therapists who worked on extension and flexion and strengthening. My left leg did remarkably better than the right, from the very beginning. After I returned home, I had home health come by for several weeks to guide me through home exercises until I could get into an outpatient PT facility after the first of the year. I was in PT there from January through March, usually 3 times a week. All in all, I was in therapy from November to March. At end of therapy my left leg was approx 120 degrees and my right 110 degrees, with a bit of help from therapists to get to that amount. I have not had a great amount of pain through any of this but what has remained consistent is the amount of numbness and stiffness and the tightness that comes after a workout, in both legs, although more on the right than the left. My surgeon always has my legs xrayed at each visit and says they look great. He quickly asks me to show him my extension and flexion to which he says it looks good and to my complaint about the constant stiffness he merely says that recovery can take up to a year and I am coming along normally. I feel that he is not taking my concerns seriously as he is in and out of the room in under 3 minutes and is rather dismissive. My PT feels they have done about all they can for me and I am able to continue my work on my own. I have no complaints about the therapy I have received as I believe they have been thorough and taken the time to work on many aspects with me. However, they don't have any real explanations on why I continue to have numbness and stiffness when walking, sitting too long or after a good workout. I am reminded over and over that its only been 6 months and I can expect the healing to continue for up to a year. My hope is that they are all correct. During these 6 months since surgery I have been diligent and worked hard at therapy and done exercises and stretching at home as recommended. Since therapy ended however I have not been doing nearly as much. I hoped that taking a break might allow my body to rest and recuperate and heal and that the stiffness/tightness across my knees might recede. It has not. The past 4 days I have been walking and doing stairs consistently. It doesn't seem to have changed anything either. I have spent the afternoon reading through posts like your's, in hopes of finding out what I am missing and/or doing wrong. I am beginning to worry that I will have this tightness from now on and that i will have to learn to live with it. Any insight or help you can give me would be most appreciated. TIA.

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Christopher Gorczynski, MD link
4/27/2020 08:44:35 pm

I think the advice you have been given sounds correct. I understand you would like your surgeon to spend more time with you (this is a common issue) but, there is really not much your surgeon can do for you now. It is not unusual for the knee to feel stiff or sore for many months after surgery. And most people DO report improvement for up to an entire year. It is hard to be patient, but time is on your side.

A numb patch on the outside of the incision is normal and nearly universal due to the nerve anatomy around the knee. If your numbness goes down your legs/into your feet, this could be coming from your back and deserves further investigation. This is not likely related to your knee replacements. An MRI scan of your lumbar spine may be needed if this complaint persists.

Your progress seems fairly typical, particularly considering you chose to undergo bilateral knee replacement simultaneously. That is definitely a challenging rehab.

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Gloria Applegate
4/28/2020 09:14:56 pm

I appreciate your timely response. Would doing the long duration flexion and extension exercises you speak of on this website be useful in my situation? If so, do you have a page or site that I could look at that explains/pictures all the recommended exercises?

Christopher Gorczynski, MD link
5/11/2020 07:02:30 pm

This is a good article to start with. Right in the beginning you will find several helpful links.


https://www.yourorthomd.com/orthopedic-knowledge/stretching-is-more-important-than-walking-after-knee-replacement

Theophilous Ebenehi
5/7/2020 06:08:04 am

Hey Dr G!
Status:never had a surgery
I am 19 years old

For some time now i i have not been able to flex my knee,but it became worse recently, whenever I try to bend my knee and stretch it back again I feel like my knee is hooked and when I try to forcefully stretch it I feel an intense pain,I don't know what to do,am scared!
Any insight or help you can give to me I would be very much grateful

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Christopher Gorczynski, MD link
5/11/2020 06:59:30 pm

When someone loses range of motion in their knee, this requires investigation. I recommend you see an orthopedic surgeon in the office. They will examine your knee and obtain X-rays. At 19, without trauma, these x-rays are expected to be normal. If this expectation is correct, and MRI is needed to rule out a displaced meniscal tear or loose body (which is a free-floating piece of bone or cartilage) that can get caught in the joint.

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pat costello
5/13/2020 02:39:54 pm

hi doctor 8 weeks ago i had surgery on my knee for a complete tear of the quadriceps from the knee cap im in a brace since but last week i was to my surgeon & he let off the brace down to 110 which is fully off but he said to keep it on when walking i got excercise to do at home but one of them is to try & bring the knee back where it should be but it will only come a small bit as its very tight on the knee cap & the muscles at back of knee are very tight i dont wan to force too much in case i tear the tendon off the knee again regards pat

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Christopher Gorczynski, MD link
5/18/2020 07:17:37 pm

It sounds like your surgeon has made appropriate recommendations for this stage of your recovery. I would expect you to gradually regain range of motion for up to an entire year following surgery. If you have 110 degrees already, I think you are doing quite well.

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Pat costello
5/19/2020 11:39:25 am

Thanks very much for your reply regards pat

Kevin Cheyne
5/22/2020 05:51:29 pm

Good Afternoon Dr Gorczynski
I am a 58 yr old male TKR right knee patient who had severe arthritis and a leg that was bowing out badly.Surgeon was amazed i wasnt in much pain but he suggested now was the right time to do the TKR.Had the operation on Nov19th 2019 and experienced a very stiff knee almost immediately after surgery.Im in a rural area and had my first physio on Dec 6th[74 ROM} and again on Dec 20th{80 ROM} and was basically was measured and shown a few exercises to continue.At 6 weeks i was 88 ROM but really stalled after that with the knee being like a rock and very stiff.
I left that PT and opted for a place i could drive 100 miles one way and get in twice a week which helped immensely as well as swimming for 40 mins after each physio appointment.I improved over the month of February where i was about 115 ROM and about minus 5 extention.My knee through seemed to swell if i was on it even walking around the house and definately swole up on the drive to and from physio.
Im at 6 months now and i have been walking close to 3\4 of a mile daily and riding the stationary bike for at least 35 mins per day as well as streching the knee for at least 40-60 mins per day the way i was told by the PT in the 15 second intervals.
Riding the bike for even 5 mins seems to take away the "full" feeling in my knee and gives me more mobility to strech afterwards.Im noticing over the last 4-6 weeks the knee clicking when i walk and more noticable in the house without shoes.When im walking with good support and orthotics in im not noticing the clicking as much all though sometimes it clicks while riding the bike.
I still have a very tight band of scar tissue above my knee to the point of it really feeling balled up when i do alot of leg lifts and wall squats as well as my daily walk.This tight band still limits me for my extention which id say is still around mins 5 with the ROM of about 115.I havnt been back to physio for a measure due to the Covid 19 pandemic.The knee still swells up but usually wake up each day with a fresh start and not overly swollen and not any pain so im lucky!
Im worried about the clicking part of the knee and will it and the tightness above the knee go away in time?? I know lots is said about a year or more for full recovery and im wanting to do everything i can to get the most out of this operation.Also do you think the extended streching you recommend will help in gaining a little more ROM?I started yesterday for a hour of extended streching and will gladly continue if it helps.Should i be going back to using naproxin for the swelling with a couple sessions of icing daily to see if it improves my situation??
Looking forward to your answer and have enjoyed reading about your answers given to other people...thanks in advance!!

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Christopher Gorczynski, MD link
5/26/2020 07:57:26 pm

I definitely think long duration stretching is the way to go. Clicking can have a variety of causes and it is not possible to be definitive in your case via the internet. If it is associated with swelling, the kneecap may float up a bit when your knee is extended and then engage into the trochlear groove in the femur with further flexion. You may experience this as a click. This is just a thought. If this is indeed the cause, it will resolve with time, as your swelling improves. Anti-inflammatory medication and/or ice will also help with pain and inflammation. And, look forward to many months of gradual improvement yet to come.

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Julie Mittman
6/10/2020 06:35:17 am

I had a TKR on 25/3/2020.I have had trouble walking as there seems to be something catching on the bottom outside of my knee.I am able to to all the non weight bearing exercises and my bend is 118%and 1% off straight When I have to push with my toes it catches and really hurts.Also when I wake up I can't weight bear at all and this is painful to start to walk as all the muscles especially the outer ones right up to the top of my thigh are extremely stiff
Will the stretching exercises help

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Christopher Gorczynski, MD link
6/26/2020 06:54:11 am

This complaint should be investigated by your surgeon. Your range of motion is totally acceptable, and compatible with an excellent, pain-free result. While some pain, and stiffness is normal for a couple of months following knee replacement surgery, this should be trending down, particularly at 3 months from surgery. While you are far from maximum improvement (which can take up to an entire year from surgery) inability to bear weight at 3 months from surgery is clearly not normal. I recommend you contact your surgeon for an examination and x-ray evaluation of your knee replacement.

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Viola
6/29/2020 01:29:06 pm

Six months after total knee replacement and still have stiffness and difficulty bending or walking. Tested on blood for everything including metal allegories and all come back normal. I can (with 20-30minutes of exercise) increase ROM, but lose it again after walking a short distance. Had a manipulation at 3 months and this caused no difference. Any suggestions?

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Christopher Gorczynski, MD link
7/1/2020 07:27:14 am

In my experience, manipulation at 3 months is very unlikely to be effective. I recommend manipulation at 6-8 weeks. Beyond this, a stiff knee usually requires arthroscopic lysis of adhesions in addition to the manipulation. Even then, there is not a guarantee range of motion will easily return as this procedure is being performed in a high-risk individual. At this point, I would discuss this procedure with your surgeon.

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Viola
7/1/2020 11:46:10 am

Thank you for your quick reply. I’ve been doing your long stretching since first reading this blog. How is it possible for me to gain ROM to almost 140 after about 45 minutes of stretching, and then lose it again? After a short time, it is painful to bend beyond 90 degrees and I must start over again. Could something have shifted (tendons or ligaments since X-ray is good for replacement), could it be scar tissue or could my immune system be the problem by causing inflammation? Taking Celebrex, but have taken myself off of Tramadol.

Christopher Gorczynski link
7/1/2020 09:35:17 pm

If you are able to achieve 140 degrees of flexion while stretching at 6 months from surgery, and your surgeon feels your x-rays look good, I would be patient, continue stretching, and let time pass. I would expect gradual improvement for up to an entire year after surgery. Particularly since you had a relatively recent manipulation- you are still within a significant inflammatory period of recovery. If you tolerate it, consider using some anti-inflammatory medication and definitely ice your knee after stretching- these modalities should help reduce inflammation.

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Keely link
7/26/2020 09:41:02 pm

I so wish I’d found this site sooner! I’m 7 weeks out of TKR and am at 108 degrees bend. I’m concerned that this not good enough. My Dr. mentioned manipulation but because I was able to get from 90 to 108 in two weeks (A time frame he gave me) he said I didn’t need to. My knee is stiff but not incredibly painful at least not like before. Do you think prolonged stretching would help me? I’ve never been told to do that. As a few people have mentioned here this surgery has really affected me mentally. I don’t know if I could go through the pain and even more therapy of a manipulation.

Christopher Gorczynski, MD link
7/26/2020 10:43:15 pm

@Keely - 108 degrees is not "enough," but I agree with your surgeon. You have achieved a functional range of motion, and gained nearly 20 degrees in 2 weeks time. I believe, with solid effort, daily stretching, and generous use of ice you will probably gain at least another 10 or so degrees over the next month. I definitely recommend prolonged stretching, particularly at this stage of your recovery as the scar tissue is starting to become more organized and stiff. Check out my article on viscoelasticity which explains this further.

https://www.yourorthomd.com/orthopedic-knowledge/viscoelasticity

Andy
8/10/2020 07:15:10 am

I had a TKR las Wednesday (august 5th), so far all seems to be ok. 2 questions: 1. very stiff on my upper hamstring - halfway between my hip and knee. I have not seen any comments/reference to that. this seems to be preventing more knee flexion. any comments please? 2. I would swear I hear feel movement of the muscles/knee when I move (like clicking but not quite that pronounced, just feels like muscles/knee is moving a bit). is this normal? I do understand that the muscles around the knee were stretched back some during surgery. would appreciate input here as well. thank you.

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Christopher Gorczynski, MD link
8/14/2020 05:36:17 am

It is still very common for surgeons to use a tourniquet during surgery. If this was the case, some bruising and/or soreness around your mid-upper thigh is frequently seen and will rapidly improve. While it may be sore, when stretching properly, it should not hinder your ability to rehabilitate adequately.

Immediately after knee replacement surgery, there will be blood in the knee joint, this causes the patella (knee-cap) to float up a bit when your muscles are relaxed in full extension. When bending your knee, the plastic patellar button will be felt to engage into the groove in the metal femoral component.

Lastly, the muscles were definitely stretched during surgery. We need to see the inside of your knee during surgery. To facilitate this, special retractors are used temporarily dislocate your patella laterally. Your quadriceps muscle gets stretched with this maneuver.

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Andy
9/4/2020 10:28:48 am

Dr. Gorczynski - thank you very much for your reply and apologizes it took me so long to say thank you. as I am now exactly one month, I am improving steadily, and I will say some of the pain in making progress is substantial. With that said, everyday the swelling seems to be getting better and mobility improving.

Christine
8/31/2020 12:14:41 pm

I am 3 months post TKR surgery. Since the beginning of my PT I have been wearing a thigh-high compression stocking. My physical therapist recommended it and says my swelling has gone down rapidly as a result of wearing it during the day. The stocking also reduces the “clicking” In my knee; the feeling of “metal” in my knee; and reduces the pain. Is there any reason for me to discontinue wearing the stocking? Will it affect the healing process?

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Christopher Gorczynski, MD link
9/3/2020 05:14:06 pm

As long as your wound is healing nicely, and you do not mind taking the stocking on and off for hygiene, I see no reason you should not continue using it. Keeping swelling down is definitely encouraged. It should not harm the healing process.

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andy
9/9/2020 10:00:10 am

Dr. Gorczynski, again thank you. I would like to ask 2 followups. 1. I am now 5 weeks post op and I still have swelling on the top of the knee. its almost like a 2" wide / 6" long band of swelling that follows under the scar. Is there anything I can be doing to help accelerate the swelling going away? 2. When I push my flexing (at about 105 degrees) I get a serious stabbing pain on the underside / outside of the knee that prevents further flexion. Any suggestions on how to break thru? I am doing all of my suggested PT everyday. thank you. Andy

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Christopher Gorczynski, MD link
9/10/2020 03:22:34 pm

It is normal to experience some ongoing swelling at this stage for recovery after knee replacement. Ice, gentle, long duration stretching, and time will all contribute to its gradual resolution.

As for the pain you experience with flexion exercises, my best advice is long duration stretching, while trying to relax as much as possible during the stretch. Ice the area and hold the stretches for as many minutes as possible, trying to progress by a couple of degrees every day. Ideally, you will have regained an acceptable range of motion by post-op week six.

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andy
9/12/2020 07:52:48 am

Thank you very much for your quick response.

Christine
9/12/2020 05:58:40 pm

My TKR was 4 months ago. From the beginning I have had the sensation (on the outside part of the knee) of something catching and/or not operating smoothly. In the last month it’s gotten worse. It frequently happens when I change positions on bed. When it happens I have to stretch my knee out for it to feel normal again. I don’t see my Dr for another month. Should I see him now. For the first 2 months i made incredible progress—all the PTs were amazed. Now I feel like I have regressed. I do have more pain than I had at the earlier stage especially sitting down and standing up. Thanks for your help.

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Christopher Gorczynski, MD link
9/13/2020 10:48:54 am

Without knowing your knee's range of motion, it is hard for me to make much of a recommendation. As I discuss elsewhere in this blog, there are several moving parts inside your knee (with or without knee replacement surgery). This could cause mechanical sensations. That being said, it is not common for a patient to experience a catching sensation that worsens with time. If you have a concern, definitely see your surgeon sooner than scheduled. To be clear, some mechanical sensations can be normal, some pain can still be normal at this stage, and I would expect improvement in knee function and pain level for up to a year or more following knee replacement surgery.

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Chris B
9/12/2020 10:39:25 pm

Good evening - I had my left knee replaced 15 months ago. Things went well. Good range of motion. No pain. Tonight I noticed a "wobbly" bit on top of my knee cap, closer to the inside of my leg. If I press on it, it shifts. It feels quite hard (ie, not a squishy lump) Is this something I should be getting checked out or maybe it was always there and I never noticed it before? Thanks in advance for your advice.

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Christopher Gorczynski, MD link
9/13/2020 10:22:28 am

In the absence of pain, and as long as it isn't getting larger, or red, it probably does not require any significant treatment. As always, there is no harm in having your surgeon check it out at some point. I would recommend setting up an appointment at your convenience. Things that would suggest more urgent evaluation is needed include: fevers, chills, increasing pain, increasing redness, loss of range of motion. As long as these things are not happening, it is probably some scar tissue, or calcified adipose fat) tissue, neither of which require treatment.

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Chris B
9/13/2020 10:29:52 am

thank you for your reply. I'll keep an eye on it and follow your advice.

Alicia Erickson
9/18/2020 01:28:54 pm

I am 52 and had a total knee replacement 10 weeks ago. My flexion is up to 127 and my got my extension to 0. I have been doing the stretches you mentioned everyday. I am still experiencing a lot of stiffness, especially during the night. I am still swelling quite a bit after activity. I mainly ride my bicycle on a trainer inside and do my stretching exercises. I am still doing PT 3x a week to help with the stiffness. When I am stiff I walk with a limp. After PT or stretching my walk improves then it all starts over again the next morning. Just wondering if this is due to scar tissue build up that I still need to work through and wondering how long the stiffness could potentially last? Also wondering if I am doing all the right things? Stretching, PT, and icing constantly. Thank you!

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Christopher Gorczynski, MD link
9/20/2020 02:35:57 pm

Your range of motion is excellent. I would recommend you maintain your exercises, use ice /anti-inflammatory medications for relief as needed. At this stage after knee replacement, your body simply needs to heal. As long as you maintain your range of motion, as time passes, the inflammatory process will gradually wind down. I would expect continued improvement for up to a year or more following knee replacement surgery.

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Julia link
9/22/2020 09:16:01 pm

Hello I am 3 and a half months post up TKR. I started working again and I stand like 3 hours in the a.m. And evening is about 4 to 5 hrs. I am not in any pain but it feels a bit odd in the kbee. I do ice when I get home. Is it okay to be standing this long after a TKR.

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Christopher Gorczynski, MD link
9/22/2020 09:21:17 pm

As long as you are not experiencing any pain, your knee does not swell up, and you do not lose any range of motion, I think it is OK to be back working at this stage following knee replacement surgery.

Remember, your knee will be healing for an entire year, so I would expect you to feel progressively better month by month.

I am glad to hear you have recovered enough to be standing/walking on your new knee for up to 8 hours each day. This is great!

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Becky
9/23/2020 08:12:38 pm

I had ORIF surgery after a fractured patella on 7/21/20. I can bend my knee to 125 degrees by doing a heel slide or just bending my lower leg back. But when walking my knee stiffness and swelling won’t let me bend back very far. I can walk fine with a bit of a limp. When I walk with the injured leg the knee sort of bounces the lower leg back too soon. Would that be solved with the knee stretches you described above? I’ve been mostly doing quads exercises so far. It seems like if the problem was adhesions I wouldn’t be able to get 125 degrees ever. Hope you can help me understand how to address this.

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Christopher Gorczynski, MD link
9/23/2020 08:36:54 pm

With flexion to 125 degrees, this does not appear to be a problem with adhesions. You do not specifically state it, but I assume you have full extension. It sounds to me that you have some residual gait abnormality that will resolve with time and work with physical therapy. If you have weakness with bending- instead of focusing only on quad exercises, add hamstring exercises. Also check out my article on anterior knee pain- those exercises should be very helpful to you.

https://www.yourorthomd.com/orthopedic-knowledge/anterior-knee-pain

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Sheila link
10/4/2020 09:02:59 pm

I am 12 weeks out from having bilateral knee replacement. My flexion is measuring 121 and 120 and extension is 0 and -5 .
I am having difficulty with stiffness after sitting for long periods or sleeping. When should this get better.

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Christopher Gorczynski, MD link
10/8/2020 02:24:33 pm

Looks like one of your knees still needs a little work on extension. The other one looks well rehabilitated. I would recommend working on the prone hang technique on the knee that does not go fully straight.

https://www.yourorthomd.com/orthopedic-knowledge/the-best-total-knee-extension-stretch

Other than that, you should be in very good shape. The inflammatory process will gradually wind down over the next few months. Most patients experience continued improvement for up to an entire year following knee replacement surgery.

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Sheila link
10/10/2020 02:16:16 pm

Many thanks for answering my questions. Wanted to clarify one more item with the extension and flexion. Since I have met my goals with the flexion do I need to continue my PT exercises I am doing at home to maintain 120 and 121? The same question for the knee that I achieved 0 for flexion.
It seems I spend hours daily with PT exercises (stretches and strengthening, like squats lunges etc,, exercises for balance,
climbing 13 flights of stairs And walking 2 1/2 miles, in addition to twice a week I do regular wright training and cycling( trying for 3 times a week to get my heart rate up)
I am 67 years old and still wish to go back to hiking and biking as I did before the operation but hopefully without pain.

Christopher Gorczynski, MD link
10/15/2020 04:34:23 pm

While it never hurts to do some gentle, long duration stretches, at this point (over 3 months from surgery) it is unlikely to result in significantly more range of motion. At this point, I see no reason you should need to spend several hours working on exercises every day. Perhaps take a few minutes each day to stretch simply to make sure your knee range of motion is maintained. Then, maintain whatever physical activities you enjoy. Rest assured that your knee is expected to feel better and better for months yet to come.

Dr.Shailendra Patil link
10/7/2020 03:00:50 am

Great blog.thanks for the share.<a href=https://boneandjointcare.co.in/>Knee Surgeon In Mulund</a>

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Shelley
10/12/2020 04:47:47 pm

Had a PKR 6 weeks ago. Have bend at 130 degrees which is great. Been doing exercises and stretches routinely each day. However went for a long walk 3 days ago (45 minutes and browsing the shops for 2 hrs) and how pain in inner knee area and some swelling again (had none prior). Worried I've done something to the knee which has damaged or is it telling me to stop the long walk? BTW thanks for the blog so encouraging reading.

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Christopher Gorczynski, MD link
10/15/2020 04:28:56 pm

It sounds like you have overdone it a bit. While this is likely just irritation, if you are now having pain with weightbearing, I suggest you ask your surgeon to examine your knee, and perhaps also obtain new x-rays. Although unlikely, new pain with weight bearing that results after nearly 3 hours of weight bearing activity soon after partial knee replacement could indicate a stress fracture. Pain with weightbearing in this situation should not be ignored.

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Andy Monshaw
10/16/2020 02:06:49 pm

Dr. Gorczynski - first, I would like to thank you. I have remain subscribed and find everyones Q&A to be helpful and informative. This is the only place I have found to have this level of discrete information, and its clear we are all concerned for a complete recovery.

I am now in week 10 of TKR on left knee, have about 125 degrees and -3 degrees, so progress there. I still have a band of swelling under the scar (about an 2 inches wide and the length of the scar (as if a strip of thick gauze were under there) and there is pretty significant atrophy of the calf muscle. I do PT exercises almost daily and physical training 3-4 times a week. I am 57 and in good physical condition. I am very anxious to get back to playing tennis, but I am now sure I am a good month or two from being ready. All of the strengthening is progressing, but I get severe pain on any tourque of the knee - for example getting into the drivers side of the car - lifting and twisting the knee creates a great deal of pain on the left outside of the knee area.Same for a small twist required to put a sneaker on. I have not read anyone else experiencing this, and my PT suggests that they have not seen this either. She did say that it could simply be the combination of the swelling and the atrophy. Would appreciate you thoughts. thank you. Andy

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Christopher Gorczynski, MD link
10/24/2020 04:09:25 pm

It sounds like your iliotibial band may be inflamed as it crosses your femur or the prosthesis on the outside of your knee. As you have observed, this is not commonly discussed. It is a fairly common question for patients to ask at around this stage in recovery though. I would expect this to gradually improve with time. It is very unusual for this pain to persist.

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Andy
10/24/2020 06:06:26 pm

thank you.

Patricia J Creatura link
10/20/2020 01:03:24 am

video would help to see therapy flexion and straightening exercises

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Christopher Gorczynski, MD link
10/24/2020 04:15:27 pm

Thanks for the suggestion. I am currently working on some longer format video, as I agree that it would be helpful. In the meantime, check out some video clips on how to use a yoga strap to help regain range of motion after knee replacement.

https://www.yourorthomd.com/orthopedic-knowledge/another-way-to-stretch-your-knee-replacement

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Sylvia Hubbard
10/20/2020 04:14:12 pm

Dr. G, I am 16 weeks post TKR when I completed my 12 visits of therapy my flex of my knee was at 128 and I could straighten my leg fully. I have no pain, but still dealing with stiffness when I have to sit for a period of time. Don’t remember this stiffness with my right knee TKR but that was 5 years ago and I’m73. I have no problem with walking.

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Christopher Gorczynski, MD link
10/24/2020 04:11:50 pm

It is very common to experience stiffness after a period of inactivity at this stage following total knee replacement. It will improve with time. Sounds like you have regained an excellent range of motion. Nicely done!

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MM
11/2/2020 02:29:07 pm

Today I am 6 weeks post op TKR right Knee. My flexion is 90 degrees and extension is approximately -8 deg. I am still in PT 2X per week and continue to do PT exercises at home. My knee is stiff too. I am glad I found your site and advice concerning stretching.

Thank You
MM

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Christopher Gorczynski, MD link
11/8/2020 08:06:10 pm

Unfortunately you are starting to run out of time to regain range of motion. Definitely spend as much time as possible stretching to try and catch up. Hopefully you have a follow-up appointment with your surgeon soon. I think it is appropriate to discuss possible manipulation under anesthesia so you can regain a functional range of motion. Best wishes!

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SLM link
11/10/2020 11:01:42 am

Hello,
I am 6 months post op from TKR. My knee is painful and stiff most of the time. I originally had drainage from my incision and took antibiotics for this problem.
3 months post op I saw my surgeon for these same issues and he said to give it more time, that I was a "slow healer". Fast forward 3 more months and I'm still in the same situation.
Could I have an infection in my knee and not have fever, swelling or redness? Also, my incision has healed but is extremely itchy and sensitive.
Your thoughts are appreciated.
Thank you

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Christopher Gorczynski, MD link
11/26/2020 02:05:30 pm

I am concerned about the possibility of ongoing, low-grade infection based on your history and complaints. The classic findings of fever, redness, and swelling do not necessarily have to be present for low virulence infection to be present.

The other possible concern would be material sensitivity. Do you have any skin irritation/reaction to nickel, or other metals? This can be further investigated by an allergist.

Check out this article I wrote a while back: https://www.yourorthomd.com/orthopedic-knowledge/metal-sensitivityallergy

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Uma
11/12/2020 01:12:17 am

I underwent open surgery for pvns 6 weeks ago. Synovectomy was done and tumor removed. I started physiotherapy 4 weeks ago. My flexion is around 90 degrees.

Do I have enough time to achieve a fully functional range of motion through stretching ?

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Christopher Gorczynski, MD link
11/26/2020 01:59:12 pm

You absolutely have enough time to regain full functional range of motion after a procedure like this. The stretching exercises and techniques I recommend are perfectly applicable to you. Best of luck!

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Uma
11/28/2020 10:16:04 am

Thank you so much for assuaging my doubts. I have been distressed that I was unable to attain full rom at the 6 week mark that is applicable to TKR patients.

The long duration stretching recommended by you has been particularly helpful . I have reached the 100 plus mark at 8 weeks. My progress has been slow.

Thanks to your encouraging words I hope to keep going !

Christopher Gorczynski, MD link
11/28/2020 01:42:47 pm

Just continue with long, slow end-point stretching. Try to do this multiple times every day. Use ice/NSAIDS (if you tolerate them) to reduce inflammation. I would expect you would be able to improve your range of motion for many more months to come. Best of luck, and keep up the good work!

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Uma
11/12/2020 01:18:40 am

Just to add I'm 36 years old and in good health.

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Sharon
11/12/2020 12:40:47 pm

53F 5 weeks out frim TKR. Flexion <50 Extension 0. MUA scheduled at six weeks on the dot. What should I do for therapy in order to have the highest chance for increased ROM after MUA. Include X10 and/or Dynasplint? Thank you!

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Christopher Gorczynski, MD link
11/26/2020 09:25:22 pm

The best recommendations I have are in articles throughout this website. The summary is: get to the endpoint and hold it for as long as possible, as often as possible, and take zero days off until you achieve your goal for range of motion.

For some reason, you seem to have gotten off to a very bad start with range of motion. Following manipulation under anesthesia, my recommendations remain unchanged, as above.

If you need assistance staying at the endpoint for longer periods of time, I recommend static bracing. A brand that works well is J.A.S. The goal is unchanged. Long duration stretching, as often as possible.

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Barbara Mcintyre
11/19/2020 03:12:06 am

Hi Dr G, I’m 69 yrs old had right TKR 3 yrs ago left TKR 2 yrs ago. Recovery has been normal for both knees & have been doing great. Recently got a stationary bike & ride 25 min low resistance & walk few times a week. Wish I was more active, it’s hard with the pandemic. Although I have occasional clicking in knee on & off but infrequent. But about 2 weeks ago noticed crunching feeling ( no pain at all) in knee when getting up from sitting.its happened a few times. Now area around knee feels tighter, heavier. It’s not red & minimal swelling. I thought I’d give the bike a break. Maybe that was irritating knee. I really don’t stretch at all. I’m willing to do anything you recommend. Thankyou, Barb

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Christopher Gorczynski, MD link
11/26/2020 09:30:16 pm

It sounds like you have developed some synovitis (inflammation of the joint lining). Perhaps a bit of rest is appropriate. Make sure you have a couple rest days each week, particularly after a more strenuous workout. I would also recommend using some ice, which will help reduce inflammation. Consider adjusting the seat on your stationary bike a bit, make sure the seat is high enough, and positioned not too far forward. Make sure your feet are not being forced into an abnormal position if you use clipless pedals.

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Corina link
12/2/2020 08:52:10 pm

I had a TRKR September 25 and just last week had to have a manipulation. I am doing the exercises PT has given me but the knee is still really stiff-is this normal? What are things I should expect at this point? Thank you!

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Christopher Gorczynski, MD link
12/7/2020 08:51:08 pm

I recommend long duration stretches.Typically physical therapists do not focus on LONG duration stretching the way I do throughout this website. Take a look at the "ALL ARTICLES" section of this website, There are several articles addressing how I recommend rehabilitating a knee replacement. Additionally, I recommend using ice, and anti-inflammatory medications if you can tolerate them.

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Sharon link
12/21/2020 06:56:04 am

Hello, I’m a 55 year old retired army vet. I injured my knees during my time in the service. Ii has surgery on 20 October so I’m at my 8th week of a total knee replacement recovery. I’ve had a DVT in my calf which was discovered during my post-op appointment. It’s still there after 6 weeks. I had the self injections of medicine (blood thinners) into my abdomen first then they put me on another blood thinner (pills) since and it’s still there.

My problem is my bending. I’m only at 65-70 degrees and that’s with the PT forcing my knee. I can bend it myself about 55 degrees but it will move more with force. I’ve been told I’m so far behind with my bending and may need manipulation.

I I really do not want that and I’m trying daily to extend my bends I do my stretches but I did start off walking a lot because that’s what I was told that would help. My first week after surgery I believe set me back. I did not know that I should have been doing more because I was not informed of that. I only did the exercises that they showed me in the hospital, 3 quick count to 10 stretches, because I only stayed in the hospital for one day and my physical therapist didn’t start coming until a week later so that put me behind.

My extension is great, my strength is good it’s just my bend. I’m able to walk, use my elliptical, and other exercises that strengthens my muscles. After reading your article I now know I should just concentrate on stretching. When I do my PT I was doing it all, strength training and stretching.

Should I stop all strength training at this point? Oh, I forgot to mention my knee has been swollen from day one and never went down. I ice and elevate and it’s hard for me to elevate more than 20 minutes because my leg starts to hurt on the inside/backside portion of my knee. Is that normal? I’m stiff all of the time. The only time I am not is after doing my PT. I constantly stand up and do knee stretches by doing stair lounges. It helps but like you said it doesn’t last long.

I guess my question is do you think I’m past the point that I will be able to achieve at least 90 degrees without getting a manipulation?

Any feed back will be greatly appreciated.

Thank you 😊

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Christopher Gorczynski, MD link
12/22/2020 11:25:12 pm

It sounds like you have had a tough time....Based on your progress thus far I think at this stage manipulation is appropriate. Your surgeon should be able to get you caught back up to a reasonable level of flexion (110-120) if this is done soon. If you decide to proceed in that manner, I would strongly advise focusing on stretching as your full time job for several weeks afterward. Use ice and anti-inflammatory medications if you can tolerate them. Spend hours each day stretching.

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Collins
12/24/2020 08:40:56 am

Reading ur reply have been helpful of previous comment,you are truly the best, I had im nailing of my tibia on both legs and the incision was from my knee down, my left leg perfect post op,didn't don't any exercise and I regained full range of motion 3weeks post up, did the right tibia op a month after the first and I am in 3rd week now,started PT daily after 2weeks bcus of swelling,I can do every stretch and extension except touching my heels on my but when I lie with my stomach faced down,its soo painful on the right side of the knee when I try full extension to touch my heel on my butt,sharp pain when I try to push down and hold,what she'd I do to be able to touch the heel on my butt and is it normal to have this knee pain during tibia operation(intramedullary nailing)

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Christopher Gorczynski, MD link
12/24/2020 10:33:36 pm

Anterior knee pain is not uncommon following intramedullary nailing as the insertion point is just behind the patellar tendon (just under your kneecap). This is a sensitive area. Scar tissue can make this very sensitive area tight and stiff postoperatively. I would be patient with your knee. In my opinion, you have at least 6-8 more weeks to regain range of motion, possibly even longer. This surgery is much more forgiving relative to knee replacement surgery as there is much less trauma within the knee joint itself. Just follow your surgeon's and therapists advice and work on daily stretching exercises. This plus time should maximize your recovery.

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Mark Egan link
12/26/2020 07:56:59 pm

Love your comments I’m 2 weeks in from a tkr and it’s going well. Can you tell me how long I should hold the stretch?

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Christopher Gorczynski, MD link
12/27/2020 09:23:09 pm

I would hold the stretch for several minutes at a time, minimum. Longer if your knee is stiff. Ideally, you will have at least 0-90 degrees motion by 2 weeks post-op, 0-120 by 6 weeks post-op. If you are not making progress quickly enough to meet these benchmarks, add more stretching duration, and additional stretching sessions.

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Moira Spearman
12/29/2020 08:40:33 pm

Hi, I’m 10 weeks post op and had 95 degrees bend when I left hospital at 4 weeks post op I was 120 degrees.
Because of the pandemic I never saw a physiotherapist and have done the exercises at home.
I don’t know if I have a straight leg -0 but in the mornings I am stiff and have to push my knee down until leg is straight. I am also still using the crutch but do try to walk around the kitchen without it, I feel like I’m not going to get better.

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Christopher Gorczynski, MD link
12/29/2020 09:32:44 pm

At only 10 weeks post-op you are far from fully recovered. Count on continued improvement for many months yet to come. Just keep doing your exercises. If you are able to maintain 0-120 range of motion at this point- simply maintain this and allow your body to heal.

It is not typically normal, however, to require crutches at any point after knee replacement surgery. If this is still a requirement because of pain with weight bearing, I would recommend you follow-up with your surgeon for further evaluation.

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Therese Humphrey link
1/3/2021 12:32:40 pm

Hi Dr. Gorczynski,

I am 6.5 weeks post LTKR. Flexion is decent at 120 & I’m still working towards goal of 130 if possible. My concern now is my extension seems to be stuck at -5 with pressure & after stretching I can get it to -3, but seems to bounce back the next day.
Is it too late too get a full 0 extension at this point? It scares me to think it’s never going to totally straighten. It feels like a block of cement in my knee everyday. I don’t seem to have problems walking, biking but this stiffness concerns me!

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Christopher Gorczynski, MD link
1/4/2021 09:28:13 pm

You only have a few degrees to go to regain full extension. Are you doing prone hangs? If not, I think you should try. Spend increased time working on this technique daily, and I think you still have a decent chance of gaining full extension.

copy this into your browser window and navigate to the 2:30 mark to see me demonstrate this technique.

https://youtu.be/xQASZaKZRxs

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John K.
1/4/2021 09:26:24 pm

Dr G. I am glad I found your website. I am 66 years old and just completed the 10th week from TKR. I did PT the first 6 weeks and have continued the exercises daily at home. I had 120 degrees deflection at week 4 but things kind of stayed there. My P Therapist and doctor did not say much about stretching it further. The last 2 weeks or so after reading your blog, I have stretched it a lot and I am now at about 130 degrees but with pain when i get there. I am doing the stretching every day along with the exercises and riding my stationary bike for an hour. Do you think I can improve beyond 130 degrees ? if so what do you think is the max I can get to ? also how long before the soreness on the knee goes away ? thanks a lot.

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Christopher Gorczynski, MD link
1/4/2021 10:18:02 pm

It sounds like you have adequate range of motion for your desired activities. If this is the case, then I would recommend against forcing your knee to bend more simply to gain bragging rights.

It is theoretically possible for a well done total knee replacement to flex without any inherent limitations. That means your heel should be able to touch your buttocks, or your calf would touch the back of your thigh. This is not realistic for most patients to achieve. And most knee replacement patients have long since discontinued activities that require extreme knee range of motion like that.

So: if you can do everything you desire, don't stretch just to get a better number.

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Trey Wilson
1/5/2021 06:33:10 pm

Hello, my name is Trey and I am 33 years old. I underwent ORIF to my right patella for a slip and fall on 11/12/2020. My ortho recommended not bending my knee and had me in a circular cast for 4 weeks. Once removed he had me in a leg immobilized with full extension for 2 more weeks. Now I am 7 weeks post op and only have about 70° of flexion. I am cleared to start PT but my ortho is recommending manipulation under anesthesia. I do not want to go forward with the procedure at this time but he has given me until this next Monday to make a decision before he will not offer it for me anymore. I am currently uninsured and money is an issue in these difficult times. Would your method of hanging my leg over the couch arm be beneficial for someone in my position or would you recommend I have the MUA? If I am unable to have the MUA would your methods help me gain any range of motion at all? He stated that I should still be able to gain a few degrees but it wouldn’t be very significant without causing much pain. Thank you for your time and looking forward to hearing from you.

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Christopher Gorczynski, MD link
1/5/2021 10:37:13 pm

You were treated appropriately after this procedure. Based your range of motion, it is reasonable to consider manipulation at this point. There is a time window, after which manipulation will not be effective. I agree with your surgeon, if you are going to undergo manipulation, it should be done prior to 8 weeks postop.

My experience with fractures, however, suggests that you may be able to regain motion for a longer period of time following surgery as compared to knee replacement patients. If you are trying to avoid manipulation, I would spend several hours each day stretching prior to discussing your case with your surgeon next week. See if you can get past 90 degrees by then. If so, then maybe you won't need the procedure. If you still haven't gotten to 90, strongly consider manipulation.

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Jennifer
1/8/2021 09:34:20 pm

I had a tto, mpfl implant, outer tendon release, and a macy on 11/4. I was up to 90 degrees at 6 weeks when we discovered a wound infection. The wound doctor had me stop all pt and strengthening for past 2 weeks. I was released to start again yesterday. I immediately started walking. I cannot however move past 40 degrees now. It is very painful behind my knee. Could it just be stiffness from disuse these past weeks, should I be worried, and any tips to move or help the pain behind so I can push back to 90 degrees? Any advice is helpful.

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Christopher Gorczynski, MD link
1/16/2021 09:23:43 pm

Long duration stretching. I wish there was another secret I could share. I do have some videos demonstrating how I would stretch on my youtube channel:

https://www.youtube.com/channel/UCOJg4ht1mEKBey-skLftDKw/videos

Use plenty of ice. Hold stretches for many minutes without relaxing. Aim for a minimum of an hour per day at the endpoint.

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