Stretching is more important than walking after knee replacement

As you navigate through this website, it should become quite clear how much I emphasize regaining range of motion as soon as possible after knee replacement surgery. 

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Ability to walk does not indicate adequate knee range of motion. 

One of the first questions I ask my patients at each follow-up visit after undergoing knee replacement surgery is: " How is your range of motion doing?" For some reason, a very common response is: "I am able to walk (x amount of ) distance."

Clearly patients value ability to walk. And while I agree that walking is important, it is crucial to understand that regaining knee range of motion early after knee replacement is absolutely crucial to an excellent long-term outcome. 

Try a quick experiment. Take a few steps trying to keep one of your knees as straight as possible.

See? It can be done. You will have a strange gait, but you can walk with almost no knee range of motion.  

Now walk normally while watching your knee move. Once again, very little range of motion is required to walk normally.

Now sit in a chair and put your feet flat on the ground in front of you. Notice how your knees are bent to around 90 degrees. 

Now without bending your knees beyond 90 degrees, try to get up from a seated position without pushing off with your arms or thrusting your upper body foward to generate momentum. It is not possible. This is because your center of gravity is behind your feet. To stand up from a seated position, you simply must be able to bend beyond 90 degrees.

It is essential to regain  functional range of motion by 6 weeks after surgery. 

Remember, patients can only reliably regain knee range of motion for the first 6 weeks following knee replacement surgery. Beyond this point, scar tissue becomes too stiff and inflexible for simple stretching to be successful. 

When patients have not achieved an acceptable, functional range of motion by 6 weeks postoperatively, I recommend  manipulation under anesthesia. 

My message is NOT - "Don't walk."

Walking is important. It helps to prevent blood clots, it will help reduce swelling, and it is good for the lungs after surgery. Walking is just not sufficient to obtain an excellent result following knee replacement. As much as patients are focused on walking as a sign of recovery, I focus on regaining knee range of motion as the true indication of progress. 

To summarize:

1- Walking is important to patients and surgeons following knee replacement.

2- Walking does not require very much knee range of motion. 

3- A patient's ability to walk after knee replacement does not necessarily indicate adequate knee rehabilitation.

4- The focus, particularly early after knee replacement (first 6 weeks), must be on regaining as much knee range of motion as possible.

5- The closer your knee range of motion is to normal following knee replacement, the more functional your knee will be for all activities (not just walking).

6- There is a limited time period (6 weeks) after a knee replacement for a patient to reliably regain range of motion. This is why I fixate so much on regaining motion as soon as possible after surgery. 

7- Walking, comfort, confidence, strength, coordination, and endurance all will improve for months/years after knee replacement surgery. These factors all are improved when a patient has regained excellent range of motion. This means we should be patient with all of these parameters while focusing on early, consistent stretching to help ensure a good result. 










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