Total Knee Rehabilitation Roadmap

How much motion should you have at any given point after surgery? Of course, you should speak to your surgeon about the specifics of your case. However I'd like to provide some general guidance on this subject. 

During knee replacement surgery, the knee will be reconstructed using a metal and plastic prosthesis, and the ligaments balanced. At the conclusion of the operation, the knee will be able to fully extend (straighten) and fully flex (bend back). After surgery, although initially pain will prevent full range of motion, scar tissue has not had a chance to form. Most patients are able to move from full extension (0 degrees) to 90 degrees (foot flat on floor while sitting in normal chair) within 24-48 hours. 

It is not uncommon for patients to lose a bit of motion around 7-10 days from surgery. This is a result of increased pain and swelling due to the inflammatory cascade. This inflammation peaks around 10 days from surgery. It is ok to go a bit easy on yourself during this time. Use plenty of ice and anti-inflammatory medication if it is allowed by your surgeon. But keep stretching.  Do not allow yourself to lose full extension. This is crucial. 

By the first postoperative visit around 2 weeks from surgery I would like to see a minimum of 0-90 degrees of motion. 

By 6 weeks from surgery I would like to see 0-120 degrees minimum. 

Patients may gain an additional 5-10 degrees of deep flexion  over the course of the first year following surgery if they've gotten to 120 degrees by 6 weeks. 

If these parameters are not met, other options are available. I begin asking patients to follow-up with me every other week  or more to track their progress, to answer questions, and provide motivation and support. I understand that this process isn't always easy and is never fun. If inadequate range of motion isn't achieved by 6 weeks, I then recommend manipulation under anesthesia to break up scar tissue that has been allowed to form. This buys us some time and generally gets things back on track. 

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