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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. total knee
8 Comments
Karen M. Ohlsen
8/17/2016 12:16:29 pm
I have been doing some rehab with weights. I don' t have any pain but I would like to know if I can hurt my new knee and how much weight is too much? 8/18/2016 11:43:27 am
Gentle progressive resistance exercises are perfectly fine after total knee replacement. There is one important exception - I would definitely avoid the leg extension machine. This overloads the patellofemoral joint (knee-cap) and tends to pull the tibia forward. Although this exercise can strengthen the quadriceps, it is not optimal for knee function. I would focus more on strengthening the core, hip flexors, and abductors. Adding gentle squats would be fine as well. Please see the blog posting on anterior knee pain to see me demonstrating some simple exercises that will focus on hip strength.
Richie
12/20/2020 04:55:25 pm
Dr. Gorczynski, when you say you would like to see a minimum of 0-90 degrees of motion by two weeks from surgery, does that mean 90 degrees after being at rest for a while, or 90 degrees after warming up and stretching for several minutes? 12/22/2020 11:16:42 pm
I would like to see an easy 0-90 degree arc in my office at 2 weeks without a lot of warm up/stretching. If you are not quite there, no problem...just increase your duration and frequency of stretching so you start seeing progress.
Mike
12/20/2020 07:33:42 pm
I had TKR 10 months ago and although I can do all that I did prior to surgery, including playing golf, I still have some pain when I reach my flexion limit. I also still get some swelling after any activity. Is this normal? 12/22/2020 11:19:48 pm
It may be normal. This is partly dependent on what your range of motion is. In general, golf does not require very much knee range of motion, so I would not expect you to be maxing out your knee range of motion with that activity. If you mean it hurts a bit when you force flexion (and you have at least 120 degrees of flexion), I would expect this discomfort to gradually subside with time and as you stop pushing for more motion.
Bernard Cunningham
12/22/2020 03:49:25 pm
i have just had a replacement knee surgery on 3rd Nov.2020. With local NHS physio i was initially able to walk with a Zimmer frame. I continued with the exercises but know find that the more i excersis and try and straighten the knee joint the stiffer it becomes. The swelling has remained same size even after resting. I would appreciate your thoughts. Regards Bernard 12/22/2020 11:27:27 pm
Slow, long duration stretching is the key to rehabilitating your knee replacement. Ice can help. Swelling may occur, but this will resolve with time. the longer you hold the stretches for, the better. This video will be helpful to you: Your comment will be posted after it is approved.
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