Nearly half of American adults will develop knee arthritis at some point during their lives. Pain, stiffness, and limited mobility are often the result of knee arthritis. Knee replacement surgery can relieve pain and restore function when your knee is severely damaged by arthritis or injury. The average recovery time from knee replacement surgery is approximately six months, but it can take roughly 12 months to fully return to physically demanding
activities. Though the recovery process can be long, there are steps you can take to heal well and enhance your recovery speed. The team at Tri-State Orthopaedics provide the latest advancements in treating chronic knee problems. When conservative options aren’t enough, your provider may recommend knee replacement surgery. Also called arthroplasty, this procedure involves replacing the structure of the damaged knee joint with metal
and plastic parts to restore the normal function of the knee and relieve chronic pain. Knee replacement is an incredibly common and successful procedure. Over 90% of people who have knee replacement experience significant improvement in pain and their ability to get around. For most people, knee replacement restores a good quality of life, giving back independence and allowing you to engage in activities you used to enjoy. However, recovery is often a long road. If you’re scheduled
for or considering knee surgery, here are some helpful dos and don’ts in your path to recovery. People used to think that severe pain following knee replacement surgery was something you just had to push through. In fact, properly managing pain helps reduce discomfort and speed your recovery. Because pain is subjective, it’s crucial to accurately describe and pinpoint the location and intensity of the pain. Your care team needs to know whether the pain is
constant or intermittent and whether it’s sharp, tingling, or burning, among other things. Though it’s reasonable to expect some discomfort after knee replacement surgery, an effective pain management program can significantly reduce your level of pain and help boost the speed of your recovery. Recovery from joint replacement surgery isn’t always easy, but getting back on your feet as soon as the doctor says it’s okay can help you recover.
Walking helps prevent complications like blood clots, improves circulation, and keeps your joints limber. You don’t have to wait until you return home after surgery. Most patients can start walking while still in the hospital. Walking helps deliver important nutrients to your knee to help you heal and recover. You can expect to use a walker for the first couple of weeks. Most patients can walk on their own roughly four to eight weeks after knee replacement. Physical
therapy is a crucial part of recovering from knee replacement surgery. At home and at the rehab clinic a physical therapist will show you exercises that will help your knee heal. Even if you’re feeling well and confident, it’s vital to continue physical therapy as it can help speed your recovery. Physical therapy will help strengthen your leg, help you walk, and restore the movement of your knee joint. In addition to the healing movements you perform during physical
therapy, it’s important to exercise. This is different from the movements you learn in physical therapy. Engaging in safe physical activity helps your muscles get stronger and helps you heal quickly. Remember, although exercise is important, it shouldn’t cause pain. It’s normal to want to heal as quickly as possible. However, pushing yourself too hard can cause a setback. Your team can tell you what type of exercises are safe for you to perform, which might include extra walks or riding on an
elliptical machine. Many patients are eager to recover, and it’s normal to feel this way. Did you know that rest is just as important to your recovery? Balancing movement with getting enough rest is necessary to heal from knee replacement surgery. For the first few months, you may have some mild-to-moderate swelling of the affected knee. Getting the appropriate rest and keeping your leg elevated, as well as applying ice, can help boost healing time. Knee
replacement surgery often changes lives. You can recover well with the help of the team at Tri-State Orthopaedics. To learn more, call our Germantown or Memphis, Tennessee locations to schedule an appointment or book online. What does knee replacement surgery involve?
Effectively manage pain
Walk as soon as possible
Physical therapy
Exercise
Rest
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. how-to-rehabilitate-your-total-knee-replacement.html another-way-to-stretch-your-knee-replacement.html the-best-total-knee-extension-stretch.html 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. google-site-verification: googlee8ce9aaf537c901b.html Sara K 4/5/2020 08:02:03 pm Hello Doctor You are very early in the recovery process to feel hopeless. You will see improvement for many months yet to come. It is most important to focus on range of motion exercises and let your knee recover while doing so. It is normal to have some pain during this process. It is normal to feel stiff, particularly after resting for a while. This all will end. Strength, endurance, coordination will all come back with time- as long as your range of motion is adequate. Be generous with the ice. Consider easing up on the 40 minutes of combined walking and biking- it sounds to me like this is simply too much too soon. Concentrate on gentle stretching and short walks a few times per day to maintain circulation. Jonathan Fausett 4/4/2021 01:58:15 pm Dr. I am 5 days out TKR. Your thoughts on what is most important, stretching to get as much knee flexion as possible in the first 6 weeks, along with completely straight leg goal has made me change where I am spending my rehab efforts. How many minutes Ideally should I hold my maximum flexion stretch position? Use an hour at the endpoint each day as a starting point. If your motion advances nicely, consider reducing the time you spend stretching. If you are struggling for motion, increase your time at endpoint. Your goal should be a minimum of 0-90 degrees motion by 2 weeks postop with minimum 0-120 degrees motion by 6 weeks postop. Most patients can not reliably regain much more motion beyond 6 weeks through stretching alone. Best of luck to you! I am in my fifty's and had knee replacement however after nine weeks I cannot fully straighten my leg The degree of flexion contracture (inability to fully extend your knee) really influences my recommendations. It is not mandatory to get perfectly normal extension to have a functional knee replacement, however, the closer you get to full extension the better. The best stretch for knee extension is the prone hang technique. Static stretching braces like the JAS brace can also be helpful. Your article is quite helpful! I have so many questions, and you have answered many. Thank you! Such a nice and superb article, we have been looking for this information about stretching is more important than walking after knee replacement. Indeed a great post about it!! Lucy 8/13/2020 10:04:15 pm I really wish I had seen Dr. Gorczynski’s advice before now. I am a 61 year old female, 11 weeks post bilateral knee replacements. I am doing well, but continue to have considerable pain and much stiffness in my knees. My PT mostly involves strength training but now I have learned, thanks to Dr. Gorczynski’s knowledge, that working on ROM (flexion and extension) should be foremost in therapy especially during the first 6 weeks! I have just begun putting more effort into working on my ROM and I want to encourage others to prioritize ROM in the first 6 weeks. P Suladha 5/5/2021 12:33:02 pm Can I sleep on stomach after 4 months of both tkr surgery Urvashi Mehta 8/15/2020 12:46:33 am I'm 54 years old and just had a TKR on my left knee (injury related osteoarthritis came on quite early for me). I came across your blog while looking for information on whether I was on track with my recovery and found your website very informative. I'm on day 8 post surgery and because of the COVID 19 situation am doing my PT at home. I just want to make sure I'm doing things right. My doctor had me flexing the knee at 120 before discharge and walking and climbing stairs as well. The physiotherapists gave me basic exercises to do (quite similar to what you recommend ) but between the my doctor and two different therapists I had a few conflicting instructions. I'm trying to follow a happy medium. I walk about in the house, sit on a chair with knees bent at 90 for a good amount of time, do wall hamstring stretches, the heel push-down and the heel raises 4-5 times a day (10 counts of 10), using a resistant band to stretch 4-5 times a day, pedalling for 7 minute stretches twice a day, trying to bend my knee to 120 2-3 times a day. Am I doing this right? should I be doing more? Looking forward to any advice and information. Thank you! Looks like you are doing everything appropriately. Don't be afraid to hold the stretches for long durations (minutes as opposed to seconds). Margaret Post 8/24/2020 04:15:14 pm I am just at 12 weeks with a very inconsistent range of motion ranging from 114-120, depending I believe on my day's activity level. Can I still improve my flexion through prolonged stretches as you suggest, or is it too late? Also, I have pain and difficulty with my step up/down exercises. Any recommendations to help with this? Absolutely. Slow steady stretching can still be effective for you at this stage. Progress will not be as rapid or predictable after the 3 month mark, but getting another 5-10 degrees is definitely within reason. Much more important that the exact degree of flexion you achieve, is function. Ultimately, you want a knee that allows you to do all your desired activities. You appear to have achieved this already, and a little extra motion would be a nice bonus. If the pain you experience with steps is mainly in the front, this is commonly due to subtle gait abnormalities that take time to resolve. Focusing on hip strengthening exercises would be my main recommendation for this. Check out this article for some specifics: //www.yourorthomd.com/orthopedic-knowledge/anterior-knee-pain Heidi 10/18/2020 01:03:05 am Thank you for your very helpful posts. I’m in a little bit of a different boat and would love any additional insight I can get. 40yo active and strong female, no knee issues. I was in a MVA Aug 10 where I broke many bones (R patella fractured into 6 pieces, L femur and tibial plateau fracture, R elbow, L ulna). The internal fixation of the femur required splitting the patellar tendon so they could put the rod in. I’m 9 weeks post op and was just cleared from all braces last week. ROM for right knee is around 90 but only around 70 for left knee. (Extension is great for both since I’ve been in nursing care for two months, just laying in a bed with gentle and likely inadequate PT several times a week). I appreciate the advice you have for long sustained stretches but my left quad forms an incredibly hard ball of muscle (like half a baseball) when I stretch my left knee, I believe it’s near the site of the trauma/broken femur. My surgeon has given me until 12 weeks post-op before doing MUA. Would you adjust your suggestions for long stretching or anything else given my situation? Advice for dealing with super tight quad? Should I push for MUA earlier? I would not change my suggestions under your circumstances. In addition to the femur fracture, the muscles surrounding the femur (quadriceps, hamstrings, adductors) all will likely injured at the time of the accident. This will heal with scar tissue and is likely why the muscle feels hard there. The femur fracture (treated with an intramedullary nail) will heal with substantial callus. This may also feel hard to you. Long, slow stretching is the best way to deal with your poor range of motion. Try to relax as much as you can while stretching. I do not think earlier manipulation is appropriate under your circumstances. Heidi 10/27/2020 02:50:24 pm Thank you so much for taking the time to respond to questions, I really appreciate it! Loretta Henry 9/15/2022 06:00:16 am What is the best stretch to do to gain rom beyond 120? Any flexion stretch that you can hold passively for a long duration. The key is holding the stretch for many minutes at a time. Stretching your knee in the prone position (lying on your stomach) will be stretching your quadriceps as well as your knee, while flexing your knee while sitting (or otherwise with hip flexed) will primarily be stretching your knee joint. I would do both of these to regain not only knee joint range of motion, but functional, dynamic knee range of motion. Feel free to experiment with different stretching maneuvers. I give several examples in the video section. Let me know which maneuvers are most effective for you. Remember, the key is long duration stretching at this point if you want significantly more range of motion. Nice blog.very useful information. Linda 11/19/2020 10:17:56 am I am just over 3 weeks post-op. My ROM (flexion) is about 110 degrees. My orthopedist aims for 120 degrees. I had a press-fit knee replacement. I felt the knee “go out” but nowhere near collapse twice. Since bone is growing into the metal pieces, should I be concerned? Also, to achieve the 110 degrees, I am moving slowly forward in a chair while keeping my feet together (starting at 90 degrees). Is it OK to achieve the flexion slowly, like this? Or should it be a smooth, all-at-once motion?? Thanks very much! This could indicate "pain inhibition". This is basically a reflex where a pain stimulus causes sudden relaxation of the quadricep muscles. Consider this your bodies defense mechanism, somewhat analogous to rapidly withdrawing when touching a hot object, even before your brain becomes aware of the heat. This would be expected to improve as your knee heals. It is extremely unlikely this is due to motion at the bone-prosthesis interface. Slow steady stretching is the best. The longer you spend at the endpoint, the better. I love that this post highlighted that walking is important following a knee replacement surgery. Whether it is the position of the feet, our posture or our walk itself, it is important to learn the proper way to prevent damaging the knee and to ensure a full recovery. My mother will be undergoing a knee replacement surgery this weekend and I will relay to her this information. Jana Trovato 11/23/2020 12:10:02 pm I am a 54-year old female, 6 days post op from TKR on the left. Old torn ACL with reconstruction 25 years ago and inherited arthritis led to severe osteoarthritis. I am experiencing a lot of swelling. Headed to first PT session today and have been doing stretching exercises at home. Thank you for this information. My doctor has stressed the importance straightening the knee through gravity stretching more than ROM. Is this correct? My quad muscles (or top of the thigh, not sure what the correct term is) are very tight and painful. Also, is it normal for the operated knee to feel so very heavy? Will this go away? Regaining full extension is priority #1. Priority #2 is regaining full flexion. These two goals ideally will be worked on at the same time. heaviness and swelling are quite normal early after surgery. Use plenty of ice, elevation, and compression to help reduce swelling and inflammation. You will see progress for many months yet to come. Week #2 tends to be the worst with regard to inflammation/swelling. Jill DeFelice 8/10/2021 09:46:43 am Glad to see your comments on Week 2. My progress has been terrific (6 days out full extension and 105 for flexion) but in this second week as I am up and around more, I have had more swelling and stiffness. Good to know this is normal. Also lots of odd pains and sensations this week. All transient, but notable. BTW, I prehabbed with a lot of strengthening and stretching prior to surgery. Erin Durrant 11/24/2020 04:38:36 pm I am 9 weeks post TKR. I have constant pain in the right side of my knee. I have been taking two walks a day. The morning walk was a mile and a half and the afternoon walk was 1 mile. Plus, I was doing 20 leg exercises twice a day given to me by an in-home physical therapist. At my 6 week check up I told my doctor how much pain I was having in my knee. He told me everybody heals at a different rate and that he thought I was doing too much. He told me to take two weeks off from all the exercise. I did that and pain in other parts of my knee did go down but intensified on the right side. Now I don’t know what to do. I feel like my range of motion has gone down instead of gotten better. What can I do at this point? Thanks, Erin Without knowing which knee was replaced, I do not know if the "right" side refers to the inside or the outside of your knee. Either way, I sounds like you were walking a bit too much. As I suggest in this article, this is a common error. The focus really should be on regaining as much normal range of motion back as possible, as soon as possible following total knee replacement. I recommend focusing on daily stretching. Use long duration stretches as I recommend throughout this website. Take short, frequent walks around your house or outside, a few minutes at a time. There is no benefit to walking for long distances immediately after knee replacement surgery. This can lead to inflammation, stress reactions, soft tissue irritation, and slow down your progress with range of motion. Once your motion is smooth and full, and your knee has healed adequately, you can gradually increase your walking distance without limitation. Definitely focus on range of motion exercises at this stage, use ice to help reduce inflammation, and let your knee heal. If this does not help over the next few weeks, you need to get checked out by your surgeon. Erin 11/26/2020 10:16:07 pm Sorry, it’s my left knee that had total knee replacement surgery. So it’s the inside of my left knee. I’ve done two days of the basic stretches you demonstrated on this website. The knee hurts more than ever on the inside of my left knee now. I have been icing after doing the stretches. If the pain gets too bad, I take some Tylenol. Thanks for your response. So, the inside of the knee is where most of the surgical approaches open the extensor mechanism. This is also where the medial collateral ligament is released to correct varus (bow-legged) alignment during surgery. These issues may explain some of your symptoms. I think it is important to try your best to achieve 120 degrees of flexion using long duration stretching. If you continue to have significant pain, in spite of reducing your activity level and improving your range of motion, you really need to be checked out by your surgeon for an examination and x-rays. Kent Hollis 11/28/2020 08:47:09 pm Hello, I am a 53 year old male and had a TKR on 9/16/20. I am doing well regarding range of motion, 0 and 121, and things have healed up well. The recovery has gone quite well. However, it is now 10 weeks post op and I am experiencing increasing stiffness and soreness in my knee. It felt a little better 2 weeks ago. Is this normal? It may be that you have been increasing your activity level a bit now that you are getting a bit farther out from surgery. Your motion sounds like is was doing ok. I would not say what you are experiencing is normal, but occasional setbacks can occur. If you have been exercising more, consider reducing your activity a bit, maybe use some ice and anti-inflammatory medications if you tolerate them. If this doesn't improve within a couple weeks, I recommend a follow-up visit with your surgeon. I am 9 weeks into my recovery and my ROM is excellent. I’ve been riding a bike 20minutes/day walking 2.5 mile per day, doing 10 different exercises daily and str stretching throughout the day. at. The he knee is still quite numb, there is considerable pain and stiffness these last few weeks, I feel frustrated I haven’t had less of that. No real progress in the last 2weeks. Cold wet weather has been the norm. Feels like something is wrong but perhaps this is normal. Is @Robert Trachtenberg: you are doing quite a lot of activity for 9 weeks out. Perhaps this is a bit too much, too soon. Maybe try reducing your activity a bit, use a bit more ice, and let your knee heal for a few weeks. Once your knee feels better, you will likely be able to gradually advance your activity level up the level you desire. Adam 12/14/2020 06:17:17 am I'm a 54 year old male and I had my TKR on 11/13/20 almost 5 weeks post op. I can straighten my left leg with no problem, but I'm only getting 90° bend. What type of exercise should I be doing and is it to late to get to 120? It is getting close to the time I would be considering offering you manipulation under anesthesia. You are a few weeks behind schedule and while everyone is different, if you are still at 90 degrees at 5 weeks you really need to dedicate a lot of time to stretching. Unless there is major improvement, if you were my patient I think manipulation will be helpful around week 6. In the meantime spending long periods of time stretching as I recommend may help. Here are some links: //www.yourorthomd.com/orthopedic-knowledge/how-to-rehabilitate-your-total-knee-replacement //www.yourorthomd.com/orthopedic-knowledge/another-way-to-stretch-your-knee-replacement //www.yourorthomd.com/orthopedic-knowledge/manipulation-under-anesthesia Almost 4 weeks out from TKR.. My ROM is around 95 on my own, therapist can measure 105 but that hurts like heck.. I do PT in the office and on my own. I am frustrated because my knee is sore and hurts when the therapist measures my ROM. Is this normal, how long will it hurt. Unfortunately your knee is going to hurt until you have finished rehabilitating it. Ideally, you will achieve at least 120 degrees of motion by 6 weeks from surgery. Long duration stretching (minutes per stretch, not seconds) aiming for up to an hour or more at the endpoint each day should be helpful. Be generous with ice and anti-inflammatory medication, if you can tolerate it. Once you regain adequate range of motion, just maintain that motion and gradually your knee will heal and the inflammation/pain will subside. While you are stretching, the process is often painful, particularly if you are not making progress with motion. If this is the case you need to stretch for longer periods and more often so that progress is being made each time. Machele Heck 12/15/2020 11:50:10 pm I had a TKR on right knee 9/21/20. Could only get to 85 degrees ROM by 8 weeks. Had a manipulation 11/23/20. I am currently getting 110 degrees ROM. My problem is the swelling. If I do any activity where I am standing, my knee swells so much that it limits my ROM. I work on bike and stretching 3 times a day and even get up twice in the night to stretch knee and ride bike since manipulation. I am 53 years old and was told by my doctor that I produce scar tissue very rapidly. I ice and elevate at least 4 times a day and ice a couple times in the night. I sleep with knee elevated. I am at a loss for what else I can do to increase ROM. My knee swells so easily and is still very painful. I still am on a walker because since manipulation my knee gives out on me while walking. Any advice would be much appreciated. Taking Celebrex for swelling. I have no tricks beyond long duration stretching, ice and anti-inflammatory medication. The longer you hold the stretches for the better. Try to find a way that allows you to spend several hours cumulatively each day at the endpoint of your motion, and try to obtain another degree or 2 each time you stretch. Eventually the pain and welling will subside. This video may help you. //www.youtube.com/watch?v=xQASZaKZRxs It's great that you explain that it's best to stretching order to recover as much range of motion as possible for your knee after replacement surgery. My friend's grandmother hurt her knee several years ago and wants to get knee surgery in January. I'll let her know the importance of stretching so she can talk to her doctor about it to help her recover as quickly as possible. I am 51/2 months out from bilateral knee replacement. My right knee still has swelling . Is this normal and at what point should the swelling be gone before I
need to worry. I was under the opinion that swelling could go on for up yo a year. While some swelling is normal after surgery, it should gradually resolve. Most knees end up with a slightly larger circumference permanently as the scar tissue that forms after surgery is thicker than the normal tissue. Since you had bilateral surgery, it is a bit surprising that your knees are not relatively symmetric. If your entire leg is swollen on one side, you should be evaluated by your surgeon to make sure the prosthesis is ok, but perhaps more importantly, to rule out a DVT (blood clot). I recommend you call your surgeon for an appointment ASAP. Great to read your words, many thanks. You have so nicely described about the importance of stretching over walking in the article above. Stretching is important to strengthen the Body. It helps patient to improve the function of the muscles surrounding the replacement. Dylan Deaton 1/4/2021 05:17:36 am Nice post!! keep sharing. Mark Irvine 1/5/2021 09:23:59 pm Thanks for your website--I wish I had seen it earlier in my recovery. I am a 42 year-old male, and I had TKR on my left knee seven weeks ago. I've haven't been able to fully bend or straighten this knee for four or five years prior to the surgery. I was able to deal with the pain and continue to play sports pretty regularly until two years ago. At that point, I hit a wall and had to stop pretty much everything except walking. At that point, my ROM was 90-95 degrees bent and 5-10 degrees straight. Right now, seven weeks after surgery, my ROM is disappointing: 90 degrees bend and 10 degrees straight, and it seems to have gotten slightly worse in the past two weeks. I've been doing my stretches and regular PT (twice a week), but as soon as I sit down again, I can feel my ligaments pulling to return to the "safe," partially-bent position it's been in for the last couple of years. I found your website last week, and so I've changed to focusing on ROM stretches that you recommend, especially straightening the knee, since that seems to be the hardest for me. When I sit with my leg sticking straight out, I just feel pain without any stretch. It just feels locked in place, and I can't seem to budge it. However, when I lie on my stomach, as you recommended, I feel the stretch much better, and so I've been doing that for at least six times a day, twelve minutes at a time. It hurts, but I can feel a decent stretch by the end. However, as soon as I stop, I can feel the ligaments pulling to go back in place, no matter what I do. Do you think I should discuss MUA with my surgeon? He's already warned me not to expect full ROM based on the limitations I had prior to the surgery, but I kind of expected to be in a better position by this point (and with less pain in the knee and in my hamstring and ligaments). If I have MUA, what do I do if my ligaments just pull to go back to the "safe" bend, and I'm in the same position I'm in now? Thanks, Mark I think it is worth considering manipulation at this point. It is crucial to regain decent range of motion for a good functional result, and 90 degrees is simply insufficient. Unfortunately, manipulation is not typically able to help you regain extension. For extension, I would spend long periods using the prone hang technique that seems to be working for you. You might also ask your surgeon for a static extension brace (something like J.A.S. or equivalent). This may allow you to continue the stretch for even longer periods. If you proceed with manipulation, expect a bit more pain for a while afterward. Maybe ask your surgeon to photograph your knee at maximal flexion during this procedure. I think this helps patients psychologically believe their knee can actually bend. Then work on long duration stretches, use plenty of ice, and get back as much flexion as possible. Mark Irvine 2/13/2021 05:25:49 pm Thanks for the advice. After consulting with my surgeon, I now have two braces, one for extension and one for flexion. I have to wear each for a minimum of three hours a day. They're very expensive to rent, but luckily my insurance is covering it. Even if it didn't, I'd pay for them myself because they're making a huge difference. This week marks 12 weeks since my surgery, but I'm still seeing improvement in both straightening and bending my knee, and overall the pain is decreasing. I only wish that I had gotten them sooner. If anyone else feels that their knee is locked in place after surgery, and no amount of stretching or physiotherapy is making a difference, these braces are worth looking into. Glad to hear you are making progress using these braces. They can be very helpful. I'm less then 2 weeks out from right knee replacement. Most of my pain is in my chin bone just under my knee pounding and the back of my knee gets very sore! I'm currently at 90° to 95°. But walking starts the chin to go into pounding, like heart beat and the back of my knee gets so sore Its hard to bend it again. This is just short walks. Is this a normal complaint? @BJ - What you report sounds within reasonable expectations for the first couple of weeks postop. Use plenty of ice and keep stretching. This should improve with those measures and time. It's good to know that walking doesn't require a large range of motion from our knee and therefore isn't as effective as stretching after surgery. My uncle is looking for an orthopedic surgeon with whom to discuss surgery soon because his knee pain has started affecting his everyday life. I'll have to share your tips to help his recovery if he decides knee surgery would be the best way forward for him. Marylou Westling 2/11/2021 11:51:45 am I am 4 weeks out from R TKR. At my first PTappointment therapist told me I was ahead of schedule with ROM. My issue is constant pain on R side of knee and difficulty with straightening the leg. What exercises and stretching can I do to improve this? Thankyou Please check out the articles and videos I have posted throughout this website. I have done my best to present my recommendations. If you click on the "orthopedic knowledge" tab in the menu above you will find pages that contain "all articles" and "all videos" I have posted. Jenn K 2/16/2021 01:18:36 pm Hi, I had MACI & TTO surgery on 6/4/2020. I have a 2-3 degree extension deficit in my surgery leg. Should I be concerned about this? Will it be detrimental to my progress or my ability to return to normal activity? Can stretching get my extension back at this point in my recovery? It may be challenging, but still possible to regain the last couple of degrees. Check out this video I recorded, particularly around 2:45 where I discuss the prone hang technique. This is a powerful way to regain full extension. Long slow stretching could help you get the last few degrees. //www.youtube.com/watch?v=xQASZaKZRxs&feature=emb_logo Jenn K 2/16/2021 07:44:06 pm Wow! Thank you so much for the response, I will definitely do that exercise everyday. Thank you so much again! 😀 Pat. Capone 2/19/2021 07:17:52 am I’m a 72 year old man. Today is week 4 since my bilateral knee surgery. I’ve had 4 PT sessions at home and this week I had my first PT at the gym. I’m very diligent in doing the many exercises I was shown. I am taking a variety of medications. I sit in an oversized chair with an ottoman to keep my legs straight. Here’s my question, someday I wake up and have very little discomfort. Other days I wake up and it feels like I have a vice on my knees. The knees are stiff and painful. Is this considered normal? There is really no such thing as "normal" after knee replacement surgery. It is incredible how much variety we see in patient's responses- particularly during the first few weeks following the operation. That being said- I would suggest that what you are experiencing is within normal expectations for where you are in the post-operative period. Good days, bad days, but an overall trend of improvement. The best things you can do at this point include making sure your knee regains full extension and work hard to regain as much flexion as possible, as soon as possible. This is accomplished by sustained stretching every day. Using ice throughout the day will help minimize the inflammation/swelling that is expected to occur. Best of luck to you! I am an 81 year old male, reasonably fit, and am in my 13 th week post-op (24 Nov 2020). I had an uncomplicated TKR of the left knee, and had six weeks of supervised PT, plus surgeon's check-ups at 3, 6 and 9 weeks. All seemed satisfactory and I am now on my own. Despite all that, I wish I had read this blog earlier, for its strong emphasis on early stretching. I am now enduring continuous pain in my knees, which seems to lessen after stretch exercise and also massage, but the relief is temporary. My ROM is about 117 and straightness about 3. Any comment from you would be much valued. Stretching, ice, and time...Those are the basic keys to a good result after knee replacement. You should expect progress for many more months yet to come. I also might direct you to the article I wrote on anterior knee pain. //www.yourorthomd.com/orthopedic-knowledge/anterior-knee-pain Making sure your hips are properly rehabilitated can also help relieve knee pain. Best of luck to you. DougP 2/24/2021 07:15:59 pm I am an 81 year male, reasonably fit, and had a left TKR on 24 Nov 2020. All seems well, despite having more or less continuous but manageable pain in my knee. I have some awkwardness (in both knees) descending stairs. My supervised PT stopped over a month ago. All of it involved sets of DAILY exercises. However, in your section on Anterior Knee Pain, you recommend doing leg lift exercises TWICE WEEKLY only, to allow for healing. This seems reasonable, but how do you reconcile this with recommendations for daily exercise elsewhere? Should all PT exercises be better performed twice weekly? This is a very important point. There is a crucial difference between stretching and strengthening. Stretching must be done every day. This should be done as often as possible, as many times as possible, without days off. Strengthening should not be done every day. The strengthening exercises (when done properly) should overload your muscles causing strain/inflammation/even micro-tears in the muscle fibers. This overload stimulates muscle growth. This growth takes time. Re-overloading the muscles prior to their full recovery is inefficient at best, counterproductive at worst. If you are strengthening completely unrelated muscle groups, then strength training can be done more frequently. An example of this would be working on chest exercises on monday, leg exercises on tuesday, back exercises on wednesday, taking a day off from strengthening, then repeating the cycle. As you can see from this cycle in a given week you would only work the same muscles twice. Again- Stretching must be done each day. Strengthening a particular muscle group no more than twice per week to avoid over-training. 2/24/2021 07:28:37 pm Thank you for your encouraging reply. I was not sure whether my question went to the right section, and I have sent another inquiry regarding recommended intervals of stretch exercises. Pamela Oakley 2/27/2021 06:18:38 am Good Morning, I am 16 weeks out of tkr left knee, and stretch, strengthen, static cycle, walk,but I drove my car 10 miles using clutch and since then my knee is in awful pain. I already had inner knee pain which I try and ignore. I’m still limping despite trying to stretch, can get 100 flex and manage to ride my static bike slowly. Being athletic and a netball coach I don’t feel as if I’m improving. It’s like two steps forward one back. Should I be worried about this inner pain, should I continue even with driving and will it or will it not help. No physio outside due to covid so been doing it myself and manipulated hard rock and bruised leg after surgery for two weeks to get it moving, manipulated it also but feel I’m two weeks behind where I should be. I wanted to return to bowls soon but can’t like this with a limp. Please can you give me some advice. I only take paracetimol as most heavy painkillers give me breathing problems due to allergies. Had to come off dehydrcodeine after three weeks so been a gruelling time. It seems your knee is a bit stiffer than optimal for this stage following surgery. If you are still having this much discomfort, I think you need to be evaluated by your surgeon. X-rays, lab work to help rule out infection, and consider MRI to rule out stress fracture. This is not a typical result for your stage postop. 15 wks after tkr on rt knee. Have some pain in quads and hamstrings,rom is full flex but having problem getting full extension. Do home pt stretching,stationary bike,walking and bending all to no avail. Is it going to be possible to get full extension this far out. It will be a challenge. I think the best way to achieve full extension at this relatively late stage is to use a static stretching brace like J.A.S. Your surgeon would need to prescribe it. This allows very long duration passive stretching. It would be helpful to know how far you are from full extension, though. I am 50 and 7wks TKR post op. Back to work at a sedentary job. I’m my job is mostly sitting, but I make sure to stand for at least 15 minutes each hour. I ice my knee every 1-2 hours for 15 min and elevate. I even make sure sure I get up and walk. End of day, I’m exhausted and my knee aches and feels really swollen. My knee feels great in the morning, but after I stretch it tightens right up. In physical therapy I’m at 108-110 flexion. My therapist says I should be at 120 and if I don’t get there soon, my doctor could recommend a MUA. I stretch every night. I’m I really that far behind in my recovery? You are not really that far behind. While I agree that 120 degrees of flexion would be ideal at this point, if you are at 110, you may actually gain another 5-10 degrees throughout the first year following surgery if you keep stretching. I personally would probably not recommend MUA if you were my patient unless you report significant difficulty with desired activities. 120 degrees is a guide, function is what really matters. Tracie 4/13/2021 08:45:58 pm Hi again! I have another concern I hope you can help. Last week 9 wk post op I was doing a one leg squat (previously done in PT) and I heard a what sounded like a large tear in the front of my knee. I immediately stopped and shook it out and iced my knee. The day after my therapist noticed my knee more swollen than usual and warm to touch. I told her what happened and she had me try some flexion exercises. Nothing! I couldn’t bend my knee past 95. The week before I was at 115. She was concerned and me stopped. The pain and warm feeling continued through the weekend. On Monday at PT, I pointed out again where the pain was (facing right knee, under the knee cap to the right) and was told that my bursa sac could be irritated. It’s been a week and still can’t bend past 95 with the pain. She I be concerned? Did I cause any damage? @Tracie - My first thought is that doing single leg squats at week 9 is aggressive. I might have advised against that. My general philosophy is to regain motion first, then work on gait normalization, then gentle strengthening. While it is possible you bled into your prepatellar bursa, I would consider that unusual. Hopefully this problem has resolved since you posted your question. Helen Smith 3/24/2021 12:01:57 am Hi, This is a wonderful article and so useful. 3 weeks into a post TKR I have flexion of 90 degrees plus, ( flexion ex. 3-4 times per day) do knee raises x 10 for 3 sec 10 times, 3- 4 times per day and knee hanging , foot pointing upwards on a stool, 5 times each session, 3 - 4 times a day. 5 mins each time, Not my favourite exercise. I have been told that this is more than adequate for 6 weeks. I am using a walking stick, 0.6km per day. Is all this enough in your opinion? I am 71. I would like to see more flexion by this stage postoperatively. Other than that, it sounds like you are doing reasonably well so far. I would focus mainly on stretching, no need to push for more walking at this point. Ann Demaret 4/3/2021 09:32:42 am Dear Dr Gorcznski, You have very legitimate reasons for concern. With regard to your knees and your connective tissue disorder- it is important for your surgeon to be prepared to use more constrained knee components during surgery- even including a true hinge. I recommend you discuss this with your surgeon preoperatively. The fatal pulmonary embolism history is also a concern. In my practice, we typically use aspirin for DVT (blood clot) prophylaxis. But with this history, I would likely recommend using a more potent anti-coagulant for at least a month following surgery. I also recommend discussing this with your surgeon preoperatively. Your rheumatologist will likely make recommendations with regard to medications to may be using to control your other autoimmune issues. A cardiologist should be consulted preoperatively to evaluate your heart function preoperatively. While we can never make surgery zero risk, I think it is important to evaluate and optimize each medical problem to the best of our ability prior to elective surgery. We want to control everything as best we can, understanding there are issues that may arise in spite of our best efforts. Regina Marie Montgomery 4/4/2021 03:09:44 pm I've tried to research my patella fracture for months I am sorry, I am not sure I understand your question. I have many questions before I can help you. Is your fracture healed? Are you having pain? What is your range of motion? If your fracture is healed, you have no pain, and your range of motion is back to normal. Perfect! Return to normal life. If you are having trouble, I need more specifics to help. Regina Montgomery 4/25/2021 11:35:27 pm Sorry for not being clear. I am 5.5 months after ORIF patella right knee surgery. I can barely walk and dont know if scar tissue is too built
up, this is the way I'm going to feel all the time.. I never even heard about ROM until 10 weeks after surgery and my PT told me dont worry about numbers. I have since bought a ROM tool. My specific questions what should my ROM numbers be for what area???? I would speak with your physical therapist about your ability to drive at this point. I would expect it to be safe. I don't think you need to get new providers- this is a straight-forward problem. Although this blog is focused on knee replacements, the exercises I recommend are applicable to your situation. You personally, are the most important person with regard to fixing this problem. You need stretch daily, for long durations as I recommend throughout this website. If you do not make progress after a reasonable period of time, I recommend discussing arthroscopic lysis of adhesions with manipulation with your surgeon. There is no reason you should not be able to regain a functional range of motion. Yes stretching is very important as it opens our joints and increases blood flow. You have written this blog very well. Thank you for this share. Kelen Kimbrel 4/13/2021 09:21:22 pm Thank you for taking the time to answer my question, I can honestly tell you that this blog , this site has been so reassuring to me during a very difficult and painful recovery . I have followed your advise and reduced the resistance when I cycle but I have discovered that my knee is pretty comfortable with rowing . Thank you again. Kendall 4/19/2021 12:59:35 pm Hi there! My situation is a little different- I am 11.5 weeks post op from a Type III Tibia plateau fracture. I am currently at 4-85 ROM, and have been gaining 3-5 degrees/week. Coming up on 12 weeks, I am worried that I will have to undergo an operation to improve ROM. Is it possible to achieve ROM with PT alone? Thank you! Generally you have more time to recover motion following trauma. With a tibial plateau fracture, I would expect improvement in range of motion for up 6 months or more. Just keep stretching on a daily basis and only consider more aggressive intervention when your motion plateaus and does not improve after several weeks of ongoing stretching. Until that occurs, there is no reason to consider any surgery. Kendall Quinn 5/11/2021 05:34:44 pm Thank you so much for your feedback Dr Gorczynski, I really appreciate it! Your POV has given me peace of mind :) I will continue to stretch and work with PT to regain ROM. I also submitted a new comment please disregard. Hi. I am a 56 year old female approximately 2 weeks post right TKA. I started aggressively with stretching and working for 0-120 in Day 1, however on day 3 I experienced patella instability and subluxation. My first day of PT the subluxation occurred again. I returned to see my surgeon and as they took new X-rays, my knee subluxed again. Pain occurs with the subluxing, but as the knee goes back into place the pain subsides. I am now on POD 13. On POD 10, my surgeon fitted me for a knee immobilizer and told me that I will likely need a lateral release, but that I will be required to wait until 6-8 weeks post op before this can be done. PT has been canceled indefinitely. I am quite frantic about this, as not having PT could potentially affect my outcome, correct? Or will a lateral release essentially put me back to square one? I am confused, because when the knee X-rays were taken, my surgeons first reaction was that there was excellent alignment and nothing to worry about. Several days later on a return trip to the office I was told of a slight patella shift, and that was when the brace and lateral release was discussed. I am quite concerned. I need the best outcome or I will likely refuse to have my left knee done. I have had knee issues for years and was diagnosed with severe osteoarthritis bilaterally. I also have rheumatoid arthritis. Any feedback you could provide would be appreciated. Patellar instability, particularly early following surgery is concerning. It can indicate an internally rotated femoral or tibial component, or both. It can also indicate failure of the medial reticular repair. This is an uncommon problem with a properly performed total knee replacement. This can require a CT scan specifically a version study to verify proper rotational alignment of the prosthesis. I am sorry you are having difficulty. pvrk 4/27/2021 02:59:00 am Hello Dr., I had COMMINUTED RIGHT PATELLA FRACTURE (INFERIOR POLE) and it was operated 12 weeks ago (beginning Feb). I was under cast for close to 7 weeks and since then my range of motion certainly has improved, but not able to go beyond 90 degrees, even after 10 sessions of PT. My surgeon advised me to do brisk walk for 45 min a day apart from doing regular quadriceps strengthening exercises. Will it help in improving my ROM, as I put a lot of efforts but not seeing much improvements in last 1 week (after I achieved 90 degree flexion). Is Manipulation an option even after 24 weeks? I still have constant nagging pain every night (may be due to exercises) and don't get proper sleep because of it. Kindly advise. Walking will not help your range of motion. In my opinion and experience, manipulation alone is not advisable at this stage. I would recommend arthroscopic lysis of adhesions followed by manipulation under anesthesia. Then it would be your job to stretch consistently, frequently, and for long durations to maintain the gains. Heidi Johnson 4/27/2021 06:35:08 pm I am a 49 year old female, 11 weeks post op R tkr. I have full extension and approx 125-130 flexion since early after op. Since 2nd week post op, 3x per day, I have been doing stationary bike 20 min, no resistance and short walks (10 min), followed by icing and elevating. I need some advice on how to increase my walking time and distance as well as standing tolerance. I am trying to return to a job that requires constant walking and standing. I have recently overdid the walking and experienced a major setback, not in ROM but in pain (medial compartment) and swelling. I am now somewhat nervous about how to progress it more quickly without overdoing it. I'm running out of time off. Should I just grit my teeth through the pain and do it anyway? What's the best way to return to my prior level of function more quickly? Thank you so much in advance!! Unfortunately, it is not possible to rush the healing process. I would advise you to listen to your body, and not overdo your exercises. You really need to let your body heal, use ice and incorporate rest days with regard to exercise. Simply maintain the excellent range of motion you have regained and your knee should progressively improve without much additional input at this point. Kendall 5/11/2021 05:32:51 pm Hi Dr Gorczynski- You generally have more time after trauma to regain range of motion. I agree with the plan to use splinting to help. If your motion is not acceptable once your fracture is solidly healed, and a reasonable time period has elapsed (perhaps 3 more months or so), then I would consider arthroscopic lysis of adhesions and manipulation. Otherwise and until then, stretch, stretch, stretch. Best of luck to you! Darieus 5/23/2021 09:26:55 am Dr. Your information is very helpful, as many others I wish I had read your guidance earlier on. I am 59, in the middle of week four. I could not allow in home PT based on an immuno compromised family member, I followed the guidance of the outpatient therapist, or I thought I had. At this point I am in PT twice a week, my flexion is my concern. I am probably at 95 maybe 100. Is it reasonable to expect to get to 115-120 in the next two weeks? It is definitely possible to get 20 degrees of motion over a 2 week period with long duration stretching as I describe in this website. I hope by now you have achieved your goal. As I am getting to your comment a bit late, I would be curious to know how you did. Anne 5/23/2021 12:26:26 pm Hi am 6 weeks from surgery have been doing stretches every day can get leg to 120 but still very stiff and tight is this normal This is totally normal for this stage. Keep stretching and working on other PT exercises. This, plus time, should solve this. Great Blog. I am really thankful to you for sharing this blog. This blog is very helpful for those who have gone through a knee replacement surgery. I will definitely share this blog with others so that everyone should take advantage of this blog. Thank you for sharing, Have a good day, Andrea 5/29/2021 11:03:07 am Hi there! I am 42, and was in an MVC 7-8 years ago resulting in a traumatic arthrotomy. After rehab, life was normal for a few years. I then developed pain and rapid progression to grade 4 chondromalacia. My surgeon performed a scope, and the hope was for a cartilage transplant. Unfortunately I had too much damage so for 3 years we did injections and Mobic. Fast forward to now. I am almost 8 weeks out from TKA. I am still having significant pain. When I have expressed these concerns, I am told that I’m progressing fine and this is a big surgery and to be expected. They have ended scheduled PT for me. But I was told I was measuring 0-120. I have noticed since I have returned to work, that walking seems to be a painful trigger for me. Not so much the short distances around the house, but longer distances requires at work. In the last few weeks I have also developed a popping on the back side of my knee, more lateral. I can feel it becoming tight and with some flexion at the ankle, and a slight bend of the knee, it will pop and release. Several times an hour. At this point I feel as though I am regressing. Pain and stamina are worse. Although I have not been measured lately it appears that my range of motion has worsened. Constant popping does not seem normal to me. And at this moment in time I am having significantly more pain and restrictions than before the surgery. And to be quite honest I wish I never would have done it. Does this all sound normal and the recovery process? With the exception of six week x-rays my surgeon has not done anything to investigate my pain complaints. And to be honest with worsening pain, I am not very effective at doing my home exercises as of late. The knee feels more heavy and unstable. Everything feels quite hopeless, and I am fearful I actually need to go back on disability from work as I cannot adequately perform my job due to pain and walking/mobility issues. I moved my next 6 week appointment up to this next week. But any advice or guidance would be appreciated! Popping, decreasing motion, and increasing pain is not normal at this stage post-op. You need to be checked out by your surgeon again, perhaps consider a metal artifact reducing MRI scan if the x-rays look good. Sometimes patients experience unusual symptoms, but we can usually figure it out. If your surgeon is not able to help, consider another opinion. This is not a typical outcome following knee replacement.
Catherine 6/22/2021 11:40:32 pm Dr. Gorczynski, It is not normal to feel side to side instability. You could feel some weakness or pain inhibition in the early postop period. This is basically a reflex where your muscles temporarily relax a bit when subjected to a painful stimulus. This happens frequently early after surgery and gradually resolves. Focus on regaining your motion and reducing inflammation and you should be all set! If you are feeling side to side instability- I recommend you get checked out by your surgeon to make sure your collateral ligaments are ok. Catherine Locke 12/17/2021 12:20:35 pm Thanks for your reply. My surgeon says the valgus laxity at 0 ° is something that can happen with the prosthetic used and the only way to change that at this point is by swapping out the polyethylene spacer. @Catherine - While strengthening hamstrings and quadriceps should be helpful with regard to function/endurance, it is unlikely to help improve valgus instability. This problem results from unevenly tensioned collateral ligaments. If this is a significant ongoing problem, changing to a more constrained implant (revision of polyethylene) or full revision could be required. I had bilat TKR on 4-8-2021. The recovery has been painful but I seem to have good ROM. R 0/125 & L 0/133. The physical therapist wanted to keep pushing and get strength and after my right knee had tendonitis because of the constant pushing I had to baby it and it is now behind my left knee. They want to continue PT but I do not want to because they are pushing so much that my pain goes through the roof. At 11 weeks out can I get more range of motion? What exercises should I be doing? I can go up stairs with no problem but downstairs I need a cane or a rail. Thank you for your support and encouragement. In my opinion, your motion is great. It is certainly very functional for nearly all desired activities. I doubt that you will regain much more at this point. Continuing to stretch aggressively is likely to cause irritation. I would maintain the motion you have, and work on strength, coordination, balance, endurance. Laura-Ashley Garrett 6/29/2021 02:50:56 pm Aw, thank you so much for your response!! I felt so relieved to read it!! I am 61 years old and the pain has been incredible and the physical therapy rough but at least I have great range of motion!! You are such a blessing and I am so grateful for this site! hi , i read this whole blogs and it was so informative for knee patient and i just want to give thank you for providing this valuable information. Teresa 7/2/2021 03:42:30 pm My 86 yo mom with mild Alzheimer's/dementia had TKR on 4/20. She was at a rehab (fell twice within 48 hrs. post op) for 7 weeks, PT 5-6 times a week. The problem was that she couldn't remember to do the exercises on her own. She then went to an AL unit with PT coming 5 days a week and I came 2 times a day to assist. Going on 11 weeks post-op, her flexion is inconstantly around 95 degrees and extension at -10. There's talk of a manipulation and I'm not sure if this something that should be done but also concerned that she could lose what little flexion she has. Unfortunately, I would not encourage manipulation at this point. Manipulation is not likely to help the flexion contracture she has developed, and at 3 months postop, even flexion is unlikely to be improved, safely. I would consider offering her a progressive static extension/flexion splinting in an attempt to correct the stiffness in a more gradual, less aggressive way. Robin 7/20/2021 08:46:21 am I had TKR Jan
20/20. When the pandemic hit I was in week 6 of therapy and had to stop due to shut down. I was not disciplined with my stretching. My Dr was happy with my progress but I am not. It is a year and a half post TKR. Is it at all possible to increase my ROM at this point, or am I wasting my time? Unfortunately, I think it is not very likely you will be able to regain much motion at this late stage by stretching alone. You don't mention what your motion is, but I surmise you lack deep flexion. While I don't discourage you from trying to stretch, I think it is more likely you would require an arthroscopic lysis of adhesions with manipulation. You are best discussing this with your surgeon at this point. I had tkr June 15th. I am 6 weeks. My rom is 117. I have yet to sleep in my bed. I can't get a decent sleep or comfort. I've tried pillows everything. I've slept in a recliner. I can't keep this up. Is this normal? It inhibits my exercises because I'm always so tired. No, this is not typical. Sounds like you need to see your surgeon for an evaluation. If your surgeon finds everything to look ok, consider some benadryl or melatonin before bed to help you relax. I like that you mentioned that patients need to regain their range of motion by 6 weeks or the scar tissue will become too stiff. My dad is getting a knee replacement in the next couple of weeks and he is worried about not being on his feet fast enough. I will send him this article to show that you will be up and going by 6 weeks if you stretch properly. Floyd Baldo 8/12/2021 06:26:03 pm Hello. I'm a 51 year old male who is 7 weeks out from double knee replacements. I gained my flexibility within a couple weeks in both legs. Two days ago I started back work at a high school where I walk a lot. I walked 3.5 miles two days ago and my legs are sore (lack of exercise for duration). I rested a day and walked 2.5 miles today. In doing so the inside portion (medial?) of my left knee hurt quite a bit. It's not swollen but this is the first time the left knee had any major pain. Am I over doing it? I would not encourage you to walk for such long distances at this point. Your body needs time to heal, and adapt to the new prostheses that have been implanted in both of your knees. Floyd Baldo 8/20/2021 07:20:27 pm Thank you, Dr. Gorczynski. Prior to surgery I was walking 7 miles a day Monday - Friday, cut down from 347 Lbs to 297 Lbs in 2.5 months. Most people think I'm a powerlifter and are surprised that I weigh so much. Most think I weigh about 250Lbs. Walking is the only workout I've done in 12 years. I was really surprised that my left knee rarely hurt even moments after surgery but now its the knee that causes the most issues. I wonder if it could be a pinched nerve, is that possible? While anything is possible, it is very unlikely that a pinched nerve would be causing the pain you describe. This sounds like overuse to me. Typically a "pinched nerve" happens in your back. This would cause pain/numbness in a curving swath down your leg, not just pain on the inside of your knee. Does it make a difference to a tkr if you have cp i had atr on 27 /3 /2021 not been able to walk at all my knee just wabble and let me down Balancing the soft tissues may be more challenging in a patient with CP. Depending on the severity of your CP your muscles may have a difficulty time controlling the prosthesis as well. If you are experiencing instability in your knee, it could be either of these issues, or a combination of both. I recommend discussing this with your surgeon. I would expect you to be much more confident in your knee 5 months after surgery than you report. Robert J. Ross 9/1/2021 05:54:45 pm I'm 5 weeks post TKR. I was doing great and then therapist had me ride the bike and get it the whole way around last week. Ever since I've had a bad pain on the outside of my left knee and goes up towards my hip. This has really slowed me down. Seems like the past week I've gone backwards. I don't know if I injured something on the outside of my knee. You really should be able to make a full revolution of the pedals at 5 weeks post-op following total knee replacement without difficulty. It is very important to regain range of motion as soon as possible following surgery. Check out my other articles and videos on how I recommend rehabilitating your knee replacement. I doubt you injured something by pedaling a bike, it sounds like your tight tissues need to be stretched more. Martha Howar 9/22/2021 10:04:32 am Hi Dr Gorczynski, I am 6 weeks s/p revision to TRKR after suffering for 6 months due to complications of partial knee replacement which led to worsening osteoarthritis. My question is about ROM. I was able to get my knee to flexion to 90° By 2 weeks but since then my ROM has only progressed to 110-113. I’m worried that now that I am at 6 weeks will I continue to gain ROM. My knee still has swelling as my body tends to hold on to it. Still have pain with walking independently but I am able to do it. And then I suffer the next day. Is my knee going to just take longer because of the two surgeries only 6 months apart? Also I was trying just this past two weeks to push the bending (did achieve a straight leg at 0) and now I feel like I have pain in the bone right Where the patellar tendon attaches to the tibia. The implant he put down my tibia was 120 mm deep because of bone fractures that I had at the top of the bone. It’s a lot. It is definitely harder for you based on 2 surgeries 6 months apart. It sounds like you required a stemmed tibial prosthesis, this is normal based on what sounds like a revision surgery you underwent. I would be patient and persistent with your knee. If you were at 113 degrees at 6 weeks, I bet you might get another 5+ degrees or so over the next few months if you stick with the daily, long duration stretching regimen. Natalie Beth 9/30/2021 03:20:05 pm I'm 66 and 7 weeks out of TKR. I initially injured this knee in college, had four prior surgeries on it including one for ACL reconstruction, two for meniscus removal and one for scar tissue after my ACL. Two years ago after PT my knee became painful and swollen. I was told I needed a TKR but had to wait until this summer because I had chemo last winter. I hadn't regained all my leg/core strength before surgery but was doing the pre-surgery excercises. The day before surgery my PT measured my ROM at 10 and 110. Now I'm at 115 and 7 after religiously doing the home PT and seeing her twice a week. My muscles spasm when doing stretches even as short as 20 seconds. At night my knee spasms every few seconds for an hour or more. I've taken a muscle relaxant and that seems to help sometimes. I'm still using one crutch or a cane to walk. I feel like I'm behind in both ROM and walking. My questions: will my ROM get to 0-130 since for years it was at 10-110? What is causing the spasming and how can I stop it? Why is it taking so long to walk without an assistive device? The surgeon did have to take out a screw from my ACL reconstruction. Thank you. Unfortunately, you are a bit behind schedule. At this stage following surgery with 7-115 degrees of motion, I doubt you will achieve 0-130. I would focus on regaining full extension. Check out my articles/ videos on how to do this. The prone hang technique is probably the best for this. Walking with a flexed knee is a high energy/low efficiency way to walk. This is likely why you struggle getting off assistive devices. I would definitely follow up with your surgeon and discuss options if your range of motion remains restricted and pain continues. Nancy Lynne 10/12/2021 03:46:25 am Like everyone else I find this blog incredibly useful. I am just starting my third week of a tkr on my right knee. I have 0, 116 extension and bend. My questions are i(1) do I have to sleep with my leg elevated because that's almost impossible for me and can I sleep on my side? and (2) will I be able to get to 130 if I had that before my tkr? I walk about 15 minutes every 3 hours and do the usual knee bends and stretches and balancing on one leg. It is not necessary to sleep with your legs elevated, particularly if it is interfering with your ability to sleep. I would not recommend sleeping with your legs dependent (below heart level)- as it will cause them to swell. Sleeping on your side is also fine, unless specifically instructed otherwise by your surgeon. A properly implanted, modern, total knee replacement has the ability to flex without limitations. Flexion is limited only by the patient's ability to rehabilitate- so, yes, you have the ability to flex to 130 with an ongoing, persistent, stretching regimen as I outline throughout this website and in my videos. Best of luck to you! Kim Judge 10/18/2021 12:54:37 am I had tkr I 9/14, for at least 2 years prior to surgery my ROM was 0-45. My surgeon said I was at a great risk for tendon/ligament rupture. I am almost at 5 weeks post surgery and I’m at 92 flexion. I have stretched religiously since surgery, a minimum of 4 times a day with no days off, but I am getting frustrated that I’m so far behind at this stage. Since my muscles were in such horrible shape prior to surgery what is my reasonable expectation of flexion? Extension is good, thankfully. Compared to your starting point, you are doing very well. You are doing exactly what needs to be done to maximize recovery- long duration stretching on a daily basis. I would not be surprised if you require a manipulation around 6-8 weeks from surgery, if you feel your flexion is inadequate. This would buy you a few more weeks of time to continue gaining motion. Did your surgeon tell you how far your knee was able to bend at the conclusion of surgery? This is the maximum possible motion you could expect to recover- assuming perfect rehabilitation. In most cases, we can flex the heel nearly to the buttocks. Your knee might not have allowed this much flexion, even after surgery, due to severity of the preoperative contracture. Kim judge 10/21/2021 07:32:06 pm Thank you ! AJG 10/31/2021 07:44:13 pm First I want to thank you for
this site, Reading the threads has been a tremendous help. If MUA was only able to get 110 degrees, then I would not expect her to regain any more than 110 degrees via stretching. Perhaps the best thing to do is maintain 0-110 while allowing the knee to gradually heal, and the inflammation to resolve. Sometimes, gradually, over the next year or more, a knee will gradually loosen up a bit through normal daily activities. Even if this does not occur, with motion of 0-110 she should end up with a reasonably functional knee, and it is unlikely that any invasive treatment would be worth the surgical risk to her. CARMEN FAY PRICE 11/7/2021 07:54:32 pm Thank you so much for the great information and the time it must take to respond to all of us. I am 5 weeks TKA and for the most part am meeting my marks. I was at 130/0 at 4 weeks. I've been doing the rehab exercises, biking on my trainer easily. My concern is what I'll describe as a tight band below the knee joint itself. When I take a step, it feels like it catches or rubs on my tibia. It's bad enough that it's uncomfortable to walk. I've noticed this since Week Two, but now that I'm ambulating normally, I feel it's gotten worse. Not sure how to attack it. This issue occurs frequently. Many people describe a feeling of a "tight band" around their knee. It will generally resolve gradually over the first 8-12 weeks following surgery. I recommend simply continuing to stretch and rehabilitate. Use ice/NSAIDs as needed. Your body will heal for an entire year following surgery. i read this whole blogs and it was so informative for knee patient and i just want to give thank you for providing this valuable information. I would not be surprised if you require a manipulation around 6-8 weeks from surgery, if you feel your flexion is inadequate. This would buy you a few more weeks of time to continue gaining motion. Did your surgeon tell you how far your knee was able to bend at the conclusion of surgery? Paul windrath 11/23/2021 01:46:50 pm I am 2 weeks post TKR and have 5 & 110 rom. Had 0 & 135 before). I am stretching 3x/day. Am wondering if more stretching sessions/day will help or hinder or make no difference. My goals are to be able to do child's pose, heel sits, and deep squats again. Thanks for replying. Stretching is dose dependent. More frequent sessions plus longer duration of stretch is the recipe for improved range of motion. Rke 11/30/2021 11:53:07 pm Hi Doctor I had bilateral knee replacement 3 weeks ago. In my 4th week my left knee is in tremendous pain more on the back side of the leg. I can not bend the knee as it is excruciating pain. Now I have consistent pain even when walking. It almost feels likes muscle are tight and at time it is throbbing. What to do in this case where I can not do any pt due to pain? Jack You should contact your surgeon for evaluation. You need to be examined, and new X-rays obtained. This is not normal. Douglas Pollard 12/16/2021 04:24:49 pm I am 82, and just a year past TKR of the left knee. Thanks in large measure to your guidance, I feel I have made good progress. But I have a serious problem rising from a chair, especially a low one. Both surgical and non-surgical knees feel extremely weak and painful, but once I am standing everything is OK, including walking. I put the problem down to inadequate exercise during post-op recovery, affecting both knees equally. Because of this, and because of Covid-related postponement of TKR scheduled for my other knee, I have cancelled the operation. I am too old to spend another year in recovery. I have had some therapy for the problem and do prescribed exercises (mainly repeated rising from sitting.) Do you view this as normal, and when might it subside? Assuming you have adequate range of motion in both of your knees, then this problem sounds like weakness. To improve strength, it is important to stimulate your muscles to grow by overloading them with resistance exercise, but then allow them to respond for a few days before repeating the exercises. Ideally, each time you exercise you should be able to do more repetitions and/or use more resistance. Very interesting reading. I am 63yrs, 10 months post
bi lateral tkr. It sounds like you are doing reasonably well for this stage. I think ongoing improvement with time and strengthening is a reasonable expectation. Vicki O’Brien 2/1/2022 03:53:23 pm Hello doctor. Thank you for all this incredibly helpful information. I am 8 weeks post RTKR and currently at 118/0. I have had a couple of painful setbacks due to an over enthusiastic physio, then an hour spent in an uncomfortable position in an MRI machine. I have rested after both experiences and am back focussing on my stretches. My problem is swelling. It has not reduced since leaving hospital and introducing meloxicam has made no difference. It is hard to make improvements in my ROM due to pain from what feels like catching on the outer side of the knee. I am trying a very light and large elastic knee sock, which prevents the ‘catching’ and allows more mobility. I would never wear it for long periods, or at night. Is there any downside with this sort of light compression? I see no downside to using light compression. If your swelling is significant, it is important to bring this to your surgeon's attention- to rule out a blood clot. Sam T. 2/5/2022 01:32:41 pm Hi Dr. Gorczynski, My teenage son had an osteochondral fracture in the knee. Surgery was 2 months ago. some metal screws were used to secure the broken piece. I am worried at this point he has difficulty to walk. when he walks, he has a limp. He was not supposed to put much weight for the first 6 weeks post surgery. He was wearing a hinged knee brace. For the first 6 weeks, every time he walked, he was supposed to lock the brace (not bending). Now 2 months after, he no longer uses the hinged brace. he is trying to walk without crutches. He can walk for about 20 feet or so without his crutches. But he walks with a limp. His physical therapist from the hospital said the limp is there because of "confidence issue". I do not believe so. The surgeon said the muscles need time to walk normally. Is this normal? I am worried. I read even people with total knee replacement can walk 6 weeks post surgery. I am not sure if knee replacement people also wear a hinged brace post surgery. My son has good range of motion. No pain. His swelling post surgery was significant until week 6 or so. the swelling is not so noticeable now. The skin on and near his knee sometimes has a strange blotchy orange red look. I wonder if it's an indication of any issue. To summarize, I am trying to figure out why he can't walk well at this point. Thank you! His surgery was completely different than a total knee replacement. His progress should not be compared to a knee replacement patient. After being nonweightbearing for 6 weeks, gait abnormality and weakness is quite common. A limp is expected. Without being able to examine him myself, I can not comment any more specifically, but it does sound like his physical therapist and surgeon are providing good advice. He should expect improvement for up to an entire year following surgery. Janice 6/13/2022 01:56:17 am Hi, I am 10 weeks out of right knee replacement. I can get 115 rom with PT encouragement. I am worried this is not enough. Any ideas ? I also just started to get burninglike pain on outside of knee. Is this normal ? Btw , I am 60 year old women. Thank you so much My suggestion to aim for 120 degrees is really a goal that allows most people to resume most desired activities, but is not an exact requirement. It may be 115 is adequate for you. Others may require 125 or more to be happy. I have seen patients with range of motion like you report to gain additional 5-10 degrees or so over the course of the first year postoperatively if they continue to stretch appropriately. Catherine Locke 7/15/2022 10:48:03 pm I had my right knee replaced last June and regaining full extension came easily in the first couple of weeks. I had the left knee replaced this June and at 4 weeks post op I am still struggling with full extension. This knee had restricted ROM for 3 months prior to the surgery ( +5-115) so perhaps this is contributing to this challenge. I am following your suggestions for extension faithfully many times a day. In your opinion am I still on track to regain my full extension. I am currently + 7. Thanks very much. Catherine I am 12 weeks out from total knee replacement and have done well with both flexion and extension having reaching 0 degree extension and 128 degree flexion rather quickly. At this point I am working in PT on strengthening the knee and quads. I am actively pool walking, walking around track at gym, knee exercises to gain strength and trying to concentrate on heel toe walking to improve my limp, but I have a constant clicking in my knee which is very aggravating and frustrating and doesn't make walking pleasant. I've been told it will eventually go away, but on talking to other with TKR find it doesn't happen to everyone. Is there anything you recommend to help me. Some mechanical feelings/sounds can happen after knee replacement surgery. As long as there is no pain, these sounds are just the "hard" metal and plastic surfaces moving relative to each other. Some people are more aware/disturbed by this, particularly early after surgery. In the vast majority of cases, these sensations will become "normal" for you as your brain adjusts to the situation. Michele Dresden 7/30/2022 10:59:58 am Thanks for the information about the clicking in my knee. I do have another question. I have three hard small nodules under the skin on the left side of the knee that are very tender and about one inch from my incision. I sent a note to the physician's office and the PA said they are knots from the internal incisions and are of no concern. I asked both of the physical therapists working with me and neither has heard of this. Plus I know many who've had total knee replacements and none have experienced this. Have you heard of this? And if in fact that is the issue will those internal sutures eventually dissolve eliminating the problem? Thanks for your advice. Yes, sometimes the deep suture material can be palpable. This is particularly the case with PDS suture, which is a tough, strong monofilament. It will dissolve with time and this problem should resolve spontaneously. Valerie 7/15/2022 03:13:31 pm Dear Dr. Gorczynski, I'd like to thank you so very much for all of your very helpful advice! I had TKR 4 weeks ago and was not given any information about duration stretching - only PT exercises - and I wasn't making good improvement until I started doing 70 - 90 cumulative minutes a day (10 - 15 minutes for
each stretching session) of the stretching you recommended. At 2 weeks post-surgery, I was at 78 degrees flexion and my knee was extremely painful and stiff. I was very anxious about recovery. I think I'm still a bit behind today at 102 flexion and 2 extension. It's going slowly, but better now that I'm doing the duration stretches. From the time I get up until bedtime, I'm consumed with stretching (letting my legs dangle off the side of a tall chair and doing the wall stretching with leg
"walking" down), taking a couple of walks, using a strap to pull my leg back, walking up and down steps a few times a day, etc. My knee continues to be very sore. Still noticeable swelling. I do ice it, take Tylenol and wear compression bandages. When I go to PT, my therapist always makes me cry! It hurts so much on the inside of my knee when she pushes my leg back...and then I resist and it's just hard to figure out how to get things moving more easily. Is there anything you can recommend to me
to help speed up my flexion? I don't want to end up having to undergo MUA. I'm worried I won't be at 120 in 2 weeks' time (which will be 6 weeks post surgery). Darren McKenna 8/23/2022 12:37:16 am Hello Dr. Gorczynski, I’m 14 weeks post surgery. Two days shy of 12 weeks I had a MUA for a stiff knee from a total knee replacement of my right knee. Injured it 45 years prior in a sports activity. Hard to get doctors to take a 17 year old upper limb amputee serious back then. So I had the home Physio team visit me for 12 weeks but most exercises I could not do. My ROM was 60 degrees with a stiff knee. Surgeon waited to the last minute to do the manipulation and for the most part it was successful. My hamstrings and calf muscles are so tight now. My ROM is around 90 degrees and after I stretch for 15-20 minutes I have got to 100 degrees. I am a 62 year old male and pain in those muscles are unbearable at times. After 12 weeks the home Physio team had to stop, there normal treatment is 4 weeks. I was most appreciative for all they did. I only wish I could have vent my knee in those 12 weeks. It is most difficult to do phase one and phase two exercises with a stiff knee. After 14 weeks I realize it is going to be so troublesome to get over 100 degrees. I also had one side of my knee on the outside of the insidious line where I gave no feeling and it has effected a muscle because the nerve was severed. When I walk I have a block because this muscle does not work any longer. This is most frustrating. I have been working so hard as I’ve the manipulation. Am committing at least five hours per day on a large range of exercises. It has been almost two weeks since the manipulation. Is there anything I am using trying to get these muscles loosened up? After the home Physio team ended there sessions I was told the hospital Physio team would be taking over and I would get Physio there. My first day there I was informed I would not be getting Physio there and just do the exercises at home. I feel I could really benefit from more extensive Physio but that is off the table for unknown reasons. I also suffer from other calamities such as a torn rotator cuff in my good arm and carpal tunnel in my only hand. If that isn’t enough I’ve suffered from renal colic for 32 years now. I passed a 8.5 mm stone the morning of my knee replacement. All of these effect my recovery. At times I feel like giving up. Coming home after surgery in a taxi to a empty house was hard and yet I still give 100% on my exercises. I walk with a noticeable limb, they tell me I have a 50/50 chance that the nerve will regenerate but until then all my n on eg muscles are screaming like a banshee every time I walk. I am so frustrated and sore. Any advice is most welcomed. I wish I had an easy answer for you. Unfortunately, I can only reassure you that consistent, frequent, long duration stretching is the key. If you ultimately do not end up with a functional knee range of motion, you could consider arthroscopic lysis of adhesions with repeat manipulation. Your experience with stretching appropriately prior to this potential procedure will prepare you to rehabilitate better at that point. For now, I would simply encourage you to stretch as often as possible for as long as you can. naresh bharwani 8/27/2022 05:33:46 pm Dear Dr. Gorczynski, Long duration stretches as described throughout this website and demonstrated in the video section. Even with a proper stretching regimen, at 16 weeks from surgery, significant gains will be unpredictable at best. Keep in touch with your surgeon, consider arthroscopic lysis of adhesions and manipulation if you are unable to regain acceptable motion. That was really a great post.Thanks for sharing information. Continue doing this. Your comment will be posted after it is approved. Leave a Reply. | Dr. GorczynskiOrthopedic Surgeon focused on the entire patient, not just a single joint. Categories All RSS Feed |