Even whenknee replacement surgeryis successful, stiffness in theknee jointcan remain. People with a stiff knee after surgery may be unable to fully straighten the leg, to bend the knee, or both. Fortunately, there are ways to get rid of knee stiffness.
This article explains the causes of stiffness after knee replacement surgery and the treatments that are used to relieve it and restore normal range of motion in the knee.
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Causes of Stiffness
Inadequate Pain Control
Pain control after joint replacement is usually a manageable problem. But in some people, this can be quite difficult. Some patients find the side effects of pain medication impossible to tolerate. But a lack of adequate pain control can lead to difficulty increasing the motion of the newly replaced joint.
It is important to partner with your healthcare provider to develop a pain treatment plan that works for you.
Poor Motion Before Surgery
When trying to predict the likelihood of stiffness after a knee replacement, the most important thing to consider is how well you can move your knee before having surgery. People who have stiff knees heading into knee replacement surgery are more likely to have stiff knees after the operation.
There are steps that can be taken at the time of surgery to help release tightligamentsand tissues around the joint. These methods can also help remove any damaged pieces of cartilage or bone that are interfering with movement. But sometimes the flexibility of the tissues is limited to a point that cannot be fully corrected.
Those who can easily move the knee before having surgery are less likely to have stiffness after surgery.
Excessive Scar Formation
Some people seem to naturally make morescar tissuethan others, a condition known as arthrofibrosis. Arthrofibrosis affects 3% to 10% of patients who have undergone total knee replacement.
Improper Positioning of the Implants
Surgeons make an effort to balance the knee at the time of surgery. This means finding the proper size and alignment of the knee replacement so that the knee joint is not too tight and not too loose. The goal is to make this balancing the same whether the knee is straight or bent.
This is precisely why a knee replacement is a difficult procedure. In fact, the art of perfecting this takes many years. Errors in the positioning of an implant may not be apparent on the operating table and may only become noticeable when the patient is slow to recover from surgery.
Other Surgical Complications
Complications of surgery often lead to other problems. Patients who experience joint replacement infections,complex regional pain syndrome, or other complications have a higher chance of developing stiffness.
Treatment
After knee replacement surgery, it is important to work with a physical therapist to restore as much range of motion as possible. Typically, the range of motion will progress quickly during the first three months. It can continue to increase for up to two years following surgery.
Normal motion after knee replacement is defined as the ability to get within 5 degrees of a straight knee and the ability to bend the knee back to 90 degrees. Most knee replacements have movement ranging from 0 degrees to 110 degrees or more.
The range of motion of the replaced knee can be improved with a combination of stretches, exercises, and gradual resumption of normal activities. Some surgeons will recommend the use of a machine to bend the knee, called a CPM (continuous passive motion) machine.
Treatment of stiffness after knee replacement depends on how long it’s been since surgery and the cause of the stiffness. The usual treatments for stiffness include the following approaches.
Aggressive Physical Therapy
Physical therapy is a useful treatment for a stiff knee, especially within the first three months after knee replacement. Physical therapy can also be considered after this time, but the results are not as good as early physical therapy.
You will be prescribed exercises that target different muscle groups, encourage aid in maintaining joint mobility. These may include such asquadriceps sets, heel slides,leg raises, and various knee-straightening exercises.
A type of splint called a dynamic splint has also shown some encouraging results when used in conjunction with physical therapy.
Manipulation Under Anesthesia
In a manipulation, a patient is givengeneral anesthesia, usually through an IV. A surgeon forcibly moves the knee to break up scar tissue. This procedure is most beneficial in the six to 12 weeks after surgery.
The primary concern with a manipulation is the risk of bone breakage. This is a real issue because most patients who have a manipulation treatment are older and at greater risk ofosteoporosis. Breakage is also more likely if the manipulation is performed more than a year after the replacement.
Surgical Removal of Scar Tissue
Surgical removal of scar tissue after knee replacement is seldom performed but may be helpful in some rare circumstances. The results of removing scar tissue have not been particularly good at improving motion. Healthcare providers usually consider other treatments first.
Revision Knee Replacement
When all other options fail or the knee replacement parts are not positioned well and can’t be repositioned, it may be necessary to perform a revision knee replacement. The size of the new replacement can be modified to help allow for better knee motion.
Summary
Treatment options include aggressive physical therapy, manipulation under anesthesia, surgical removal of scar tissue, and revision knee replacement. Your surgeon will decide which treatment is best for your unique needs.
Causes of Knee Pain After Replacement Surgery
9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Rodríguez-Merchán EC.The stiff total knee arthroplasty: causes, treatment modalities and results.EFORTOpen Rev. 2019 Oct 7;4(10):602-610. doi:10.1302/2058-5241.4.180105Cochrane.Continuous passive motion after knee replacement surgery.Abdul N, Dixon D, Walker A, et.al.Fibrosis is a common outcome following total knee arthroplasty.Sci Rep. 2015 Nov 10;5:16469. doi: 10.1038/srep16469Scott AM.Total knee replacement and imaging.Radiol Technol. 2015;87(1):65-86.National Institute of Neurological Disorders and Stroke.Complex regional pain syndrome fact sheet.Kittelson, AJ, Elings J, Colborn K, et.al.Reference chart for knee flexion following total knee arthroplasty: a novel tool for monitoring postoperative recovery.BMC Musculoskelet Disord21, 482 (2020). doi:10.1186/s12891-020-03493-xOrthoInfo.Total knee replacement exercise guide.Issa K, Pierce TP, Brothers A, et al.What is the efficacy of repeat manipulations under anesthesia to treat stiffness following primary total knee arthroplasty?Surg Technol Int. 2016 Apr;28:236-41HSS. Hospital for Special Surgery.Revision knee replacement frequently asked questions.
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Rodríguez-Merchán EC.The stiff total knee arthroplasty: causes, treatment modalities and results.EFORTOpen Rev. 2019 Oct 7;4(10):602-610. doi:10.1302/2058-5241.4.180105Cochrane.Continuous passive motion after knee replacement surgery.Abdul N, Dixon D, Walker A, et.al.Fibrosis is a common outcome following total knee arthroplasty.Sci Rep. 2015 Nov 10;5:16469. doi: 10.1038/srep16469Scott AM.Total knee replacement and imaging.Radiol Technol. 2015;87(1):65-86.National Institute of Neurological Disorders and Stroke.Complex regional pain syndrome fact sheet.Kittelson, AJ, Elings J, Colborn K, et.al.Reference chart for knee flexion following total knee arthroplasty: a novel tool for monitoring postoperative recovery.BMC Musculoskelet Disord21, 482 (2020). doi:10.1186/s12891-020-03493-xOrthoInfo.Total knee replacement exercise guide.Issa K, Pierce TP, Brothers A, et al.What is the efficacy of repeat manipulations under anesthesia to treat stiffness following primary total knee arthroplasty?Surg Technol Int. 2016 Apr;28:236-41HSS. Hospital for Special Surgery.Revision knee replacement frequently asked questions.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Rodríguez-Merchán EC.The stiff total knee arthroplasty: causes, treatment modalities and results.EFORTOpen Rev. 2019 Oct 7;4(10):602-610. doi:10.1302/2058-5241.4.180105Cochrane.Continuous passive motion after knee replacement surgery.Abdul N, Dixon D, Walker A, et.al.Fibrosis is a common outcome following total knee arthroplasty.Sci Rep. 2015 Nov 10;5:16469. doi: 10.1038/srep16469Scott AM.Total knee replacement and imaging.Radiol Technol. 2015;87(1):65-86.National Institute of Neurological Disorders and Stroke.Complex regional pain syndrome fact sheet.Kittelson, AJ, Elings J, Colborn K, et.al.Reference chart for knee flexion following total knee arthroplasty: a novel tool for monitoring postoperative recovery.BMC Musculoskelet Disord21, 482 (2020). doi:10.1186/s12891-020-03493-xOrthoInfo.Total knee replacement exercise guide.Issa K, Pierce TP, Brothers A, et al.What is the efficacy of repeat manipulations under anesthesia to treat stiffness following primary total knee arthroplasty?Surg Technol Int. 2016 Apr;28:236-41HSS. Hospital for Special Surgery.Revision knee replacement frequently asked questions.
Rodríguez-Merchán EC.The stiff total knee arthroplasty: causes, treatment modalities and results.EFORTOpen Rev. 2019 Oct 7;4(10):602-610. doi:10.1302/2058-5241.4.180105
Cochrane.Continuous passive motion after knee replacement surgery.
Abdul N, Dixon D, Walker A, et.al.Fibrosis is a common outcome following total knee arthroplasty.Sci Rep. 2015 Nov 10;5:16469. doi: 10.1038/srep16469
Scott AM.Total knee replacement and imaging.Radiol Technol. 2015;87(1):65-86.
National Institute of Neurological Disorders and Stroke.Complex regional pain syndrome fact sheet.
Kittelson, AJ, Elings J, Colborn K, et.al.Reference chart for knee flexion following total knee arthroplasty: a novel tool for monitoring postoperative recovery.BMC Musculoskelet Disord21, 482 (2020). doi:10.1186/s12891-020-03493-x
OrthoInfo.Total knee replacement exercise guide.
Issa K, Pierce TP, Brothers A, et al.What is the efficacy of repeat manipulations under anesthesia to treat stiffness following primary total knee arthroplasty?Surg Technol Int. 2016 Apr;28:236-41
HSS. Hospital for Special Surgery.Revision knee replacement frequently asked questions.
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