Knee replacement flexion (bend) and how to improve it!

How to increase knee bend after knee replacement?

Knee bend after knee replacement surgery is very important to reduce pain and improve function. I get asked every day how to manage knee issues, so here are my top five tips.

  1. Good bend before operation: A knee that bends better before a knee replacement has a higher chance of achieving a better bed after a knee replacement
  • Soft tissue swelling: Keep soft tissue swelling to a bare minimum
  • Ice therapy: Please use spurious amount of ice after the knee replacement as this will reduce pain and swelling thereby making recovery much enjoyable.
  • Activities after operation: Keep walking activities to an optimum level in the first 4 weeks. Staying upright for a longer period of time at a stretch will cause swelling of the knee, leg and foot which usually reduces when the leg is elevated.
  • Pain killers: Take pain medications (and anti-inflammatories if prescribed by your surgeon) on a regular basis and reduce them only after pain and physiotherapy milestones have all been achieved. It is difficult to standardise the length of time one needs to take drugs as activities, pain threshold and compliance differs between patients.
  • Physiotherapy: It is my opinion that the physiotherapists are extremely important until a full extension (straightening) and functional bend of 110-120 degrees has been achieved
  • Rest: Adequate rest is good but keep mobile
  • Travel: If travelling after the knee replacement operation, take adequate breaks and keep the knee mobile as keeping the knee in one position for longer than 1-2 hours increases stiffness and pain.
  • Massage: I do not recommend soft tissue massage in the initial 6 weeks after the knee replacement. This is not required, and it is my opinion that if all the above modalities are done, massage is not required
  1. Quality rather than quantity: I recommend fewer but quality exercises and doing too many exercises does not mean that a quick recovery is more likely. Please discuss this with your surgeon and physiotherapist before you leave the hospital with regards to an optimum physiotherapy required.


Why does a knee become stiff after a knee replacement?

Knee replacement is a predominantly soft tissue operation and swelling is a very natural response. It is vital to keep the swelling to the bare minimum immediately after and in the first 2-4 weeks after your operation. Your surgeon may use various modalities to optimise swelling by not using a tourniquet (tight band around thigh to reduce bleeding), catch all vessels during the operation, reducing soft tissue injury, and suing various drugs to reduce swelling. Immediately after your operation adequate physiotherapy, usage of abundant amount of ice and specific physiotherapy modalities can be used to keep the swelling to bare minimum

When is the best time to get a good bend?

It is my opinion that the golden time to achieve the movement is in the 1st week and best achieved in less than 2 weeks. If 100 degrees or more is achieved in less than 2 weeks, the rest of the time is just spent in allowing the soft tissues to heal and muscles to regain its tine and strength. After a knee replacement operation scar tissue formation in the healing stage is but natural. There is a race between the scar tissue stiffening the knee and the patient doing physiotherapy to keep the knee supple.

How does a knee bend easily?

It is again my preference to get the patients sat in a chair and doing the bending exercises and there are various opinions amongst physios and surgeons to have different strategies. My approach always is to do quality work rather than quantity.

Why do I need a good bend?

A knee that bends more than 100-120 degrees usually functions quite well. This depends upon the height of the patients and the functional activities that you are wanting to do after the replacement as a leisure and activity of daily living. In the western culture a bend more than 120 degrees is not always required but, in some cultures, bending on the level of the floor needs higher than 130 degrees of bend. Please discuss this with your surgeon before your operation.

Is it a problem if the bed is less than 90 degrees?

Some knees form a lot of scar tissue! Getting a good bend after the operation depends upon a good bend before the operation and hence a supple knee is very important. At the Droitwich Knee Clinic, I strongly encourage 2-5 sessions of physiotherapy called pre-habilitation which supple the knee in preparation of a knee replacement

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