Knee stiffness is one of the most undesirable after effects of knee surgery or a related procedure. While the occurrence of stiff knee is not just related to Total Knee Replacement (TKR) surgery, it is commonly observed as the after effect of this procedure. Stiff knee affects a considerable number of patients who undergo TKR, but not all need a revision surgery. Physical therapy can help in resolving stiff knees with a positive effect in most cases.
Knee Replacement Surgery
Knee replacement surgery is a treatment procedure which involves replacement of the damaged knee joint surfaces with metal or plastic components. There are two type knee replacement surgeries, partial and total. Partial Knee Replacement (PKR) involves replacing only one side of the knee joint with metal or plastic components. Total knee replacement procedure involves cutting distal end of the femur bone and the proximal end of the tibia. Metal components are then fixed on the bone using polymethylmethacrylate (PMMA) cement. Though post-operative rehabilitation in PKR is simpler than TKR, the TKR implants last longer and so are more recommended. Research also points that women tend to recover faster than men from TKR surgery.
What is Post-operative Stiff Knee?
Post-operative stiff knee is an after effect of knee surgery which affects a patient's mobility. In normal circumstances, patients require a knee flexion of 65° for walking, 70° for lifting from the floor, 85° for stair climbing, 95° for sitting and standing motion, 105° for tying shoelaces and 115° for squat and pickup activity. There is some debate on the exact range of motion to be defined as stiff knee, but there are two most commonly accepted definitions, the first being flexion contracture of 25° and arc of motion less than 45°.
How Physiotherapy Can Help?
Amongst all the patients that undergo replacement surgeries, around 5-7% develop stiffness in the knee. Patients who are diagnosed with stiff knee are recommended to undergo physical therapy and exercise therapy to achieve desired range of motion. Manipulation through physical therapy is effective in treating most of the cases with only 1% patients required to undergo revision surgery out of the 5-7%. Physiotherapy and exercise therapy is most effective against knee stiffness that is detected in less than three months after the surgery.
Manipulation technique has been successfully used to increase range of motion and control pain in most of the stiff knee cases. Closed manipulation is administered to patients who are not able to achieve 90° of flexion. Manipulation is performed under local anaesthesia to provide relaxation in case of complication. Though manipulation is highly effective a delay of at least 3 weeks is expected to decrease the risk of soft tissue damage after surgery. Along with the manipulation, patients are expected to continue their pain medication as specified by their physician. Swelling in the knee is treated with elevation technique which requires resting your operated leg by elevating it above your hip level in a straight position. Ice packs can also be used to get the swelling and pain under control. Your therapist might recommend self-supervised exercises like static quads, hamstring curls, leg raise, calf stretch, walking and lunges depending on your physical condition.
If you have a stiff knee condition, visit your physiotherapist soon to achieve best results.