Post-Surgery Rehabilitation Challenges After Knee Joint Replacement

Rehabilitation Issues After Joint Replacement Surgery

Hello, Doctor.
My mother underwent a right knee arthroplasty and is currently two weeks post-surgery.
On the second day after the surgery, her knee was bent, and the nurse informed us that it needs to be straightened.
They assisted in applying pressure to straighten the knee joint.
She returned home on the fourth day post-surgery and has been performing daily strength exercises.
Currently, she is lying in bed for observation.

Her left leg (which did not undergo surgery) can be straightened, with a gap of about one palm's width between the joint and the bed.
However, her right leg (which had surgery) cannot be fully straightened, with a gap of about two to three palms' widths.
When assistance is provided to straighten it by applying downward pressure (without putting pressure on the incision, just pushing the joint down), it causes severe pain.

I would like to ask if she needs to continue trying to straighten the knee? Should the right leg be in the same position as the left leg to be considered normal? Or is it acceptable for her not to be able to fully straighten it, with an additional one to two palms' widths being a normal phenomenon? Should she just rest and wait before attempting to straighten it again?
Currently, she is performing strength exercises that involve bending, stretching her thigh and foot, and raising her thigh.
According to the hospital's recommendations, she can achieve a bend of 110 degrees without any issues, but she is having some difficulty with straightening.
We are concerned about the possibility of developing a leg length discrepancy in the future.
Please let us know your thoughts when you have a moment.

Chris, 40~49 year old female. Ask Date: 2016/07/19

Dr. Shi Guozheng reply Orthopedics

Are you referring to artificial joints, specifically that after total knee arthroplasty, it is important for the knee joint to achieve full extension for better mobility? If full extension is not possible, then it is essential to perform rehabilitation exercises to help straighten it.
The first three months post-surgery are a critical period, and beyond that, it becomes challenging to make significant changes.

Reply Date: 2016/07/19

More Info

Post-surgery rehabilitation after a knee joint replacement is a critical phase that can significantly influence the overall recovery and functionality of the knee. Your mother's situation, being just two weeks post-operation, is quite common, and it is essential to address her concerns regarding the inability to fully straighten her knee and the associated pain during rehabilitation exercises.

Firstly, it is important to understand that after a knee joint replacement, some degree of swelling and stiffness is expected. The surgical procedure involves significant manipulation of the tissues around the knee, which can lead to inflammation and discomfort. The inability to fully extend the knee, as you described, where there is a gap of two to three hand spans between the knee and the bed, is not unusual at this stage. It is essential to differentiate between normal post-operative swelling and complications that may require further medical intervention.

Regarding the need to continue attempting to straighten the knee, it is advisable to follow the guidance of the healthcare professionals involved in your mother's care. Gentle stretching and range-of-motion exercises are crucial for recovery, but they should be performed within a pain-free range. If the stretching causes severe pain, it may be a sign that the knee is not yet ready for that level of intensity. It is essential to listen to the body and avoid pushing through pain, as this can lead to further complications or setbacks in recovery.

The goal of rehabilitation is to regain full range of motion, which includes both flexion (bending) and extension (straightening) of the knee. While achieving equal extension to the non-operated leg is ideal, it may take time. The timeline for regaining full extension can vary significantly among individuals, depending on factors such as age, pre-existing conditions, and adherence to rehabilitation protocols. It is not uncommon for patients to experience a lag in extension compared to flexion, especially in the early weeks post-surgery.

In terms of muscle strength, it is excellent that your mother is engaging in muscle endurance exercises. Strengthening the quadriceps and hamstring muscles is vital for supporting the knee joint and improving overall function. As she progresses, the focus should be on gradually increasing the intensity and duration of these exercises while ensuring that they remain comfortable and manageable.

Regarding concerns about leg length discrepancies, it is essential to note that while some patients may perceive a difference in leg length post-surgery, this is often due to swelling or muscle tightness rather than an actual difference in bone length. As rehabilitation progresses and swelling decreases, many patients find that their legs feel more equal in length. However, if there are persistent concerns about leg length discrepancies, it is advisable to discuss them with the orthopedic surgeon during follow-up appointments.

In summary, your mother's current experience of not being able to fully straighten her knee is likely within the realm of normal post-operative recovery. It is crucial to continue with gentle stretching and strengthening exercises while avoiding excessive pain. Regular follow-ups with her healthcare team will help monitor her progress and make necessary adjustments to her rehabilitation plan. Patience and adherence to the rehabilitation protocol will be key to achieving the best possible outcome.

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