Post-Operative Knee Manipulation: Pain and Range of Motion Recovery

Manipulation after knee surgery

Hello, Dr.
Lee! I just underwent a manipulation surgery under anesthesia yesterday.
My original range of motion was about 95 degrees, and the attending physician mentioned that they were able to push it to 120 degrees.
However, due to postoperative pain, I can currently only flex to about 100 degrees.
If I try to push further, I experience significant pain above the knee.
Therefore, I would like to ask:
1.
After manipulation surgery, is it possible that the improvement in range of motion is minimal?
2.
Could this be a temporary situation, and will the range of motion increase in a few days once the pain subsides?
3.
Additionally, I have a swollen, smooth area above the knee where adhesions were present.
Normally, this should resolve after the adhesions are released, but it seems to remain the same.
Is it possible that this is just a temporary release, and the adhesions will return if not moved?
4.
I previously had this type of surgery once before, but this time the pain is significantly greater, even though the knee was anesthetized.
Why is there such a difference in pain levels between the two surgeries? (The first time I had a flexion of 115 degrees, and this time it was 95 degrees.)
Thank you for your answers!

Niming, 20~29 year old female. Ask Date: 2018/04/08

Dr. Li Yongheng reply Orthopedics

Hello, after undergoing manipulation surgery, if rehabilitation is not actively pursued, there is a possibility that the joint may only be temporarily opened, and without movement, it may adhere again.
As a result, the improvement in range of motion may be minimal.
Therefore, it is essential to endure the pain and engage in active rehabilitation.
Regarding the pain after knee manipulation and the duration of adhesions, it is related to the range of motion of the knee prior to the manipulation surgery.
Generally, the longer the duration of adhesions or the smaller the range of motion before the surgery, the poorer the recovery after the manipulation procedure.
Wishing you a speedy recovery.

Reply Date: 2018/04/08

More Info

Post-operative knee manipulation is a procedure often performed to improve range of motion in patients who have experienced stiffness or limited mobility following knee surgery or injury. Your concerns regarding pain and range of motion recovery are valid and common among patients undergoing this type of procedure. Let’s address your questions one by one.

1. Limited Improvement in Range of Motion: Yes, it is possible that after a manipulation procedure, the improvement in range of motion may be minimal, especially if there is significant pain or swelling. The manipulation itself can temporarily increase the range of motion, but if the underlying issues—such as inflammation, scar tissue formation, or muscle tightness—are not addressed through rehabilitation, the gains may not be sustained. It’s crucial to engage in a structured rehabilitation program post-manipulation to maintain and further improve the range of motion.

2. Temporary Pain and Future Improvement: The pain you are experiencing could indeed be a temporary reaction to the manipulation. Post-operative pain is common and can be exacerbated by inflammation or muscle guarding. As the inflammation decreases and you begin to move more, you may find that your range of motion improves. It’s essential to follow your physician’s advice regarding pain management and rehabilitation exercises, as these will help facilitate recovery.

3. Persistent Swelling and Adhesions: The swelling you observe above the knee could be due to several factors, including inflammation or the presence of scar tissue (adhesions). While manipulation can help break up some of these adhesions, it does not guarantee that they will not reform. Continuous movement and rehabilitation exercises are critical to prevent the reformation of adhesions. If the swelling persists, it may be worth discussing with your physician, as they may recommend additional interventions, such as physical therapy or further imaging studies.

4. Variability in Pain and Recovery: The differences in pain levels and recovery between your two manipulation surgeries can be attributed to several factors. The initial range of motion before the procedure, the extent of the underlying injury, the presence of scar tissue, and individual pain tolerance can all influence the post-operative experience. Additionally, the surgical technique and the specific conditions of your knee at the time of the procedure can also play a significant role in how you feel afterward.

In summary, post-operative recovery from knee manipulation can be complex and varies significantly from person to person. It is essential to maintain open communication with your healthcare provider regarding your pain levels and progress. They can help tailor a rehabilitation program that addresses your specific needs and concerns. Engaging in physical therapy, adhering to prescribed exercises, and managing pain effectively will be crucial for your recovery. Remember, patience and persistence are key components in the rehabilitation process. Wishing you a smooth recovery and improved mobility in the days to come!

Similar Q&A

Managing Swelling and Pain After Knee Replacement Surgery

Hello, Director Su! The elderly lady had a knee arthroplasty two months ago, and her knee is still red and swollen. Can she apply ice to the swollen area around the artificial joint? Will this affect her walking in the future? Is rehabilitation possible? Thank you!

Dr. Su Hongci reply Rehabilitation
Degenerative arthritis is currently the most common reason for performing total joint replacement surgery. Knee osteoarthritis is a slowly progressive joint disease associated with aging, joint injuries, genetics, individual constitution, obesity, and overuse, typically occurring...

Evaluating Recovery After Knee Replacement Surgery: Fitness Assessment Tools

How can we assess the healing status after knee replacement surgery? If we use physical fitness as a measure, is there a specific assessment scale to evaluate the condition after knee replacement surgery? Thank you!

Dr. Lin Yijun reply Orthopedics
The recovery after knee joint replacement surgery involves a wide range of factors. In addition to the range of motion of the knee joint and the strength of the surrounding muscles, it also includes the range of motion of other joints and the muscles around the hip and calf. This...

Understanding Anesthesia-Assisted Manual Manipulation for Knee Recovery

Hello Doctor, I had a car accident three and a half months ago that resulted in a femur fracture. After surgery, my knee cannot bend properly. Although I have been undergoing physical therapy, the range of motion returns to its original state after each session. A few days ago, m...

Dr. Li Yongheng reply Orthopedics
Hello, you have had a femoral fracture for three and a half months, and currently, your knee cannot bend normally. Manual mobilization under anesthesia is an appropriate treatment. Typically, intravenous medication is administered, and once the patient is anesthetized, the manual...

Understanding ACL Reconstruction: Surgery Duration, Rehab, and Work Leave

Knee pain and numbness... After squatting for about 2 minutes, I experience pain behind the knee and cannot stand for a moment, but it returns to normal quickly... The hospital wants me to undergo arthroscopy and ligament reconstruction... I am unsure how long the surgery will ta...

Dr. Shi Guozheng reply Orthopedics
The surgical time for an anterior cruciate ligament (ACL) reconstruction of the knee is approximately one to two hours, and the rehabilitation period is about three to six months.