Stiffness After Knee Replacement

Stiffness after knee replacement surgery is generally caused by a combination of excessive swelling, tight muscles and scar tissue. Stiffness is normal for 6 months to 1 year post surgery, and might linger for several years depending on age and activity levels. While the surgery is successful in most cases, some patients may experience stiffness after knee replacement, which can affect their quality of life. In this article, we will discuss the causes, symptoms, and treatment options for stiffness after knee replacement. Knee replacement surgery, also known as knee arthroplasty, is a common surgical procedure that is performed to treat severe knee joint problems, such as osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis. Knee replacement surgery involves replacing the damaged or worn-out parts of the knee joint with artificial implants made of metal, plastic, or ceramic materials.

Causes of Stiffness After Knee Replacement

Stiffness after knee replacement can occur due to a variety of reasons. Some of the common causes of stiffness after knee replacement include:

1. Scar Tissue Formation:

After knee replacement surgery, scar tissue can form around the knee cap (patella) or around the implant. This scar tissue can limit the range of motion of the knee joint, leading to stiffness. True, dense scar tissue is rare and only happens in approximately 3-6% of patients. If you are making progress with your range of motion each week, it is unlikely you have scar tissue causing the stiffness.

2. Postoperative Swelling:

Swelling is a normal response to surgery, and it is the biggest contributor to stiffness by increasing pressure within the joint. This can make it difficult to move the joint, and can also cause pain and discomfort. The more activity you complete throughout the day, the more swelling and stiffness you will have. Controlling swelling is key to improving stiffness.

3. Muscle Weakness:

After surgery, the muscles around the knee may become weak due to disuse or the effects of anesthesia. This can contribute to stiffness by reducing the strength of the joint and making it more difficult to move. The surgery itself, as well as the period of immobilization and reduced activity during recovery, can cause muscles around the knee joint to weaken. This can make it difficult to perform daily activities and may increase the risk of falls and other complications.

4. Poor Rehabilitation:

After knee replacement surgery, it is important to undergo rehabilitation exercises to regain strength and mobility in the knee joint. If the patient does not follow the rehabilitation program as prescribed by the surgeon, it can lead to stiffness, including reduced mobility, increased pain, and a longer recovery period. 

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Symptoms of Stiffness After Knee Replacement

The symptoms of stiffness after knee replacement can vary from mild to severe. Some of the common symptoms of stiffness after knee replacement include:

1. Limited Range of Motion: Patients may experience difficulty in bending or straightening the knee joint.

2. Swelling: The knee joint may appear swollen and may feel tender to the touch.

3. Pain: Patients may experience pain in the knee joint, especially when trying to move the knee.

4. Difficulty Walking: Patients may find it difficult to walk or may experience a limp due to stiffness in the knee joint.

Strategies for Managing Stiffness After Knee Replacement Surgery

Fortunately, there are several strategies that can help manage stiffness after knee replacement surgery. These include:

1. Physical Therapy: Physical therapy is an important part of the recovery process after knee replacement surgery. A physical therapist can help you develop a customized exercise program that will help improve your range of motion and reduce stiffness. Physical therapy may include exercises to strengthen the muscles around the knee, as well as stretches and other techniques to improve flexibility.

2. Medications: Over-the-counter pain medications, such as acetaminophen and ibuprofen, can help manage pain and inflammation after knee replacement surgery. Your doctor may also prescribe stronger pain medications if necessary such as opioids. Always talk with your doctor before taking any medication. 

3. Ice Therapy: Applying ice to the knee can help reduce swelling and inflammation, which can help improve range of motion and reduce stiffness. Ice therapy should be used in conjunction with other treatments, such as physical therapy and medication.

   

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4. Compression Therapy: Compression therapy, such as the use of compression stockings or bandages, can help reduce swelling and improve circulation. This can help improve range of motion and reduce stiffness. Finding compression hose or stocking that are comfortable is always a challenge for patients. 

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5. Manual Therapy: Manual therapy and massage can help improve circulation and reduce muscle tension, which can help reduce stiffness after knee replacement surgery. Your physical therapist may complete some manual therapy or massage to help with stiffness. 

6. Elevation: Elevating the leg is an important strategy for controlling swelling after knee replacement surgery. When you elevate your leg, you are promoting better circulation and drainage of fluids, which can help reduce swelling and promote healing. When you elevate your leg, you reduce the pressure on the knee joint, which can help decrease swelling. This is because the fluids that accumulate in the knee after surgery are able to drain away more easily when there is less pressure on the area.

Proper elevation after a knee replacement 

7. Biking: biking is a very good way to move fluid out of the knee joint temporarily. Most patients report they feel less stiff after biking for 5-10 minutes. If you cannot make full rotations with the bike, doing half circles is acceptable for managing stiffness. 

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Severe stiffness that does not improve with aggressive physical therapy can be fixed. The first procedure that will be done is called a: Manipulation Under Anesthesia (MUA). Manipulation under anesthesia is a procedure where the surgeon moves the knee joint while the patient is under anesthesia. This can help break up scar tissue and improve range of motion. If the MUA does not work a Revision Surgery can be explored, generally after 1 year post surgery this is considered. Revision surgery is a more invasive procedure and should only be considered if other treatment options have failed. A revision surgery may be necessary to correct implant misalignment or to replace a defective implant. 

Preventing Stiffness After Knee Replacement

While it is not always possible to prevent stiffness after knee replacement, there are some steps that patients can take to reduce the symptoms temporarily. Most importantly, it is imperative to follow your physical therapists and surgeons guidance. Making sure you are not doing too much activity too soon is very important with managing stiffness. You will notice that the more active you are, the more stiff and swollen you will be. This is normal and expected. The only true treatment that will completely heal your stiffness is time. Letting the body heal is a long process, especially after a knee replacement. 

The stiffness will last 6+ months due to the extensive nature of this surgery. 

Conclusion

Stiffness after knee replacement is a common complication that can affect patients' quality of life. While it can occur due to various reasons, proper rehabilitation, icing, elevation, and early detection of symptoms can help manage the stiffness after knee replacement. Patients should follow the recommended rehabilitation program and report any symptoms to their surgeon to ensure a successful recovery from knee replacement surgery.