Knee Contracture Following Total Knee Replacement

After a total knee arthroplasty (TKA or total knee replacement surgery), some individuals develop joint stiffness also called a joint contracture.  A knee contracture causes the envelope of the knee (called the capsule) to stiffen and become rigid so the knee can no longer move the way it used to.  If range of motion is not regained early on, only a second surgery can potentially break up or remove the contracture.  Keep in mind that any decrease in range of motion is considered a knee contracture.

Knee contractures typically develop early on after surgery.  Signs and symptoms include morning stiffness, anterior knee pain and decreased range of motion.  This can be reversed or prevented with consistent range-of-motion exercises, stretching and adapting proper knee positions.

In a review of the literature, authors state that stiffness occurs in roughly 20% of cases, making it the most common TKA complication.  Proper physical therapy along with manual manipulation and a carefully carried-out exercise program is the preferred method of intervention.

Devices such as a Dynasplint can be used for prolonged stretching to treat more significant contractures.

In extreme cases, manipulation under anesthesia (done by the surgeon) is generally successful when completed within the first three months post-surgery.  If that fails, more aggressive surgical options should be considered to avoid fracture or soft tissue damage from manipulations.

At Core Performance Physical Therapy, our Doctors of Physical Therapy implement a non-invasive method for the prevention and treatment of knee contractures.  Patient compliance is of utmost importance!  I’ve shared a few common stretches that our therapists recommend to ensure good range of motion:

To improve knee extension (straightening), use the Prone Knee Hang exercise.  Lay on the edge of the bed with a towel roll resting above the knee cap on the involved leg and let gravity extend the knee downward.  Hold for 30 seconds x 4 repetitions x 3 times a day.

To improve knee flexion (bending), use the Heel Slide exercise.  Sit propped up in your bed, use a belt or strap to tie around your ankle.  Slowly pull your ankle towards your chest while bending the knee to end range.  Do this dynamically for 5 minutes, 3 times a day.

Dr. John Kwon

Physical Therapist