Knee Manipulation After a Total Knee Replacement

After you have had your knee replacement surgery, you enter a physical therapy program almost immediately to begin the process of gaining adequate range of motion with your knee. In most cases the range of motion to strive for is 125 degrees of flexion and 0 degrees of extension at the end of your rehabilitation, Of course these numbers will differ from patient to patient.

Knee manipulation is a procedure used to obtain a more productive range of motion for your knee if your physical rehabilitation efforts have not worked. During physical therapy your goal should be to have at least 90 degrees or more of knee flexion in two weeks. Lack of functional knee flexion is the reason most receive a manipulation to begin with.

Lack of using adequate pain control after surgery can be a reason someone will under achieve in their physical therapy program. If you are in constant pain you will not put in the effort needed to get your knee to bend and extend sufficiently. If your are not getting at least 90 degrees of range of motion within two weeks your surgeon may consider manipulation as an option after your initial office visit.

Excessive scar formation is a problem with some patients for several reasons. Either from not being as aggressive as they should be with their physical therapy or in many case patients they have prolonged the knee replacement surgery to begin with has allowed their body to build adhesions throughout their knee causing poor results in gaining motion during rehabilitation.

In some cases implant mal positioning can be a cause. In this case your surgeon may try manipulation to correct your lack of mobility in the knee initially however, if the implant is too far out of alignment than a new prosthesis will have to be inserted. Some of these problems can be avoided today by having a computer assisted total knee replacement.

If manipulation has been considered and recommended by your orthopedic surgeon than you are given an appointment to report back to the hospital and under anesthesia, your knee is manipulated. This is best performed within 4 to 12 weeks from the date of surgery. Manipulation is not a delicate procedure. Your surgeon who is trained in this procedure uses great care as not to injure the knee joint. In the osteoporotic patient your surgeon has to be careful for instance not to cause a fracture around the implant.

Surgical removal of excessive scar formation is also an option however the results have not been very good.

You are sent home the same day of the procedure. You are then started back on an aggressive physical therapy program.

Make sure once you get back home and continue with rehabilitation or continue at an outpatient facility, that you put your best effort into maintaining and advancing your knee mobility.