Using An Estimate Method
Most people don’t have a goniometer at home. However, you can still estimate your knee ROM.
Estimating Knee Extension
To estimate your knee extension, lie on your back on a firm surface. Use your leg muscles to push your knee into the floor. As you do, slide your hand underneath the knee. This will be easier or harder depending on your knee ROM:
- If you can, with difficulty, slide a few fingers beneath your knee, your knee is near full extension
- If you can slide all of your fingers but not your hand beneath your knee, your knee remains around 5º flexed
- If you can slide your whole hand beneath your knee, your knee remains around 10º flexed
Estimating Knee Flexion
Estimating knee flexion requires a ruler or tape measure and, once again, a helper. This method won’t give you a measurement of knee flexion in degrees. However, it will give you a guideline to track your progress at home.
To use this method, lie on your back on a firm surface. Slide your foot back until your knee bends as far as possible. Then ask the person helping you to measure the distance between your heel and your bottom.
Knee Replacement Range Of Motion
Range of motion will be a term you hear time and time again in the days and weeks following TKR surgery. This article shares my range of motion progress after total knee replacement surgery as well as my timeline and range of motion goals.
As Ive explained in earlier articles my TKR was a result of sports injuries suffered 40 plus years ago.
Because of the prior injuries I never regained optimal range of motion in my right knee. This was partly due to having a full cast up to my thigh for 7 months after a broken leg and 2 meniscus surgeries that resulted in a soft cast for 6 weeks each.
Even after physical therapy for my past injuries the best range of motion I could achieve was 125 degrees.
As time passed after those surgeries I was walking with my knee bone-on-bone. Also, my knee always seemed to build up with fluid which further decreased my range of motion.
My flexion and my ability to extend my leg straight decreased.
After my recent TKR surgery I was pleased with the progress I made in regards to my range of motion. I must emphasize that progress came with a lot of hard work and perseverance .
The first two weeks after surgery were crucial and there were many times during those two weeks that I wanted to cheat on workouts or just give up. Im glad I decided to tough it out because the improvement I gained in my range of motion was worth it.
Range Of Motion Milestones
Although there are some things that can predict who will have an easier recovery , a lot of it boils down to the individual. Some people will hit certain milestones sooner than others. Always remember, that everyones recovery is different.
Use the below range of motion milestones as a general guide but stay focused on your own personal goal-setting and ReHab. Regaining full motion and getting back to your new and improved normal typically takes a full calendar year.
Day 1 to 2 Weeks
Data suggests that patients return to the ROM they had before surgery within this timeframe. In saying this, chances are that your range of motion was poor before your replacement. With your new artificial joint you have the ability to gain far more movement. You and your physical therapist will be meeting 2 or more times a week to work on your motion. In addition, you should be working through an at-home, low-impact ReHab routine. Its important to keep active during this period to avoid stiffness, decrease swelling, and reduce inflammation.
GOAL: 65-90 degree flexion or greater. This means you will be able to stand, walk and go up and down stairs .
2 to 6 Weeks
GOAL: 90 degree flexion or greater. This means that you should be able to go up and down stairs with just one crutch, walk normally without an assisted device, and should be able to sit and stand more comfortably.
6 to 12 Weeks
GOAL: 115 degrees to 135 degrees. For those fully recovered, ideal flexion is around 125-135 .
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Swelling After Knee Replacement
Leg swelling is going to be present after having a knee replaced. Swelling has a significant effect on knee flexibility and the ability for muscles to contract. Think of trying to roll up a full water hose versus an empty water hose.
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It is also important to continue monitoring for blood clots and infection, as sometimes the onset of symptoms is delayed and requires immediate medical attention, possibly rehospitalization.
Preparation For Total Knee Replacement Surgery
Patients undergoing total knee replacement surgery usually will undergo a pre-operative surgical risk assessment. When necessary, further evaluation will be performed by an internal medicine physician who specializes in pre-operative evaluation and risk-factor modification. Some patients will also be evaluated by an anesthesiologist in advance of the surgery.
Routine blood tests are performed on all pre-operative patients. Chest X-rays and electrocardiograms are obtained in patients who meet certain age and health criteria as well.
Surgeons will often spend time with the patient in advance of the surgery, making certain that all the patient’s questions and concerns, as well as those of the family, are answered.
The surgeon’s office should provide a reasonable estimate of:
- the surgeon’s fee
- the degree to which these should be covered by the patient’s insurance.
Total Knee Replacement Surgical Team
The total knee requires an experienced orthopedic surgeon and the resources of a large medical center. Some patients have complex medical needs and around surgery often require immediate access to multiple medical and surgical specialties and in-house medical, physical therapy, and social support services.
Finding an experienced surgeon to perform your total knee replacement
Some questions to consider asking your knee surgeon:
- Are you board certified in orthopedic surgery?
- Have you done a fellowship in joint replacement surgery?
- How many knee replacements do you do each year?
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Right After Knee Replacement And Range Of Motion
When I arrived in my hospital room one of the first things that I noticed was how swollen my leg was. The knee was huge but so was my thigh and ankle.
Because of the swelling, I had very little flexion but I could straighten my leg. During the in-hospital therapy sessions the therapists were mostly concerned about getting me on my feet, walking with a walker, and taking the stair test.
They never measured any range of motion during my stay in the hospital. When the doctor arrived the morning after surgery he did mention that after the surgery they saw a gain of 7 degrees when straightening my knee. That was a pleasant surprise.
Anatomy Of The Knee And Associated Ailments
The knee is comprised of three bones, the Tibia , the Femur , and the Patella . These bones align in such a way that allows them to bend. The muscles, tendons, and ligaments surrounding the knee serve as stabilizing agents. There is fleshy cartilage between the bones which acts as a cushion, preventing the bones from rubbing against one another called bursa.
When someone experiences pain in the knee, there are several potential causes. The three most common are:
- Osteoarthritis: soft tissues in the body degrade naturally over time. When the cushions between bones begin to deteriorate and the bones begin to rub against each other, this is called arthritis. This condition can cause a great deal of pain and occurs predominantly in people over the age of 50, but can occur to anyone at any time.
- Injury: an injury can occur for many reasons, including a sports injury, falling, or a traumatic injury such as a car accident. When these occur, the bones not only experience trauma but may realign in such a way that causes pain. These can include torn cartilage, a torn ACL, or broken bones.
- Overuse: repetitive motion in the knee can lead to more rapid degeneration of the soft tissue.
Certain individuals may be more prone to knee pain than others due to their lifestyle. These people include:
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Pain Or Swelling After Exercise
You may experience knee pain or swelling after exercise or activity. You can relieve this by elevating your leg and applying ice wrapped in a towel.
Exercise and activity should consistently improve your strength and mobility. If you have any questions or problems, contact your orthopaedic surgeon or physical therapist.
Assessing Risk Before Surgery
When trying to predict the likelihood of stiffness after a knee replacement, the most important thing to consider is how well you can move your knee before having surgery. People who have stiff knees heading into knee replacement surgery usually have stiffer knees after the operation.
Those who can easily move the knee before having surgery are less likely to have stiffness after surgery.
There are steps that can be taken at the time of surgery to help release tight ligaments and tissues around the joint. These methods can also help remove any damaged pieces of cartilage or bone that are interfering with movement. But sometimes the flexibility of the tissues is limited to a point that cannot be fully corrected.
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Total Knee Replacement Surgery
Total knee replacement begins with removing the damaged parts of the femur and tibia. They are then shaped in such a way that will best accommodate the foreign objects that are used. The ends of both the tibia and femur are fitted with a piece of metal. The piece of metal that is on the tibia is attached to a piece of plastic. The patella is also sometimes fitted with a piece of plastic.
These foreign objects allow for smooth motion in the knee, and by removing the damaged parts can prevent further degeneration or injury.
Optimal Range Of Motion After Total Knee Replacement
Pain, loss of motion, and limited function are the main reasons older adults choose to have a total knee replacement . And though many obtain pain relief, range of motion and function are not always fully restored.
But what is the optimal range of motion needed in the knee for everyday activities such as walking and climbing stairs? This study from the Center for Hip and Knee Surgery at St. Francis Hospital in Indiana takes a look at this question. They went back and reviewed over 5,500 patient charts who had a TKR.
A comparison was made between motion, pain, walking and stair-climbing ability, and knee function before and after TKR. Everyone had a posterior cruciate-retaining implant. This type of knee replacement leaves the posterior cruciate ligament intact. The PCL helps hold the knee stable and prevents too much backward motion of the tibia under the femur .
Previous studies have shown that 90-degrees of motion is needed to go up and down stairs. Getting up from a chair requires just slightly more motion . And lifting an object requires at least 117-degrees of flexion.
These movements and activities are all that are needed by most adults in a Western culture after TKR. Adults in other cultures requiring more squatting, kneeling, and sitting cross-legged need between 111 and 165 degrees of knee flexion to use these positions.
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Range Of Motion 4 Months After Tkr
As Ive mentioned in other articles, your range of motion will increase the most in the few weeks after knee replacement .
However, you can still achieve some improvements in the 3rd and 4th months.
I would encourage you to continue to do the range-of-motion exercises that were prescribed by your physical therapist. I use a fitness center to continue my workouts Use your Silver Sneakers free pass if you are over 65.
Ive developed a routine with the physical therapy exercises, the stationary bike, and regular bicycle rides 6 to 10 miles. I believe they continue to help me maintain flexibility and help me to increase my range of motion, slowly, by a few degrees.
I am not seeing the huge gains as I did early on, but I am increasing my range of motion little by little.
I continue to massage my knee with Free Up before and sometimes after workouts. It helps to loosen the knee before activity and feels better when I begin my exercise.
Conventional Treatment Methods Of Knee Pain
Knee pain is treated in a variety of ways. Once the cause is diagnosed using proper techniques, a treatment plan is set in motion. Doctors use information such as a patients medical history, overall health, activity level, and comfort level to create a treatment plan that is unique to each patient. In the beginning, these plans typically enact the RICE method. This stands for Rest, Ice, Compression, and Elevation. Sometimes patients also take over the counter NSAIDS such as ibuprofen. Pain is often caused by a form of inflammation, so these methods can help subside the pain.
If these less invasive methods fail to relieve pain, doctors will turn to slightly more intense treatment methods such as physical therapy or corticosteroid injections. Physical therapy seeks to strengthen muscles surrounding an injury and increase a patients range of motion. Corticosteroid injections are used to inject a powerful anti-inflammatory agent directly into the pain area. This is most often successful at relieving pain in the short-term but has been proven to damage tissue over time. Corticosteroid injections are not considered a long-term solution to knee pain.
After undergoing slightly more invasive treatment methods and still failing to see results, doctors may discuss surgery as an option. Initial surgeries for knee pain are less invasive than a total knee replacement. These surgeries may include:
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First Week After Knee Replacement Surgery: Range Of Motion
During my first in-home therapy session the therapist did measure both my flexion and my ability to straighten my knee. I did all of her assigned workouts first including intense flexion exercises that encouraged me to flex and straighten my knee.
During the last exercise of each she measured my flexion at 70 degrees and I was able to straighten my leg completely to 0 degrees. The flexion measurement was taken during exercise and with pain .
The straight leg measurement was also taken during exercise but there was little if any pain during that measurement.
How Long Do You Need Physical Therapy After A Knee Replacement
Of course, this will vary from patient to patient, depending upon your individual situation. However, in general, you can expect around 3 to 4 weeks of formal physical therapy from our experts.
Dr. Christian Eccles, our Fellowship-trained Hip and Knee Replacement surgeon, says Therapy is vital to obtaining the best functional outcome possible after a knee replacement as it can aid in pain control, improve motion, and expedite recovery.
Our patients typically are able to drive within 2 to 4 weeks, go back to work in 6 to 8 weeks, and golf in 6 to 12 weeks.
Your physical therapy exercises that you learn should be continued on your own for a minimum of two months after your surgery. They may also recommend some additional exercises such as riding a stationary bicycle after this period to help keep your knee flexible. This will also help build your muscle tone.
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Exercises To Avoid After Knee Replacement
Stairs are a great exercise, but avoid the stair stepper machine immediately after knee replacement surgery as you may injure yourself until you build up your strength and coordination. The AAOS suggests finding a flight of stairs and using the handrail to go up the stairs with your good knee, and down the stairs on your recovering knee to build up strength and mobility.
The Mayo Clinic states that excessive activity can wear out your artificial knee and cause the replacement to become loose and painful. Therefore, it’s safer to avoid high-impact activities, such as running and jumping. Lifting more than 50 pounds can overload your knee joint, so stick to lighter weights.
Strategies For Using A Stationary Bike After Knee Surgery
The first thing you will use a stationary bike for after surgery is range of motion. If you dont have the ability to pedal all the way around, there is a commonly used technique that can help you slowly improve your range of motion. While doing this technique make sure you start off with the resistance levels set very low, you can always move it up later if the low resistance is too easy. First, start off in a position where both feet are on the pedals in a comfortable position. Begin by pedaling in one direction as far as you can and stop and hold that position for 10-15 seconds.
Next, pedal in the opposite direction as far as you can and hold that position for 10-15 seconds. Continue doing this back and forth, trying to pedal a little bit farther as often as you can for about 30 minutes. The more often you do this, the faster you will gain back your range of motion, so multiple times a day is preferable if you own your own bike. If youre going to a gym to use a bike, try getting there daily and having longer sessions.
ROM, then Strength
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