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Range Of Motion In Knee

Why Is Range Of Motion Important Following My Knee Replacement

Active Range of Motion (Knee Joint)

Swelling, weakness, pain, and fear of movement are all common following your knee surgery and may all contribute to less motion in your knee. Your knee will likely feel stiff and be unable to move as much as your uninjured knee. Throughout your recovery, one of your main goals will be to regain as much of your flexion and extension range of motion as possible.

The amount of movement in your knee during your recovery will determine the types of activities you are able to do after surgery! While full knee flexion or bending is not required for all activities, a research study shows that a minimum of 110 degrees of active knee flexion is ideal for walking, climbing stairs, and getting up from sitting to standing.

If you are preparing for an upcoming knee replacement surgery, or have already begun your rehabilitation journey, check out our app available on Apple and Android devices specifically for knee replacement recovery. The Curovate app can assist in your recovery with a personalized rehabilitation protocol developed by a licensed physical therapist.

Stay tuned for our upcoming blogs in this series, which will investigate how to improve your knee movements, how to measure your range of motion using our app, and how accurate this measure is!

References

  • Magee, D. J. . Orthopedic Physical Assessment. St. Louis, MO: Elsevier Saunders.

    • 6 Jul 2022 8 min read

    • 10 Jun 2022 6 min read

    What Not To Do After Knee Replacement

    Post-Total Knee Replacement Surgery, you will have to take some precautions like how much walking or How Far to Walk After Knee Replacement is required.

    Here are some Things You Cant Do After Knee Replacement Surgery:

    • Dont cross your legs
    • Dont kneel and place anything behind your knees
    • A pillow or any item for that matter should not be placed behind the knees
    • If you require elevation and/or support under the operative leg, it is to be placed under the heel
    • You should not torque or twist on your new knee
    • You also have to avoid running, trekking, and playing contact sports like football, cricket, etc.

    Basic Range Of Motion Timeline For Recovery

    While everyones timeline differs a bit, heres a general timeline for where you should be regarding your range of motion.

    When your leg is fully extended it will measure 0°. When you pull your foot back toward your buttock the maximum flexion that can be achieved in a healthy non-surgical knee is around 140° however, even people in the best shape have a difficult time reaching 135°. If you can get your flexion to 125° then you are doing great! Keep up the hard work.

    0 2 Weeks

    Within the first 2 weeks, you should be at or around 65°-90° flexion.

    2 6 Weeks

    12 Weeks +

    Once you reach the 12-week point you should be able to do most routine tasks and care for yourself without much assistance. Dont be discouraged if you are not where you want to be at this point. Just keep working. A positive mindset will help more than anything.

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    What Affects Knee Rom

    Full knee range of motion is imperative for ideal functioning. Even if you have a minute loss of motion, it can lead to restricted movement and painful conditions. While if your condition is severe, it can lead to significant damage and disability. Hence, it would help if you had symmetrical knee ROM and strength for proper functioning.

    However, a loss of motion may cause problems in the lower extremity, intense pain, and loss of strength.

    The reasons include:

    • Anterior Cruciate Ligament restructuring
    • Lower extremity ruptures
    • Dislocated bucket-handle semilunar cartilage tears
    • Mucoidal deterioration of the ACL
    • Posterior Cruciate Ligament injuries
    • MCL Sprain

    Ligaments & Joint Capsule

    Liposuction Shown to Improve Knee Function

    The joint capsule has thick and fibrous layer superficially and thinner layers deeper. This along side the capsule ligaments enhances she stability of the knee. As with all of the structures that from the knee they are under most tension therefore more stable in an extended position in comparison to the laxity present in a flexed position . Inside this capsule is a specialized membrane known as the synovial membrane which provides nourishment to all the surrounding structures. The synovial membrane produces synovial fluid which lubricates the knee joint. Other structures include the infrapatellar fat pad and bursa which function as cushions to exterior forces on the knee. The synovial fluid which lubricates the knee joint is pushed anteriorly when the knee is in extension, posteriorly when the knee is flexed and in the semi flexed knee the fluid is under the least tension therefor being the most comfortable position if there is a joint effusion.

    The ligaments of the knee maintain the stability of the knee. Each ligament has a particular function in helping to maintain optimal knee stability.

    • Flexor and internal rotator of the knee
    • Prevents the femur from slipping forwards on the tibia during squatting
    • Weak extensor when knee is extended
    • Weak flexor and external rotator of the knee in flexion greater than 30o
    Superior gluteal
    • Weak flexor of the knee
    • Weak internal and external rotator of the knee
    • Strong plantiflexor and inventor of the heel

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    How To Evaluate Knee Range Of Motion

    Did you know that numerous ways help treat the disabled ROM of your knee? However, the proper assessment of your kneecap motion is essential. Also, some grade of hyperextension is normal. According to doctors, if you are a male, you may usually experience 5 degrees, while a female may experience 6 degrees of hyperextension. Hence, it is not beneficial to re-establish motion to a random zero degrees.

    One of the critical factors that help assess loss of knee movement range is to examine a non-working knee. You cannot ignore this as you need to establish a reference point for what is regarded as normal in every patient.

    • The foremost check is to grip the first toe with a single hand to move the foot off the table.
    • You may need to use a cloth roll of varying heights for this purpose.
    • Then you need to properly examine the knee to ensure that it is fully hyperextended.

    How To Measure Knee Rom Without A Goniometer

    If you dont have a goniometer, you can still assess your knee ROM. This can be really helpful for seeing what progress you are making with your rehab after a knee injury. It wont be as accurate as using a goniometer, but it does give you somewhere to start.

    If you are wanting to guestimate the range of movement at your knee, try this:

    Estimating Knee Extension ROM

    • Lie on your back on a firm surface
    • Push your knee down into the floor
    • Slide your hand, palm down, underneath your knee. If you can:a. Just get a couple of your fingers underneath with difficulty = 0o extensionb. Just slide all your fingers underneath = +5o degrees i.e. lacking 5o extensionc. Easily slide your whole hand underneath = +10o i.e. lacking 10o extensiond. Cant get any of your fingers underneath = -5o or more i.e. hyperextension

    Estimating Knee Flexion ROM

    • Lie on your back on a firm surface
    • Slide your heel along the floor towards your bottom
    • Measure the distance from the back of your heel to your bottom

    This doesnt give you an actual measurement of flexion, but it does give you a measurement to compare with when monitoring you progress when trying to improve knee flexion.

    Measure Knee ROM With Your Phone

    There are also various apps that you can download that essentially turn your phone into a goniometer. They vary in quality but a study* published in Physiotherapy Journal found that the “Knee Goniometer” App installed on an iPhone was a reliable tool.

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    When Should I See My Doctor

    See your doctor about any reductions in the normal range of motion of your joints. You should also go to your doctor if you cant fully straighten or bend one or more joints or if youre having difficulty moving a certain joint.

    People arent always aware of their own limited range of motion. You may see a doctor for an unrelated reason and discover that youre also experiencing a lack of mobility in one or more of your joints.

    Your initial appointment will likely consist of a physical examination. This will include an assessment of the affected joints. Your doctor may ask questions about your limited range of motion, such as:

    • When did the problem start?
    • Are you experiencing discomfort?
    • Where is it occurring?
    • Are you having any other symptoms?

    Your doctor may also assess the function of your bones, muscles, or nervous system. As a follow-up, your doctor may schedule some tests, such as X-rays of the spine and joints.

    Your doctor may recommend a course of physical therapy designed to enhance range of motion.

    In some cases, the position of the joint may become permanently fixed. This means youll no longer be able to move the joint past a given point. These are known as contracture deformities. Conditions associated with this complication include:

    Passive Range Of Motion Exercise

    Guidelines to Achieve Maximal Knee Flexion (Bending) Range of Motion – Total Knee Replacement

    In which conditions the physical therapist should apply a passive range of motion exercise

    • Passive range of motion exercises is typically used where there is a paralysis attack, when a patient is comatose, in the presence of the healing fracture, or even if the pain is elicited while an active muscle contraction. One of the major goals of the passive range of motion exercise is to counteract the detrimental effects of immobilization. However, it is essential to remember that passive range of motion exercise cannot prevent muscle atrophy.

    Some benefits of the passive range of motion exercise

    • Passive range of motion exercise not only helps in promoting healthy joint functionality but also benefits the patient in decreasing pain, increasing healing, restoring as well as maintaining range of motion in affected knee joints, and building muscle mass, allowing for great blood flow as well as helps in improving oxygen levels as well.

    Some guidelines for passive range of motion exercise for the knee joint

    Exercises

    Passive knee flexion in prone

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    What Are 3 Exercises To Strengthen Your Knee

    Straight Leg Raises. If your knees not at its best, start with a simple strengthening exercise for your quadriceps, the muscles in the front of the thigh. Hamstring Curls. These are the muscles along the back of your thigh. Prone Straight Leg Raises. Wall Squats. Calf Raises. Step-Ups. Side Leg Raises. Leg Presses.

    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.

    It is important to monitor, limit, and attempt to reduce swelling as much as possible.& amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp lt br /& amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp gt & amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp lt br /& amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp gt & amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp lt br /& amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp gt & amp amp lt br /& amp amp gt & amp lt br /& amp gt Swelling management strategies include:

      • Laying down with the surgical leg straight and elevated above the level of the heart with an ice pack for 20 minutes of every hour.
      • A compression and cold therapy unit such as GameReady, Squid Compression, or Cryocuff may help to limit and reduce swelling.

    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.

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    Surgical Technique And Interim Management

    In the first-stage surgery, after the removal of the infected prosthesis and thorough debridement, articulating-type antibiotic-impregnated cement spacers and/or beads were inserted. These articulating-type cement spacers were made using a mold: 2 g of vancomycin was added and mixed per one bag of polymethylmethacrylate cement powder. In some patients, 2 g of vancomycin and 1 vial of tobramycin were mixed together. Tibial-side spacers were made to be thick enough to prevent hyperextension by evaluating the extension gap of the knee joint. Femoral and tibial side spacers were placed in the femur and tibia using 1 g of vancomycin with cement in the late doughy stage.

    In the second-stage surgery, the cement spacers were removed and thorough debridement was performed using the same approach as used in the first-stage surgery. During surgery, five to six samples were collected to perform frozen biopsies, and the number of WBCs per HPF was counted by a pathologist. When > 10 WBCs per HPF were observed in > 2 samples, a new cement spacer was implanted. The constrained type of prosthesis was implanted when the infection was confirmed to be under control based on surgical findings and pathological examination. At the time of prosthesis implantation, 1 g of vancomycin was added and mixed per one bag of cement.

    Measuring Range Of Motion

    The Fundamental Importance of Knee Range of Motion

    Devices to measure range of motion in the joints of the body include the Goniometer and Inclinometer . Both use a stationary arm, protractor, fulcrum, and movement arm to measure angle from axis of the joint).

    Of all the types, a universal goniometer is most widely used and comes in two forms: short arm and long arm.

    • The short arm goniometer is used for smaller joints like the wrist, elbow, or ankle,
    • The long arm goniometers are more accurate for joints with long levers like the knee and hip joints

    Tape measures can also be used to measure range of motion in some specific parts of the body .

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    The Fundamental Importance Of Knee Range Of Motion

    Fundamentally, your knee range of motion determines the activities you can engage in, not just following surgery, but for the rest of your life. This is why it is so important for you to pay attention to your ROM. In the table here we give sample activities and the ROM required to engage in those activities. We hasten to note that having the specified ROM only means that you have the potential to engage in the activityit does not indicate that you have the strength to do so .

    Range of motion is a composite parameter. It is made up of extension and flexion, the ability to bend your leg. When we put the two together we get your range of motion. Ideally, this should be from 0º extension to 130º, a fully flexed leg. Some prostheses stop a little short of 130, and that is okay.

    The Importance of Knee Extension

    Knee extension is important for two critical reasons: 1) if you dont have full extension, you are much more likely to fall, falling is one of the most dangerous things you can do, and 2) if your legs cannot go completely straight then your quadriceps muscles are always activated and tire very quickly, limiting what you can do.

    The Importance of Knee Flexion

    Knee flexion is important is because it is the primary determinant of what you can do. For example, you must be able to bend your leg so your feet are underneath a chair to stand up from the chair without using the chairs arms.

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    Knee Flexion Range Of Motion Self Assessment

    There are 2 primary ways to assess your knee flexion range of motion:

    Option 1. Lie on your back and pull your knee toward your butt as far as comfortable. Use your hands, towel or another object to provide overpressure, if needed.

    Option 2. Start on hands and knees and rock your butt back toward your heels.

    When looking from the side, measure how much your knee bends compared to the uninvolved side. An easy way to do this is looking at the distance from your heel to your butt.

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