Richard Haynes PTA/CPT - 9/17/2008

Question
QUESTION: I wrote before ,I still have right stiff knee, actually doesnt bend over 90 five yrs out of TKR didnt before but is stiffer by far after two hip replacements, Any advice I saw pt they did IT band stretches made it worse. Im told knee stiffness is a problem????Help please.


Complete Knee Flexion   ANSWER: Hi Susan,       There could several reasons why the knee does not have the mobility it needs. Depending on how far you could bend the knee before the TKR, proper fitting and placement of the TKR prosthesis, and how hard you had worked during the rehabilitation in regards to knee flexion all play a part.

After 5 years I am sure you have quite a bit of scar tissue built up in your quadriceps/thigh muscles that may be preventing the knee to bend as well. The Physical Therapist may have mentioned that.

The only thing that we are able to do as in rehabilitation unless you have extreme swelling in the knee is to place moist heat over the knee for roughly 20 minutes then start an  aggressive knee bending program either manually using our hands or placing you on a stationary bike and lower the seat gradually to get the knee to bend.

It would take quite a bit of work at this point as its been so long since the knee was replaced. Has the orthopedic doctor commented why the knee is not bending? Sometimes it had to do with the prior level and function of the knee, anatomy etc...prior to surgery.

Heat on the knee followed by AGGRESSIVE knee flexion at his time is what appears is in order. But there is no guarantee that will be the answer.

Sincerely
Richard Haynes
Punta Gorda, Fl.USA
www.totaljointfitness.com

---------- FOLLOW-UP ----------

QUESTION: No I had to fight for flexion because the knee was replaced after a car accident and the leg was stuck at sixty degrees in a brace and I had to work very hard to get to 90 degrees, It has stayed at ninety but is stiffer after hip surgery,what I wanted to know is does hip surgery affect the knees somewhat I had minimally invasive but sometimes leg feels numb also...noone mentioned scar tissue I worked hard then, they say to not do much now with the bilateral replacements,..is this true?

Answer
Susan,      I understand now regarding the knee flexion issue, Thank You. I do not feel the hip has anything to do at all with the flexion issue at he knee. I have never run across that before. So I say no on that issue.
If it did I would bet it would have been brought to your attention at the time you were rehabbing it.

As far as "not doing to much" with the bilateral hip situation the only thing you really want to stay away from is anything that places high impact on the hips. Running is no good, singles tennis another one to stay away from, basketball for instance or girls softball etc... Good exercises for the hips and knees in your case would be

1. Swimming
2. Biking/Stationary bike in a gym
3. Walking of course
4. Golf if you golf at all
5. Bowling
6. Hiking
7. Weightlifting " just avoid deep squats"

This is just several. The knee MAY also feel stiff after hip surgery as your gait or walking pattern may be off slightly which is not unusual and you compensating somehow with the hips causing the knee not to bend and extend as far. You may not have a good heel-toe gait its called which may be causing the knee to feel tighter. It may involve the muscle mechanics which in time should clear it self up. it will not be permanent.

Conclusion is when your walking clears up becomes more efficent I think you will feel a difference.
Let me know if I can  clarify any further.

Richard haynes
Punta Gorda, Fl
wwww.totaljointfitness.com