knee replacement range of motion flexion

Knee Replacement Range of Motion (Timeline and Goals)

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 I’ve 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 (before and after surgery).

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. I’m glad I decided to tough it out because the improvement I gained in my range of motion was worth it.

My Knee Range of Motion Before Knee Replacement

Before my surgery my range of motion was not great. My flexion was about 120 degrees and I was minus 7 degrees when trying to straighten out my knee (could not straighten flat).

My surgeon assured me that both of those numbers would improve after surgery. After surgery, I was hoping to be able to completely straighten out my leg and to improve my flexion to 130 degrees. The doctor told me that this was a reasonable expectation.

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.

First Week After Knee Replacement Surgery: Range of Motion

During my first in home therapy session (3 days post surgery) 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 (8 to 9 on the 10 point scale).

The straight leg measurement was also taken during exercise but there was little if any pain during that measurement.

Week 1 Progress with Range of Motion

During the first week after surgery I was able to make progress. The intense swelling made exercise and flexion difficult but as the swelling decreased the knee was easier to bend.

After my second home therapy session (6 days post surgery) my therapist measured an improvement in flexion from 70 degrees to 88 degrees. Before the surgery my knee had begun to bow.

Related: Best Ice Packs For Knee Replacement Recovery

During the surgery the surgeon took the bow out and straightened my leg when he inserted the implant. My tendons and muscles had to react to the realignment and it probably stretched them more than they had been stretched for several years.

During the week the swelling continued to decrease. With reduced swelling and three very intense workouts a day my range of motion continued to improve.

tkr range of motion

Second Week Progress After TKR: Range of Motion

During the 3rd session (day 9 after surgery) my therapist added another set of 5 standing exercises to go along with the 5 that I was already doing on my bed. She complimented me about my ability to do the exercise and was impressed with the progress I was making and she made note of the reduction in swelling.

At the end of the session she measured my flexion at 95 degrees. The exercises and the measurements were both painful. The results were worth the pain.

The two exercises that hurt the most but that did the most good were: the ankle slides on the bed using a robe rope to pull the foot as far as I could towards my butt and the foot slides sitting on a chair (with arms) sliding my foot in a plastic bag on a tile floor as far back to the chair as possible.

During the second week post surgery I continued to make progress with my flexion. The pain did not decrease during the workouts but the results motivated me to continue the workouts when I felt like cheating or skipping one.

Related: Best Walking Poles After Knee Replacement

During the 2nd week the swelling went down so much that the surgical knee began to look like a knee instead of a swollen mass. Day 10 post surgery, I had 98 degrees flexion. Day 12 post surgery, I had 100 degrees flexion and Day 14 post surgery, I had 110 degrees flexion.

Third Week Progress After TKR: Range of Motion

During the 3rd week post surgery (day 20 post surgery) I began going to my off-site physical therapist. I also began going to a fitness center on my off days.

I began workouts on the exercise bike (5 minutes at level 2) and seated leg presses with no weight. I also began doing leg lifts with a 3lb weight. The therapist took measurements of both thighs and both knees.

To finish day 1 he gave me a massage around the knee for 10 minutes and then he had me do 20 ankle slides on the table (laying on my back and sliding my foot toward my butt). At the end of the ankle slides he measured my flexion at 113 degrees and my straight leg at 0 degrees.

Knee Replacement After One Month: Range Of Motion

I’m currently going to physical therapy 3 times a week and working out at home (as well as going to a gym) on my off days.  I’m able to ride a stationary bike, albeit slowly, take walks a mile long, and do leg strengthening workouts.  Check out my suggestion for best stationary bike after knee replacement.

Because the swelling has decreased I feel it’s helped with my ability to bend my knee.  Also, my muscles and ligaments are continually being exercised and stretched – I would not being doing as well if I wasn’t active.

On my 4th visit to the offsite therapy (day 27 post surgery) my therapist measured my flexion at 115 degrees. He was pleased and told me I was doing better than the average patient and to keep up the hard work.

Knee Range of Motion Exercises and Tips

The exercise are meant to provide multiple benefits:

  1. Promote circulation and filter toxins out of your knee
  2. Strengthen muscles and ligaments around your knee
  3. Stretch the muscles and ligaments around your knee

Related: Best Wedge Pillow For Elevation After Knee Replacement

Some exercises will get your blood pumping, while others will be painful.  Bending your leg is so important but it won’t feel good when there’s still swelling.  Push through with the tips below:

  • Pump your ankles often to engage your leg muscles and promote circulation
  • Take your medicine so you can bend your knee even when it’s tender
  • Complete the daily workouts even when it’s painful
  • The first two weeks are tough and you need to persevere.
  • Set goals and don’t be discouraged. Write down your goals so you can read them when you’re frustrated and tired.
  • For me the most painful exercises were the ones that did me the most good.

Average Flexion After Knee Replacement

I’ve been told that most people don’t gain the degree of flexion that I’ve gained so quickly.  Plus, most people won’t gain their full range of motion after surgery.

Comparing yourself to others is a challenge because everyone has a different reason for knee replacement and everyone is in different physical shape.  It also depends on the age of the person with knee replacement.

My general thought would be that starting flexion will likely be between 60-80 degrees and you should aim for 120-130 degrees of flexion within 2 months of surgery.  This won’t be easy so it will take a lot of effort and determination.  I still have a long way to go. I’m ahead of schedule but I’ll continue to work to get as much range of motion as possible.

Knee Replacement Range of Motion: My Timeline and Goals

As you’ve read, I improved a lot in my first month after knee replacement surgery.  This wouldn’t have happened if I would have slacked off or not done therapy.

Even when I didn’t have my physical therapy sessions, I was doing them on my own 3 times per day.  I had heard about scar tissue building up after surgery and making the joint less flexible.  The more activity after knee replacement, the less chance scar tissue will be able to develop in and around the joint.  Here’s my range of motion timeline for knee replacement:

  • Week 1: Due to swelling your knee’s range of motion will be minimal and it will be frustrating (my first recorded flexion was 70 degrees bent and completely straight.  My last flexion of week 1 was 88 degrees)
  • Week 2:  If you’re working hard there will be big gains with flexion (My second week therapy session began with 95 degrees flexion and ended with 110 degrees)
  • Week 3: Gains should continue, although smaller, in the 3rd week (My flexion recording was 113 degrees)
  • Week 4:  Gains in the week 4 were less but I was still improving (115 degrees).  As a result of the leg workouts, leg strength on your repaired knee should be improving a feel secure.

I’ve already achieved straightening my leg so my goal for flexion is currently 130 degrees.  If I reach my goal I’ll push to gain more flexion in the knee.

Related: Must Have Items After Knee Replacement

Flexion isn’t my only goal, I’ve also created goals for therapy and exercise.  I’m riding on the bike more, walking more, and trying to stretch my leg muscles multiple times per day.  I know strength plus flexibility will result in an additional degree flexion.

Conclusion

For me it was the hard work before and after surgery that helped to improve my recovery and increase my range of motion after TKR. I would encourage you to exercise regularly at least 2 months before your surgery.

Concentrate on strengthening the muscles around your surgical knee. Bike riding and swimming were the exercises of choice for me.

The bone on bone in my knee did not allow me to hit the gym and use conventional leg machines. After surgery follow your therapist’s plan.

Progress comes with pain. After the first month you will look back and be glad you gave your best effort. You will have come along way and the work will be worth the result.

Comments

  1. Thanks so much
    All your info is so helpful

    I’m going in for simultaneous bilateral knee replacement
    There’s not a lot of info when going for a twofer
    I’m a bit apprehensive as to being able to handle this…but had my hip replaced in September so all I can say is next !
    I know the knees will be much harder but if I can get thru the first 3 weeks I’m hoping I can see some progress
    But you concise info like what you wrote is very helpful

    Hope your doing great now

    1. Author

      I can only imagine the stress for 2 surgeries. But at least you’ll get them out of the way. Stay moving and don’t go easy on your physical therapy! I’m feeling pretty good, thanks! And I still feel like there is room for improvement.

  2. Good info Kenneth. Today is four weeks after second surgery. Had to go back for revision because the incision did not heal after first surgery. This makes it hard to compare to yours. My last visit 2 days ago to PT I was able to flex to 100. My knee is still very swollen. I ice at least 3 times a day. Still very numb around the knee. My fear is that I might have to go in for manipulating after reading how fast you were able recover. I consider myself young for a knee replacement at 57 and I am in pretty good shape.

    1. Author

      Thanks for the comment Paul. Sorry to hear about your need for revision. If your knee is still swollen and you’re now recovering from a revision, then 100-degree flexion sounds pretty good to me. Keep working and don’t slack on the PT, even though it’s not fun. I still remember the man at the hospital that wheeled me out to my car who said “take the pain pill before PT”. That advice helped me a lot. Everyone recovers at a different pace with various setbacks. Please let us know how you’re doing in a few months!

  3. Had Left TKR on April 24, 2019. As of today I’m at 0 degrees straight to 130 degrees flex. I can ride stationary bike with no issues. However I’m still experiencing a great deal of pain and swelling and can’t walk a lot without having a lot of pain and swelling afterwards. I haven’t been released yet to submerge my leg in water but I very much look forward to swimming. Before surgery my job required a lot of walking and I did some stretching but not a lot of exercising otherwise.

    1. Author

      Awesome progress with your range of motion! Seems like it’s still early, so I bet you’ll continue to get improvements on the pain and swelling. After 1 year I’m still icing and elevating after exercise even when I’m not experiencing pain or swelling. Wish you continued progress!

  4. Hi Ken,
    Thank you so much for sharing your tips on best exercises to try for maximum progress. I am 9 weeks post op (left knee full knee replacement surgery). Before I injured my knee 4 years ago I rode horses, bicycled, played tennis and water skied. I had to retire early from 29 years teaching kindergarten because the knee pain was constant. Anyhow, I am determined to get my life back. Exercising every day even through painful tears. Extension was easy for me. I am at 0 degrees. But flexion is tough. Week 8 I hit 138 degrees. I was ECSTATIC. This week (9) I lost 13 degrees progress. I will not let it keep me down. I am using the top two flexion exercises that you recommended. I am hoping that as the swelling continues to lessen and doing the exercises I will hit my goal of 138 degrees. You are a great inspiration. Thank you for posting your experience.

    1. Author

      138 degrees is excellent! You can still make small improvements months after the surgery. Keep moving, massage, stretch, strengthen. Best wishes!

  5. November 4, 2019
    Inde
    I had total knee replacement on 31st July and I can only bend my knee 90 degrees. I am doing my best with the recommended exercises. I do not know how I can improve it further?

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