Total knee replacement

**Hayden123** · 21-12-2010 05:09 AM

I have question regarding the tight band described by patients with TKR. Is this just swelling or tight mm? Does anyone have a good clinical way of decreasing this band...I have been stretching and performing manual STM, DFM to muscles. but patient continues to just feel stiffness/ tight band around the knee. he is currently only getting 80 degrees or could this tight feeling be an indication of scar tissue deep and need for manipulation. Pt has had hx of decreased ROM prior to sx secondary to an old injury with rupture patella tendon and immobilization. But he has just had a recent TKR but is only 80 degrees at almost 6 week. Biggest complaint is the tight band feeling and increase swelling with walking, standing or dependent position....Any suggestions would be great. So what is this tight band this patient population is describing?

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**Gourishankarchintalapudi** · 21-12-2010 07:22 AM

Please present the question clearly with full abbrevations , so that i can help , recently i had done tkr cases around 8 . So if you clearly present it i can help you.

**Hayden123** · 21-12-2010 08:52 PM

Ok..I will try to rephrase.....I currently have a patient that had a total knee replacement almost 6 weeks post op. he had home health services for 3-4 weeks. He is still complaining about a tight band around his knee like a rubber band. He has been doing the regular total knee exercises to gain ROM..he is now currently only at 80 degrees but had a hx prior to surgery of decrease ROM in the knee secondary to old injury of patella tendon rupture in the 1970s. I have also been performing soft tissue mobilization, scar massage, mobilization grade 2-3. He continues to complain of just a band around his knee. Could you give me advice on the "tight band feeling" that total knee replacement patiens experience? most every total knee patients describes this feeling...as for him since his knee flexion is so limited I am feeling his may be more scar tissue but any advice would be greatly appreciated. i know swelling limits ROM and gives a tightness but is this the reason for the "tight band feeling" only? I think not but let me know your experiences. Thank you.

**msk101** · 22-12-2010 03:18 AM

Hi There,
i've seen many patients with this sensation. It takes at least 8 weeks to heal from a TKR. it's violent surgery! The tightness is generally due to swelling in the joint which does settle over time, but is exacerbated by lack of quads strength. Try a tubigrip bandage for daytimes ONLY (do NOT sleep with it on or allow it to roll up and torniquet) which can provide some comfort and light compression during mobilisation. Also quads - strengthen HEAPS.... step ups, step downs (hard if not enough eccentric control), SLR, IRQ, mini squats on one leg etc etc. Push ROM by getting the patient to sit on a chair, ask them to pull their foot in under neath actively as far as possible (ie. in your patient 70-80 degrees), then ask them to cross their good ankle in front of the operated ankle, and use the good leg to push back further and increase the knee flexion (make sure they keep their bottom firmly on the seat), then - and this will hurt and will break a sweat- keep the foot anchored and ask them to move their bottom an inch forwards on the seat to really push the flexion. they need to maintain this position for at least 2 minutes to elicit muscle elongation (not just short term elastic stretch) and then release gently. repeat 3-4 times and do this 6-7 times during the day. it is NOT fun.

the rule of 6's is true for TKR - the first 6 days are hell, the first 6 weeks are hard work, and after 6 months you don't know you've had it done (assuming you got the rehab right etc). Do the hard work now and by 12/52 your patient should feel better and more confident.

good luck
msk 101

**Hayden123** · 22-12-2010 04:32 AM

Thanks msk101.....i will try the bandage....sorry what is IRQ-I am not familiar with that abbreviation...I have been doing all of the other exercises.. I have been pushing knee flexion. i have to keep after my patient to keep his hip down with seated knee flexion. I have also been doing manual contract relax in this position...He has a hard time crossing legs due to his weight. I think next session I will put him on heel slide on the wall to gain more flexion. Also what did u mean by 12/52? i really do appreciate the advice. I am in a rural setting and am glad for the advice from other PTs it helps alot.