Treatment Options<\/h3>\n
Non-Surgical Care<\/strong><\/p>\n For most cases of post-surgical knee stiffness, non-invasive treatments are the first line of management:<\/p>\n Physical Therapy<\/strong>: Structured exercises focusing on strengthening the quadriceps and other muscles around the knee, as well as improving range of motion.<\/p>\n<\/li>\n NSAIDs<\/strong>: Nonsteroidal anti-inflammatory drugs like ibuprofen or naproxen can help manage pain and inflammation.<\/p>\n<\/li>\n Ice and Elevation<\/strong>: Applying ice to reduce swelling and elevating the leg can help improve comfort during the early stages of recovery.<\/p>\n<\/li>\n Continuous Passive Motion (CPM) Machines<\/strong>: These machines move the knee gently to maintain joint mobility and prevent stiffness.<\/p>\n<\/li>\n<\/ul>\n Surgical Care<\/strong><\/p>\n If non-surgical methods fail to improve stiffness, surgical interventions may be necessary:<\/p>\n Manipulation Under Anesthesia (MUA)<\/strong>: This procedure involves physically moving the knee under general anesthesia to break up scar tissue and improve flexibility. This is most effective within the first few months after surgery.<\/p>\n<\/li>\n Arthroscopic Lysis of Adhesions<\/strong>: In cases of excessive scar tissue, arthroscopic surgery can be used to remove fibrous adhesions and improve knee movement.<\/p>\n<\/li>\n Revision Knee Replacement<\/strong>: If stiffness is caused by implant misalignment or damage, a revision knee replacement may be performed to correct the issue.<\/p>\n<\/li>\n<\/ul>\n Manipulation under anesthesia is a non operative technique to manage knee stiffness following surgery. The manipulation is performed in patients who are unable to bend their knees less than 90 degrees. The manipulation has best results if performed in the first 3 months of the surgery.<\/p>\n During manipulation, the patient is put under general anesthesia. In general anesthesia, the patient sleeps while his\/her muscles are relaxed. The surgeon then tries to physically bend or straighten the knee with an aim to break the fibrosis tissue adhesions.<\/p>\n Not all patients are candidates for manipulation under anesthesia as excessive manipulation may carry a risk of fracture or rupture of extensor mechanism (patella fracture, patellar tendon rupture, etc).<\/p>\n Recovery from knee stiffness varies depending on the severity of the condition and the type of treatment used:<\/p>\n Conservative Management<\/strong>: With adequate physical therapy and rest, most patients experience gradual improvement within a few weeks to months.<\/p>\n<\/li>\n Surgical Recovery<\/strong>: After MUA or arthroscopic procedures, recovery typically involves a period of rest followed by physical therapy to restore knee function. Full recovery can take several months, and some patients may need ongoing rehabilitation.<\/p>\n<\/li>\n<\/ul>\n Potential risks from knee stiffness treatment include infection, bleeding, and the risk of injury to the knee during manipulation. For surgical treatments, complications may include damage to surrounding tissues, nerve injury, or failure to achieve the desired range of motion.<\/p>\n The long-term prognosis for knee stiffness after replacement is generally good, particularly when managed early. Most patients recover full or near-full range of motion, although a small percentage may experience persistent stiffness that requires further intervention. The prognosis is better when physical therapy is initiated early and adhered to consistently.<\/p>\n Medicare<\/strong><\/p>\n CPT Code 27570 \u2013 Manipulation Under Anesthesia (MUA \u2013 Knee): $37.21 Under Medicare, 80% of the approved amount for these procedures is covered once your annual deductible has been met. The remaining 20% is typically the patient\u2019s responsibility. Supplemental insurance plans\u2014such as Medigap, AARP, or Blue Cross Blue Shield\u2014generally cover this 20%, leaving most patients with little to no out-of-pocket expenses for Medicare-approved knee surgeries. These supplemental plans work directly with Medicare to provide full coverage for the procedures.<\/p>\n If you have secondary insurance\u2014such as Employer-Based coverage, TRICARE, or Veterans Health Administration (VHA)\u2014it acts as a secondary payer once Medicare processes the claim. After your deductible is satisfied, these secondary plans may cover any remaining balance, including coinsurance or small residual charges. Secondary plans typically have a modest deductible, ranging from $100 to $300, depending on the specific policy and network status.<\/p>\n Workers\u2019 Compensation<\/strong> No-Fault Insurance<\/strong> Example Q. What causes stiffness after knee replacement?<\/strong> Q. Can physical therapy help with stiffness after knee replacement?<\/strong> Q. How long does it take to recover from knee stiffness?<\/strong> Q. Is surgery always necessary for knee stiffness?<\/strong> Q. How can I prevent knee stiffness after knee replacement surgery?<\/strong> Knee stiffness after knee replacement is a common issue that can significantly affect recovery and function. While most cases can be managed with physical therapy and non-surgical treatments, some patients may require surgical interventions like MUA or arthroscopic surgery. Early intervention and consistent rehabilitation are key to ensuring a successful recovery and preventing long-term complications.<\/p>\n A recent study investigated the impact of prior knee surgeries on postoperative outcomes following knee replacement arthroplasty (KRA). The findings indicated that a history of previous knee surgery significantly increases the risk of complications such as prosthesis revision, infections, pain, and stiffness after total knee replacement (TKA).<\/p>\n Notably, patients with prior knee surgeries exhibited a 1.73-fold higher incidence of postoperative stiffness compared to those without a surgical history. This aligns with the understanding that previous surgeries, particularly those involving knee soft tissues or bones, contribute to fibrosis, joint adhesions, and altered knee mechanics, which complicate recovery and function after KRA.<\/p>\n The study emphasizes the need for enhanced preoperative assessment and targeted perioperative strategies for patients with a history of knee surgery to mitigate these risks. (“Study of prior knee surgery and complications after KRA \u2013 See PubMed”<\/em><\/a>.)<\/p>\n Orthopedic surgeons specializing in knee replacements are involved in diagnosing and managing post-surgical stiffness. Physical therapists and rehabilitation specialists play a key role in recovery.<\/p>\n Consult a specialist if knee stiffness persists despite rehabilitation or if it interferes with daily activities, especially if the knee is difficult to bend or straighten.<\/p>\n Go to the emergency room if you experience severe pain, swelling, or signs of infection following knee replacement surgery.<\/p>\n Recovery involves a combination of rest, physical therapy, and gradual reintroduction to activity. Most patients will regain full or nearly full range of motion after several months of rehabilitation.<\/p>\n Ignoring stiffness after knee replacement can lead to chronic pain, limited mobility, and a decreased quality of life. Early treatment and rehabilitation are essential for preventing long-term complications.<\/p>\n Prevent stiffness by adhering to prescribed physical therapy, avoiding prolonged immobility, and following your surgeon\u2019s guidelines regarding activity levels after surgery.<\/p>\n A healthy diet rich in calcium and vitamin D supports bone health and joint recovery. Proper nutrition is essential for maintaining muscle strength and joint function after knee replacement.<\/p>\n Engage in low-impact activities such as swimming or cycling during recovery and gradually increase activity levels as advised by your healthcare provider.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/article>\n [\/et_pb_text][et_pb_text admin_label=”FAQ Headline” _builder_version=”4.24.2″ _module_preset=”default” global_colors_info=”{}”]<\/p>\n [\/et_pb_text][et_pb_df_faq admin_label=”FAQ Module – Change the FAQ Category Here” filter_by_category_on=”on” include_categories=”5369″ accordion_bg_color_closed=”#1f7714″ accordion_bg_color_open=”#1f7714″ accordion_icon_color=”#FFFFFF” accordion_icon_color_open=”#FFFFFF” _builder_version=”4.25.1″ _module_preset=”default” question_text_color=”#FFFFFF” answer_text_color=”#FFFFFF” global_colors_info=”{}”]<\/p>\n [\/et_pb_df_faq][\/et_pb_column][et_pb_column type=”1_4″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_sidebar area=”sidebar-1″ _builder_version=”4.16″ global_colors_info=”{}”]<\/p>\n [\/et_pb_sidebar][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":" Stiffness after Knee Replacement Knee stiffness following knee replacement surgery is a common concern that can impede recovery and daily activities. While knee replacement surgery is widely successful in alleviating pain, stiffness may occur, affecting the patient\u2019s ability to fully extend or flex the knee. At Complete Orthopedics, we specialize in diagnosing and managing post-surgical […]<\/p>\n","protected":false},"author":37,"featured_media":13210,"parent":57534,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_seopress_robots_primary_cat":"","_seopress_titles_title":"Stiffness after Knee Replacement Surgery - Complete Orthopedics","_seopress_titles_desc":"The knee replacement surgery is the most common non-emergent surgery performed by orthopaedic surgeons.","_seopress_robots_index":"","_et_pb_use_builder":"on","_et_pb_old_content":" Knee replacement surgery<\/a> is a highly technical procedure which has successfully resulted in alleviation of knee pain due to a variety of reasons in patients worldwide.<\/p> The knee replacement surgery is the most common non-emergent surgery performed by orthopaedic surgeons. Complications after knee replacement surgery are rare but stiff knees remain one of the common complications after knee replacement surgery.<\/p> A human knee may normally bend from 0 degrees to 135-140 degrees. About 65 degrees of movement is needed for walking, about 90 degrees for day to day activities, about 95 degrees for navigating stairs, and about 100-105 degrees for comfortably sitting and rising from a chair.<\/p> Patients are generally discharged from the hospital after they can bend their knees to about 80 to 90 degrees and are medically stable. Patients are then advised home based exercises as well as participation in physical therapy.<\/p>[caption id=\"attachment_13210\" align=\"aligncenter\" width=\"500\"] Stiffness after knee replacement may be graded as mild when there is inability to bend more than 90-100 degrees, moderate 70-89 or severe <70 degrees.<\/p> Similarly stiffness may be defined as inability to straighten the knee with an extension gap of 5-10 degrees or more than 20 degrees in severe cases. The knee stiffness after replacement surgery may occur due to a number of different reasons.<\/p> Preoperative Factors<\/strong><\/p> Intraoperative Factors<\/strong><\/p> Postoperative Factors<\/strong><\/p> The range of motion of the knee continues to rapidly improve in the first 4 weeks of the surgery. The range of motion further improves in the first 3 months and continues till the first 6 months. Rarely some patients may show improvement in range of motion even after 6 months to 2 years.<\/p> Exercise therapy is started the day after surgery and the therapy in the first 4 weeks plays an important role in preventing stiffness. However patients who have inadequate range of motion despite optimal therapy may need further evaluation. Patients with limited range of motion complain of difficulty sitting and rising from the chair as well as difficulty in navigating stairs.<\/p>[caption id=\"attachment_13209\" align=\"aligncenter\" width=\"375\"] The physician may request radiological studies in the form of X-ray or CT after a thorough physical examination. Blood tests may be done to rule out infection of the prosthetic joint.<\/p> Nonoperative management is tried first in the form of physical therapy if the initial therapy was not optimal. Continuous passive motion machines (CPM) may help the patients achieve an optimal range of motion.<\/p> Manipulation under anesthesia is a non operative technique to manage knee stiffness following surgery. The manipulation is performed in patients who are unable to bend their knees less than 90 degrees. The manipulation has best results if performed in the first 3 months of the surgery.<\/p> During manipulation, the patient is put under general anesthesia. In general anesthesia, the patient sleeps while his\/her muscles are relaxed. The surgeon then tries to physically bend or straighten the knee with an aim to break the fibrosis tissue adhesions.<\/p> Not all patients are candidates for manipulation under anesthesia as excessive manipulation may carry a risk of fracture or rupture of extensor mechanism (patella fracture, patellar tendon rupture, etc).<\/p> In rare cases, where non operative methods have failed, some patients may benefit from arthroscopic lysis (cutting) of the fibrous adhesions. A small miniature camera along with miniature instruments are introduced in the knee joint and the surgeon uses the instruments to cut the fibrous adhesions.<\/p> In some cases, especially where the stiffness is a result of implant mal-position, a revision knee replacement surgery may be done.<\/p>","_et_gb_content_width":"","footnotes":""},"class_list":["post-13203","page","type-page","status-publish","has-post-thumbnail","hentry"],"_links":{"self":[{"href":"https:\/\/2025divi.cortho.org\/index.php?rest_route=\/wp\/v2\/pages\/13203","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/2025divi.cortho.org\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/2025divi.cortho.org\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/2025divi.cortho.org\/index.php?rest_route=\/wp\/v2\/users\/37"}],"replies":[{"embeddable":true,"href":"https:\/\/2025divi.cortho.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=13203"}],"version-history":[{"count":4,"href":"https:\/\/2025divi.cortho.org\/index.php?rest_route=\/wp\/v2\/pages\/13203\/revisions"}],"predecessor-version":[{"id":58922,"href":"https:\/\/2025divi.cortho.org\/index.php?rest_route=\/wp\/v2\/pages\/13203\/revisions\/58922"}],"up":[{"embeddable":true,"href":"https:\/\/2025divi.cortho.org\/index.php?rest_route=\/wp\/v2\/pages\/57534"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/2025divi.cortho.org\/index.php?rest_route=\/wp\/v2\/media\/13210"}],"wp:attachment":[{"href":"https:\/\/2025divi.cortho.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=13203"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n
\n
Manipulation under Anaesthesia (MUA)<\/h4>\n
Recovery and What to Expect After Treatment<\/h3>\n
\n
Possible Risks or Side Effects (Complications)<\/h3>\n
Long-Term Outlook (Prognosis)<\/h3>\n
Out-of-Pocket Costs<\/h3>\n
\nCPT Code 29884 \u2013 Arthroscopic Lysis of Adhesions: $147.96
\nCPT Code 27487 \u2013 Revision Total Knee Replacement (Femoral + Tibial Components): $413.16
\nCPT Code 27486 \u2013 Revision Total Knee Replacement \u2013 Single Component: $332.04<\/p>\n
\nIf your knee surgery is work-related, Workers’ Compensation will fully cover all treatment-related costs, including surgery, hospitalization, and rehabilitation. You will have no out-of-pocket expenses under an accepted Workers’ Compensation claim.<\/p>\n
\nIf your knee injury resulting in surgery is caused by a motor vehicle accident, No-Fault Insurance will cover all medical and surgical expenses, including manipulation under anesthesia, lysis of adhesions, and knee replacement revision surgeries. The only possible out-of-pocket cost may be a small deductible depending on your individual policy terms.<\/p>\n
\nDavid, a 60-year-old patient with knee stiffness after a prior knee replacement, underwent manipulation under anesthesia (CPT 27570) and later required revision total knee replacement (CPT 27487). His estimated Medicare out-of-pocket costs were $37.21 for the manipulation and $413.16 for the total knee replacement revision. Since David had supplemental insurance through Blue Cross Blue Shield, the 20% that Medicare did not cover was fully paid, leaving him with no out-of-pocket expenses for the surgeries.<\/p>\nFrequently Asked Questions (FAQ)<\/h3>\n
A. Stiffness can result from factors such as scar tissue formation, implant misalignment, inadequate post-surgery physical therapy, or infection.<\/p>\n
A. Yes, physical therapy plays a crucial role in improving range of motion and strength after knee replacement. It is essential to start therapy early and adhere to the prescribed exercises.<\/p>\n
A. Recovery time varies, but most individuals experience significant improvement within 3-6 months. Severe cases may take longer, especially if surgery is required.<\/p>\n
A. Surgery is not always necessary. Many cases of post-operative stiffness improve with physical therapy, rest, and other non-invasive treatments.<\/p>\n
A. Preventative measures include early and consistent physical therapy, avoiding prolonged immobility, and following your surgeon\u2019s recommendations for activity restrictions and exercises.<\/p>\nSummary and Takeaway<\/h3>\n
Clinical Insight & Recent Findings<\/h3>\n
Who Performs This Treatment? (Specialists and Team Involved)<\/h3>\n
When to See a Specialist?<\/h3>\n
When to Go to the Emergency Room?<\/h3>\n
What Recovery Really Looks Like?<\/h3>\n
What Happens If You Ignore It?<\/h3>\n
How to Prevent It?<\/h3>\n
Nutrition and Bone or Joint Health<\/h3>\n
Activity and Lifestyle Modifications<\/h3>\n
Do you have more questions?\u00a0<\/h2>\n
![\"X-ray](\"https:\/\/2025divi.cortho.org\/wp-content\/uploads\/2021\/05\/Stiffness-after-knee-replacement.jpg\" "\\"X-ray")
<\/a> X-ray showing a total knee replacement.[\/caption]
A low threshold of pain may play a role in post knee replacement stiffness. Patients with a low pain threshold may not participate in the post replacement physical therapy.<\/li><\/ul>![\"\"](\"https:\/\/2025divi.cortho.org\/wp-content\/uploads\/2021\/05\/Stiffness-after-knee-replacement-2.jpg\")
<\/a> Intraoperative image of total knee replacement.[\/caption]Manipulation under Anaesthesia (MUA)<\/h3>
Other operative<\/h3>