When Recovery Slows: Managing Stiffness After Knee Replacement By Physiotherapist Debbie Cameron

Most people recover well after a total knee replacement, particularly when physiotherapy begins early and continues consistently. However, some patients experience ongoing stiffness or slower progress despite good effort. Understanding why this happens — and what options are available — can be reassuring.

Delayed rehabilitation and its impact

Occasionally, recovery is delayed by factors outside a patient’s control, such as post-operative complications or infection. In clinical practice, even highly motivated individuals who commit to frequent physiotherapy and exercise may find that regaining full movement becomes more challenging when rehabilitation is postponed.

Research reflects this reality. Although small improvements can still occur after the first year, most recovery in knee range of motion takes place within the initial twelve months following surgery (Nerhus et al., 2010).

Manipulation under anaesthesia

In cases where knee movement remains limited around three months after surgery, some orthopaedic surgeons may recommend manipulation under anaesthesia (MUA). This procedure involves gently bending and straightening the knee while the patient is under anaesthetic, with the aim of breaking down adhesions that restrict movement.

Recent studies support earlier use of MUA when progress has stalled, showing improved outcomes when it is performed within the early months of recovery (Colacchio et al., 2019; Sala et al., 2022). It is not required for everyone, but it can be a helpful option when stiffness persists despite appropriate physiotherapy.

Long-term movement and joint health

Historically, average knee movement following replacement surgery reaches around 116 degrees by two years post-operatively (Nerhus et al., 2010). Maintaining strength, flexibility and regular activity helps support these outcomes and may slow the small decline in function that some studies observe several years after surgery.

Ongoing movement remains important long after formal physiotherapy has ended. Staying active helps preserve joint health and overall mobility.

A realistic and encouraging perspective

Recovery after knee replacement requires both medical guidance and personal perseverance. Progress may feel slow at times, but even small improvements contribute to better comfort, balance and independence over the long term.

With consistent effort and professional support, most patients regain strong, functional movement and return to the activities that matter most to them.

If you would like guidance at any stage of your knee replacement journey, Debbie Cameron Physiotherapy would be happy to assist.

References

Colacchio, N.D. et al. (2019) Early manipulation under anaesthesia following total knee arthroplasty and functional outcomes.Hall, S. et al. (2025) Standardisation challenges in physiotherapy interventions for post-TKR stiffness.Nerhus, T.K. et al. (2010) Range of motion and functional outcomes over time after total knee arthroplasty.Sala, M. et al. (2022) Efficacy of manipulation under anaesthesia in improving post-operative knee flexion.