TKR ‘Hard’ knee


new member
Sep 13, 2023
Canada Canada
I am finding this site amazingly resourceful, I am so glad that I found it. I had a TKR on August 11, (5.5 weeks post-op). My flexion is about 90 -100°, extension is close to zero. But my knee is very ‘hard’ limiting me in exercising and ROM and still causes pain. My knee is a bit warm to touch and slightly red, but still seems to be healing well enough. I’m assuming this is normal, but I’m a little concerned about it. And I have read the posts about PT’s and excessive exercise and have certainly taken that into consideration. I was one of those people who didn’t take many pain meds being as I was concerned with the adverse effects of them. I could tolerate the pain well enough, so it wasn’t really a problem. Although, maybe that has hindered my recovery.
Just wanted to know if anybody else has had this ‘hard’ knee and if it’s scar tissue or just swelling from the surgery. Thank you
Just wanted to know if anybody else has had this ‘hard’ knee and if it’s scar tissue or just swelling from the surgery.
Everything you describe is normal, and this hard area is most likely swelling.

Don’t let the term scar tissue concern you. We do need a certain amount of normal scar tissue or our surgical wounds would never heal. Over time that normal scar tissue heals and thins and gets less and less. The “bad” scar tissue, more correctly called Adhesions, are actually rare, and rarely form this early in recovery.

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

Knee Recovery: The Guidelines

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary

2. Control discomfort:
take your pain meds by prescription schedule (not when pain starts!)​
If you want to use something to help heal the incision,
BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.​

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​
4. PT or exercise can be useful BUT take note of these

5. At week 4 and after you should follow this

6. Access to these pages on the website

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
By "hard" do you mean "very very stiff especially after sitting still a while"? If so, it's quite normal, as is some warmth.
By " hard" do you mean "the entire area is very swollen all the time, and the swelling seems firm"? That would send me to my surgeon's office to check! Though it could be more icing, rest, and elevation is needed.
Just wanted to know if anybody else has had this ‘hard’ knee and if it’s scar tissue or just swelling from the surgery.
Yes, I had it too! I also had a "warm" knee for months. Both are normal and do get better -- slowly -- with time. If you scan through some other members' stories, you'll see lots of people report experiencing these sensations for months post-op.

It simply takes a long time for all the inflammation inside the knee to settle down. Even if you don't see any swelling on the outside, there's a lot happening below the surface! Best to keep icing and elevating as described in the articles Jockette left for you.

It does sound like you are doing very well for less than 6 weeks out!

Hello and Welcome. Thanks for joining us and congrats on your new knee, Ravendancer!
Warmth and redness are signs of inflammation, which is normal post op. As you're healing there is increased blood flow to the area. This can go on for several months so please don't worry. By hard knee, I am assuming you mean tight. All normal and part of the healing process which icing and elevation and time will help.
Happy Icing and best wishes for your recovery! :ice:
Thank you so much. I thought this might be so, but still found it worrisome. It’s a longer process than I thought, especially as I’ve never had anything worse than a wart removed before!!
Please ice and elevate as much as you can. Ice is a natural pain killer and it will help reduce the swelling that is hindering your range of motion (ROM).
It’s a longer process than I thought,
Most of us were surprised by the length of this recovery. Our surgeons really are not honest about what we are facing (maybe they are afraid they will scare us off!) and so our expectations tend to be unrealistic -- and then we panic!

You aren't alone! I can't tell you how many times other BoneSmarties put my mind at ease when I was worried. Don't hesitate to share your concerns. There are amazing people in this forum who are here to support you!

I am also about 5.5 weeks out from RTKR and have the exact same symptoms - the knee area feels pretty hard, knee area is a little warm and my ROM isn't as good as I would like (about 90 degrees). We are in the same club!

As far as everyday activities though, I think I am doing ok - can get around fine without assistance, have been driving for a couple of weeks, bowled once, washed my car Saturday and even started going up stairs normally today (not the one step at a time) but going down stairs normally is a bit of a challenge still.

I measure progress in weeks as it seems that every week there is at least a little something that is better so just hang in there!
I'm very confused about scar tissue massage and ROM. My PT has said to massage the incision around the knee several times a day to help break up scar tissue, which I am doing. I'm 7 weeks post-op and only at 105 degrees and my knee is still a bit swollen, inhibiting my ROM. The PT also says my ROM is okay but not the greatest for post-op 7 weeks!
I read I should push my knee (only to tolerable pain), as once scar tissue builds up, it will be harder (or impossible) to get ROM back. Then I read, not to worry, your body knows how to heal and ROM may take weeks/months, but it will return. Seems to be so many opposing opinions 'out there'. I know I'm not supposed to compare, but I'm feeling discouraged and unsure as to the best approach to take. Thank you for any thoughts on this.
Hello @Ravendancer,
You'll notice that I have merged your two threads together as it's best if members in recovery only have one thread. We find it much easier for everyone.
This is because:
  • That way, you have all your information in one place. This makes it easier for others to go back and review your history before providing advice.
  • If you start new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
  • Having only one thread will act as a diary of your progress that you can look back on.

Please keep all your questions and updates on this thread. We won't miss your new question as, between us, the staff read all new posts each day.
If you need an urgent response to a question, tag a member of staff.
Tagging other members and answering tags

If you prefer a different thread title, just post what you want and we'll get it changed for you.

Here are the instructions on finding your thread, How can I find my threads and posts?

A helpful hint - Many members have found it useful to bookmark their thread so they don't lose it.
The scar tissue (which is more correctly called adhesions) is very rare, and one of the easiest ways to develop it is to work your knee too hard. Over-worked knees get inflamed and hot, and hot tissues become drier than normal and more likely to stick together and form adhesions.

This article explains the difference between scar tissue and adhesions:
MUA (Manipulation under Anaesthetic) and Adhesions

You need normal scar tissue. That's what holds your incision together, and it's part of the normal healing process. Without it, you'd always have an open wound.

I have had 6 knee surgeries on each knee and my OSs said they never saw any adhesions. This country is needlessly obsessed with 'scar tissue'.
Your ROM is fine.

in my experience it's PTs and surgeons who get confused.... about the big difference between "scar tissue growing under or around an incision" (as some people tend to do after burns, cuts, wounds) and "adhesions within the muscles binding tissues and impinging movement."

I actually developed a very uncomfortable palpable ropy area under and adjacent to the top of my incision line a couple of weeks postop, and did massage twice daily and it's pretty much gone now. Frankly, if there's not a palpable something I'm not sure what good massaging will do... it's the generalized joint swelling that interferes with ROM.
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Thanks for all the input. It's so good to share our experiences and see what others are going through. :unsure: I'll just continue with my exercises, ice, elevate, cycle (extended seat--got there a couple of days ago), and walking. Still some grimacing going on though!! :nah:LOL!
I'm pretty sure that my other knee will be done soon, so at least I'll be a lot more informed about this whole process.
Hello and Happy Wednesday!
I hope the grimacing is becoming less and less. :wink: We're glad you joined and us and thankful you're sharing your progress here. Wishing you a great rest of the week and a Happy Two Month Anniversary!
My knee still feels pretty "hard" at almost 7 weeks after surgery, like you mentioned. My everyday life though has for sure improved, hopefully yours has also.

Sleeping is much better and doing the normal daily life things is routine now (including bowling and planning a trip in a month or two).

As far as my knee bending goes, I am sure that it is not nearly where my Dr. would like for it to be. Probably around 95 degrees but it is s-l-o-w-l-y improving (I can sit in a chair at about 90 degrees now without much discomfort where a week or so ago that was my maximum bend and it was very uncomfortable to hold).

I'll just keep plugging along, doing everyday life while doing some stretches, exercise bike and swimming while the swelling continues (hopefully) to go down.
I am now at 9 weeks post-op. My knee is still swollen (moderate) and this certainly inhibits me pushing further. Last week at physio I reached 110° flexion. Although I have to stretch and grunt :heehee: to get to that. I started to to some strengthening exercises there, and I think I either pulled something in my ankle or else the swelling in my knee has move down to my ankle (physiotherapist said this can happen??) So now, on top of knee pain I have ankle pain/swelling. :yikes: So I'm trying to do my exercises without further injuring my ankle, which doesn't make it easy.
When I get up in the morning, due to stiffness, I'm sure I'm closer to 90°, which also is probably normal after laying around in bed all night.:sleeep::yawn:
Definitely there is little warning/information/guidance from nurses and the osteo surgeon about the recovery from TKR. If it wasn't for research on-line and this forum especially, I'd have no clue.:SUNsmile:
Even though it's a long challenging process, I'm still glad of the surgery. And now I get to look forward to having my other leg done!! But, at least I'll be much more 'in the know'.
Before you know it, you'll have two brand-new knees!
So looking forward to that.

I’m a little concerned about sarcopenia though, as I’m unable to exercise as I used to. Muscle loss is hard to get back as one ages. I’m thinking though that walking is the best exercise for this. I am a healthy/fairly active 71 years young!

Any other thoughts??:what:


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