Recovery of knee range of motion after total knee arthroplasty in the first postoperative weeks: poor recovery can be detected early

  • A. KornuijtEmail author
  • G. J. L. de Kort
  • D. Das
  • A. F. Lenssen
  • W. van der Weegen
Original Article



The aim of this study was to analyze in detail how knee flexion and extension progress in the first 8 weeks after primary total knee arthroplasty (TKA). The secondary goal was to compare knee range of motion (ROM) recovery patterns between patients with normal and delayed ROM recovery 8 weeks after TKA.


This prospective clinical trial included all patients who underwent a primary unilateral TKA between February and December 2016 with weekly ROM data documented by the treating outpatient physical therapists (n = 137). Goniometry was used to measure knee ROM preoperatively, postoperatively on day 1 and weekly until follow-up at the orthopedic clinic 8 weeks after surgery. ROM recovery patterns were compared between patients with sufficient (≥ 90°) or insufficient (< 90°) knee flexion 8 weeks after TKA.


Knee flexion recovered from a median of 80° in the first postoperative week to 110° 8 weeks after surgery and knee extension from a mean of − 10.7° to − 3.2°. Recovery was nonlinear, with greatest improvements in the first 4 weeks for knee flexion. In contrast to patients with sufficient knee flexion 8 weeks postoperatively, the insufficient group (n = 8, 5.8%) had poor knee flexion on the first postoperative day and from week 4 to week 8 almost no improvement or even worsening of knee flexion.


Both knee flexion and extension recover in a nonlinear manner after TKA surgery. Poor postoperative knee function can be detected early, using ROM data from the first postoperative day up to the fourth week.


Total knee arthroplasty Range of motion Recovery patterns Early postoperative 


Compliance with ethical standards

Conflict of interest

W van der Weegen is a paid consultant for Zimmer Biomet Inc.; all other authors have no conflict of interest to disclose.

Ethical statement

All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Istituto Ortopedico Rizzoli 2019

Authors and Affiliations

  1. 1.Department of PhysiotherapySt. Anna HospitalGeldropThe Netherlands
  2. 2.Department of Orthopedic SurgerySt. Anna HospitalGeldropThe Netherlands
  3. 3.Department of PhysiotherapyMaastricht University Medical CenterMaastrichtThe Netherlands

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