How to resolve stiff knee

I had a total knee joint replacement early September followed by CPM treatment and then physiotherapy. However, knee had limited flex so it was manipulated under general anaesthetic early November followed by more CPM treatment.   Despite this knee has still only limited flex, about 40 degree.    How can this be resolved?  

[Dr_Veena]

Hi,
   How are you? The stiff  total knee is also a painful total knee, because the  tight, unyielding soft tissues are under stress during everyday activities.In a stiff total knee  joint the prosthesis is placed too high, so that the  patella is too low -the new joint line touches the patella.

The faulty position of the total knee prosthesis increases the tension in the extensor apparatus which cannot lengthen during the  knee bending. Besides, there is also a tight scar in the extensor musculature, that further hinders the lengthening of the musculature during knee bending.

The PCL is tight and hinders the bending of the new knee joint.If total knee is stiff (less than 90 degrees of flexion) although you have had a good range of motion in your knee before the operation and if the X-ray picture shows that the total knee prosthesis is placed correctly, then a manipulation of your knee under narcosis may be considered.

The manipulation under narcosis may be done under the first three postoperative months. Later on, the soft tissue scares  have matured and the tissues cannot be stretched passively.
Consult your orthopaedician for further assistance.
Bes

[Daniellh]

The only thing that helps if the knee is installed correctly is to continue to do therapy and keep increasing the amount of movement. I have found that an exercise bike is the best thing to get your flex back. Set the seat high enough that you can just almost rotate the pedals all the way. pedal back and forth slowly until you can go all the way around (put your heal on the pedal instead of the ball of your foot, then gradually move your foot forward as it gets easier to pedal around). When you can pedal comfortably all the way around on the ball of your foot it is time to lower the seat one position and start over. It will hurt trying to go past your last stopping point but it will gradually give you more flex. Pedaling backwards first is easier than forward. You should do this twice a day for about 15 minutes.
It has been 4 weeks since my surgery this time, and I can go more than 90 degrees already. It will be painful as you increase to each step but it is worth it in the end.