Knee Hyperextension After TKR

Posted by brendaem @brendaem, May 18, 2023

Has anyone who has had TKR experienced a problem with backwards hyperextension of the joint? I had TKR in October 2019. My recovery has been complicated by a sacroiliac joint issue with radiculopathy that has responded to injections and LOTS of PT. However, my knee continues to hyperextend. My ortho X-rays are normal, and the surgeon says sometimes it takes a year, 18 months, 2 years to fully recover. It’s been 3.5 years now and they’re telling me that maybe I need different hardware in the knee. Maybe?? I don’t want another surgery based on a maybe! Has anyone else had to deal with this?

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This is the first time I've heard of hyperextension after TKR. Usually it's just the opposite and you have to do exercises to get extension to zero, or very close to it.

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I have this. It is scaring me to death. My tkr was 12/2020. I did PT for a full year- 2021. I did 6 months of therapy in 22/23'. Now... back in therapy. Have seen 3 different neurologist and neuromuscular.

Have you had any resolution?

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I had total left knee replacement in Sept, 2023...it was a very difficult and painful recovery
I had total right knee replacement in March, 2024. That went better...I noticed that the first surgery, left knee, continued to be more painful and swollen.
Shortly thereafter my left knee was bowing backwards, called
Hyper flexing. I am still in PT and they had not seen a case like mine.
I returned to the surgeon yesterday and he said in all of his years he had not had a case like mine.
He said 3 options ...remove the device and replace it with a henge type of appliance or put in a "plastic wedge" or a full leg brace.
I am not up for another surgery. I am so disappointed...I also have other health issues.
Has anyone ever experienced hyper flexing and what was done about it? I will appreciate your input as I limp along!

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I had TNR 10 months, went through PT. Recovery has been extremely painful and very swollen. About 3 months ago my knee began bowing backwards ...called hyper flexing. Surgeon said I was first patient he has ever had with this:( He suggested another surgery and taking out the "device" and putting in another one with a henge or adding a wedge. He also suggested wearing a brace that fits from upper thigh to ankle. I am not up to either at this time... I am so disappointed and discouraged. He also replaced my other knee 4 months ago and it is healing nicely.
PT is trying to help "train" me to keep knee from flexing...next to impossible. I have other health issues and becoming very depressed.

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@salliesallie

I had total left knee replacement in Sept, 2023...it was a very difficult and painful recovery
I had total right knee replacement in March, 2024. That went better...I noticed that the first surgery, left knee, continued to be more painful and swollen.
Shortly thereafter my left knee was bowing backwards, called
Hyper flexing. I am still in PT and they had not seen a case like mine.
I returned to the surgeon yesterday and he said in all of his years he had not had a case like mine.
He said 3 options ...remove the device and replace it with a henge type of appliance or put in a "plastic wedge" or a full leg brace.
I am not up for another surgery. I am so disappointed...I also have other health issues.
Has anyone ever experienced hyper flexing and what was done about it? I will appreciate your input as I limp along!

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Hello @salliesallie - I combined your recent discussions with an existing discussion titled, "Knee Hyperextension After TKR" - https://connect.mayoclinic.org/discussion/knee-hyperextension-after-tkr/.

I did this so you could meet @brendaem and @csforrester99 who both talked about having the same issue after their TKR. They may be able to provide an update on what they learned and where they have come since first posting about the issue.

@salliesallie - with hyperextension being an issue, how are you doing with walking? Are you able to walk, or do you have to do so carefully? Is your knee "stuck" in the extension or does a particular movement trigger the issue?

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@JustinMcClanahan

Hello @salliesallie - I combined your recent discussions with an existing discussion titled, "Knee Hyperextension After TKR" - https://connect.mayoclinic.org/discussion/knee-hyperextension-after-tkr/.

I did this so you could meet @brendaem and @csforrester99 who both talked about having the same issue after their TKR. They may be able to provide an update on what they learned and where they have come since first posting about the issue.

@salliesallie - with hyperextension being an issue, how are you doing with walking? Are you able to walk, or do you have to do so carefully? Is your knee "stuck" in the extension or does a particular movement trigger the issue?

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Hello Justin, First let me thank you for reaching out to me. In answer to your questions...I am able to walk with the aid of a rotator due to damaged nerves that control balance following a very extensive cervical surgery in 2020. My knee does not get stuck in the extension...it happens when I put my weight on my leg when walking or standing. BTW, I am a 85 yo female, 5' 3", 123 lbs. I try not to let it hyperextend when I am walking but that is not working very well.
I will sincerely appreciate any information that you can direct me to.

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See my comments in this section.
Has your hyperextension increased over time?

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I have no answers yet after 5 years with this. I have been doing PT for about 2 that is helping somewhat, but the knee still snaps back after I’ve walked for awhile. The ortho continues to say the hardware is in good position. Prior to the Jenn replacement, I had surgery for a torn meniscus in that knee - I wonder if that’s a factor. Did any if you have a prior surgery u. The same knee as well?

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@salliesallie

I had TNR 10 months, went through PT. Recovery has been extremely painful and very swollen. About 3 months ago my knee began bowing backwards ...called hyper flexing. Surgeon said I was first patient he has ever had with this:( He suggested another surgery and taking out the "device" and putting in another one with a henge or adding a wedge. He also suggested wearing a brace that fits from upper thigh to ankle. I am not up to either at this time... I am so disappointed and discouraged. He also replaced my other knee 4 months ago and it is healing nicely.
PT is trying to help "train" me to keep knee from flexing...next to impossible. I have other health issues and becoming very depressed.

Jump to this post

I hope your doctor can find a solution to your problem soon. …sending you positive thoughts !!!

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@salliesallie

I had TNR 10 months, went through PT. Recovery has been extremely painful and very swollen. About 3 months ago my knee began bowing backwards ...called hyper flexing. Surgeon said I was first patient he has ever had with this:( He suggested another surgery and taking out the "device" and putting in another one with a henge or adding a wedge. He also suggested wearing a brace that fits from upper thigh to ankle. I am not up to either at this time... I am so disappointed and discouraged. He also replaced my other knee 4 months ago and it is healing nicely.
PT is trying to help "train" me to keep knee from flexing...next to impossible. I have other health issues and becoming very depressed.

Jump to this post

Yes this has happened to me twice. After my original tkr in 2022 my knee was unstable and hyperextended back and hurt all the time on the side . In 2023, I went to different surgeon. He agreed that my knee was unstable and replaced the spacer with a larger one to prevent the hyperextention. After this surgery, my knee continued to hurt on the side. The xrays looked fine and bone scan was negative. My surgeon sent me to a orthopedic doctors with lots of experience dealing with problem implants for another opinion. This surgeon told me that he thought I had MS. I have had several MRIs, bloodwork, lumbar puncture to rule out MS. I don’t have MS but now my knee is hyperextending back again.

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