Total Knee Replacement - Clicking After Surgery

Following knee replacement surgery, patientsthe surgeon works to optimize range of motion and
sometimes report hearing clicks or a clicking soundjoint stability through proper alignment and sizing of
during certain activities or at a certain point or pointsthe implant.
during their gait cycle. In most cases, this sound isThe resulting tension in the replaced joint can,
believed to be benign and is not associated with paintherefore, vary slightly from patient to patient and
or other adverse consequences.can be different within the range of motion of a
So what causes this clicking?single patient. That is, some patients may have
To answer this question, it is helpful to understand a"tighter" knees or "looser" knees or a single knee can
little bit about the nature of total knee replacement.be "tight" in flexion, but "loose" in extension and vice
In knee replacement, the ends of the bones thatversa, but in general, some degree of laxity is
make up the knee joint are "resurfaced" with metaldesirable to allow for adequate motion.
and plastic components. The surgeon uses specializedBecause there is almost always some laxity in a
instrumentation and surgical technique to properlyreplaced knee, clicking can sometimes be heard as a
align the implants to the bones and the bones to oneresult of contact between the metal and plastic
another.components during activity. Often it is heard during a
This alignment is not straightforward because in thetransition from low or non-weight bearing to weight
replaced knee joint, as in the normal knee, the bonesbearing. For example, a patient may hear the click
are not "mechanically interconnected"; rather the jointwhile walking as the leg comes out of swing phase
is constrained by the remaining soft tissue (ligaments,and makes contact at heal strike. For the most part,
muscles/tendons) and the conformity of the implantthe clicking is usually not associated with any adverse
components. During the knee replacement operation,conditions.