Knee Replacement “Clicking”
Following 
knee replacement surgery, patients sometimes report hearing clicks or a clicking sound during certain activities or at a certain point or points during their gait cycle. In most cases, this sound is believed to be benign and is not associated with pain or other adverse consequences.
So what causes this clicking?
To answer this question, it is helpful to understand a little bit about the nature of total knee replacement. In knee replacement, the ends of the bones that make up the knee joint are “resurfaced” with metal and plastic components. The surgeon uses specialized instrumentation and surgical technique to properly align the implants to the bones and the bones to one another.
This alignment is not straightforward because in the replaced knee joint, as in the normal knee, the bones are not “mechanically interconnected”; rather the joint is constrained by the remaining soft tissue (ligaments, muscles/tendons) and the conformity of the implant components. During the knee replacement operation, the surgeon works to optimize range of motion and joint stability through proper alignment and sizing of the implant.
The resulting tension in the replaced joint can, therefore, vary slightly from patient to patient and can be different within the range of motion of a single patient. That is, some patients may have “tighter” knees or “looser” knees or a single knee can be “tight” in flexion, but “loose” in extension and vice versa, but in general, some degree of laxity is desirable to allow for adequate motion.
Because there is almost always some laxity in a replaced knee, clicking can sometimes be heard as a result of contact between the metal and plastic components during activity. Often it is heard during a transition from low or non-weight bearing to weight bearing. For example, a patient may hear the click while walking as the leg comes out of swing phase and makes contact at heal strike. For the most part, the clicking is usually not associated with any adverse conditions.
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14 Responses to “Knee Replacement “Clicking””
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Introductory Topics
Introduction - Home Normal Knee Anatomy The Diseased Knee: Osteoarthritis The Knee Replacement Procedure
Surgery Overview > Total Knee Replacement Surgery Video Knee Replacement Complications Minimally Invasive Knee Replacement Unicompartmental Knee Replacement Computer Assisted Knee Replacement Knee Replacement Implants
The Parts of a Total Knee Replacement Mobile Bearing Knee Replacement Knee Implant Wear Knee Implant Manufacturers Related Topics
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In my extensive physiotherapy experience, quadriceps control also plays a role with this. If there is a decrease in optimum strength the movement becomes sloppy and uncontrolled causing the knee to jar. Good basic tone will also give the knee a tighter feel. Finally patients with both hip and knee replacements will initally be understandably focussed on their new joint. Instead of feeling the softer arthritis feel, a new harder feel is evident. As they get used to having a new joint and enjoying its capabilities (without the pain) they no longer notice the clicking.
Matt,
The idea that initial laxity and subsequent “clicking” would be mitigated or perhaps eliminated by post-op rehab and strengthening of surrounding musculature is plausible. Thanks for your input and perspective on this topic!
[...] the rest of this story on clicking noise after total knee replacement Tags: after knee replacement, clicking noise after total knee replacement, knee clicking after [...]
The above article sounds like the kind of information we hear BEFORE the operation. On the surface ,it makes sense and seems reasonable. But there are two problems with this information.
1. There is clicking, and then there is CLUNKING. Ask someone on the Topix.com thread: “Popping and clunking sounds coming from new knee” what they think of this article, and I think alot of them will tell you this is what they were told, but that’s not the issue. Clunking is a much more serious variety of clicking, and apparently it is not all that uncommon.
2. Because of this propaganda that clicking is to be expected, when you find yourself in the situation post-op where you are experiencing clunking instead of clicking, it is extremely difficult to break through to the Doctor and his assistants that your understand about the clicking expectations, but that’s not what you are experiencing. It is very hard to convince them that something is wrong, because they have this built in excuse of clicking as normal.
Hello Robert,
Thank you for your comment. You are correct, there is a distinction between the typically “benign” clicking described above and more serious “clunking” which can sometimes occur (and unfortunately, what you seem to be experiencing). A clunking involving the patella (patellar clunk syndrome) is described in the following post:
http://www.totalkneeweb.com/patellar-clunk-syndrome-complication-following-knee-replacement-surgery
There are also related posts listed at the end as well.
Hopefully you find this additional information useful.
I had double knee replacements on 9/07/10 and I have much stiffness. The worst problem is that my knees feel like they are on fire alot of the time. I walk almost 1.5 miles/6 days a week. I also have alot of clicking while walking. While walking I do not have the fire feeling and in general I feel better while walking. My doc just says that the xrays look good. Any comments? How do I get past the “good xrays” and the doc just saying it will take time when I feel that something is wrong?
tkr both knees one in 07, one in 08. left one has grinding noise underneath kneecap also clunk sound no pain but its driving me nuts. I hate the thought of having to go underneath the knife again. I wonder whats going on in there(knee)
I had a total knee replacement in November 2010. It feels good during the day but aches like crazy when I go to bed. Any ideas as to why this happens. I still have some pain pills left but I do not want to take them. I am not a pill person.
surgery of both knees tkr rpf has been done on nov. 18 in forits hosp mohali by drMANUJ WADHWA. the problen is both knees click when legs lift up get down .i am worried but doctor said nothing to worry. plz tell me what to do.thanks
about 7 years ago I jhad a knee replacement and although there is not the intence pain anymore i have a click that with each step i hear and feel i went to the dr who did the operation and he said the xrays look normal .now the knee joint is making 2 clicks .
I had talked to my nephew who is a surgical tech and he said something is not rght I have also talked to some people who had total knee replacement and they said they have no cliking at all
what concens me is this did this from day one and now the clickig is louder and now has another click happening what kind of wear or misalignment is being done when I go hunting my friends say the clicking gives a me away to my location and that is a human ear and deer or other animals can hear me much further away
I hate to say this, but it feels so good not to be alone with all this!!!
Clicking, in this article, is said to come from the metal and plastic “clicking” against each other. If this is true, the implants should fail earlier than anticipated. Simply, the plastic will wear out more quickly due to high contact/impact stress. .
I am a 78 yo healthy (albeit a cancer survivor) male who has always followed a strong fitness regime involving martial arts, weightlifting, running, cycling, indoor rowing and boot camp outdoor sessions, so when I wrecked my knee joints from 40 yrs of hard surface running, at least I had an advantage in managing the recovery & rehab stages. Here is my 5 weeks recovery timetable:
Week one/day 2 walking with 2 wheel walker. Physio started
Day 3 walker & aluminium crutches alternating
Day 4 discharged to home. Continued my own physio at home. Mod to severe pain – controlled with opioid drugs & senna pod derivatives for the severe constipation caused by opioids.
Day 5 Using alum. crutches only to get around home.
Week Two/Day 9 Using one crutch only & had modified weights session followed by sunbaking.
Day10 Still fair degree pain, swollen knee & ankle. Drove manual SUV vehicle up and down driveway.. Scared the animals.
Week Three/Day15 able to move around without crutches
Day 16 Steel incision closure clips removed Day 17 Drove vehicle out on road & didn’t kill anyone. Also walked 1km
Week Four/Day22 AB exercises & weights workout. Mowed acre of lawn on rider mower
Day 26 Resumed outdoor high intensity boot camp training with group. No running & gentle on cliff stairs..OMG…
Week Five/Day 29 Climbed ladder to inspect roof – all OK but stiff
Day 35 Indoor rowing session on Concept2 machine & road cycling. Difficulty in releasing foot from clip racing pedals due to twisting motion required. Leave a few weeks more.
After working on steep hillsides on acreage property, some knee pain develops and slight clicking.
Second knee joint due for TKR in Jan 2012.
Happy to answer any questions as patients outcomes vary enormously.. Love from Australia
Just a small correction to my previous posting. The walker used in hospital for two days, was a 4 wheel version which moves more smoothly than the 2 wheel version.