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Surgeons make an effort to "balance" the knee at the time of surgery. This means finding the proper size and alignment of the knee replacement so that the knee joint is not too tight, and not too loose, and so this balancing is the same with the knee straight and bent. This is precisely why a knee replacement is a difficult procedure, and the art of perfecting this takes many years. Errors in positioning of the implants at the time of surgery may not be apparent on the operating table, and can cause difficulty bending or straightening the knee.
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