Background: Total knee arthroplasty (TKA) is a highly reliable surgical procedure for treating advanced knee osteoarthritis. While it replaces damaged articular surfaces with prosthetic components, post-surgical recovery is frequently complicated by soft-tissue constraints. These include muscle contractures, active myofascial trigger points (MTrPs), and persistent fluid retention.

These soft-tissue abnormalities increase joint compression forces, which can compress the joint space and alter its radiographic appearance. Dry needling (DN) is an effective physical therapy technique that releases MTrPs, normalizes muscle length, and reduces periarticular swelling. Despite these benefits, its ability to alter weight-bearing radiographic joint space width (JSW) at the prosthetic interface has not been widely documented.

Case Presentation: A 65-year-old female presented with persistent bilateral knee pain, restricted range of motion (ROM), and chronic swelling after undergoing bilateral TKA (Left Knee in 2019, Right Knee in 2025). Physical examination revealed active MTrPs and severe hypertonicity in the hip abductors, quadriceps, hamstrings, popliteus, and gastrocnemius muscles.

The patient underwent a targeted 3-month dry needling protocol twice per week, focusing on the hypertonic muscle groups of the back, hip and lower limb. No other interventions, such as physical therapy modalities, joint mobilization, or medication adjustments, were performed during this period.

Results: At the 3-month follow-up, Single leg weight-bearing anteroposterior (AP) radiographs showed a visible increase in bilateral tibiofemoral JSW.

This structural change was accompanied by a 3.3 cm reduction in left knee circumference and a 3.4 cm reduction in right knee circumference. Functional mobility also improved, with knee extension returning to 0° bilaterally and the total normalised WOMAC index score decreasing from 93 to 14 points.

Conclusions: This case shows that targeted dry needling can alter the radiographic presentation of the prosthetic interface in post-TKA patients. This change is achieved by relieving myofascial hypertonicity, reducing external soft-tissue swelling, and restoring balanced tensegrity across the hip and lower limb.

These mechanisms decompress the joint, allowing the tibia and femur to align optimally during weight-bearing radiographs. This study emphasizes the importance of managing soft tissues to optimize mechanical outcomes after joint arthroplasty.