Abstract
Purpose
No definite treatment option with reasonable outcome has been presented for old and refractory flexion contracture after total knee arthroplasty (TKA). We describe a surgical technique for 21 refractory cases of knee flexion contracture, including 12 patients with history of failed manipulation under anesthesia (MUA).
Methods
Retrospective review was conducted for procedures performed by a single surgeon between 2005 and 2016. Twenty-one knees (19 patients) with knee flexion contracture after primary TKA were treated with all the following procedures: posterior capsular release, hamstring tenotomy, prophylactic peroneal nerve decompression, and botulinum toxin type A injections. Twelve of the 21 knees had at least 1 prior unsuccessful MUA before this soft-tissue release procedure. Mean age at intervention was 60 years (range 46–78 years). Mean preoperative knee range of motion (ROM) was – 27° extension (range – 20° to – 40°) to 100° flexion (range 90°–115°). All radiographs were evaluated for proper component sizing and signs of loosening.
Results
Full extension was achieved immediately after surgery in all patients. Only one knee required repeat botulinum toxin type A injection. All patients had full extension at mean follow-up of 31 months (range 24–49 months). No significant change was observed in knee flexion after the procedure (n.s.). Significant improvement was noted in the postoperative Knee Society Score (KSS) (mean 80, range 70–90) when compared with preoperative KSS (mean 45, range 25–65) (p = 0.008).
Conclusion
The proposed surgical technique is efficacious in treating patients with refractory knee flexion contracture following TKA to gain and maintain full extension at minimum 2-year follow-up.
Level of evidence
IV, retrospective case series.
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Acknowledgements
The authors thank Joy Marlowe, MA, CMI, and Amanda E. Chase, BS, MA, for their invaluable assistance with this article.
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HV, AK, VLS, MKP, and AIH declare that they have no conflicts of interest. JDC receives fellowship support from Biocomposites, royalties from University of Florida, and is a consultant for Biomet and Cerament. The following organizations supported the institution of JDC: Arthrex, DePuy Synthes, Metro Prosthetics, MHE Coalition, NuVasive Specialized Orthopedics, Orthofix, OrthoPediatrics, Pega Medical, Smith and Nephew, Stryker, Supreme Orthopedic Systems, Treace Medical Concepts, Inc.,Vilex, and Zimmer Biomet.
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The study was performed according to the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments.
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Study performed at Sinai Hospital, Baltimore, Maryland, USA.
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Vahedi, H., Khlopas, A., Szymczuk, V.L. et al. Treatment with posterior capsular release, botulinum toxin injection, hamstring tenotomy, and peroneal nerve decompression improves flexion contracture after total knee arthroplasty: minimum 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 28, 2706–2714 (2020). https://doi.org/10.1007/s00167-020-05939-0
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DOI: https://doi.org/10.1007/s00167-020-05939-0