Abstract
Total knee arthroplasty has become a very common procedure over the last decade. Patients are being treated earlier, and the severe deformities seen in previous decade are encountered less frequently. Despite this, there are occasions where the patient presents with a significant fixed deformity. A stepwise approach is required to safely deal with these severe deformities. Failure to do so may lead to skin compromise and further complicate the surgery. Once the arthrotomy is performed, in a stepwise fashion, tight structures need to be released to enable good surgical exposure. Quadriceps snip and an early lateral release are two techniques that can improve exposure. The bone cuts are also important, and often additional distal bone is resected to allow for full extension. A post-capsule release is also often required to enable achievement of full extension. Caution is needed, and patients need to be counseled when there is a severe flexion contracture as well as valgus deformity, since this deformity can be associated with a postoperative foot drop.
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References
Bhan S, Malhotra R, Kiran EK. Comparison of total knee arthroplasty in stiff and ankylosed knees. Clin Orthop Relat Res. 2006;451:87–95.
Hwang YS, Moon KP, Kim JW, Park WS. Total knee arthroplasty for severe flexion contracture in rheumatoid arthritis knee. Knee Surg Relat Res. 2016;28(4):325–9.
Meftah M, Blum YC, Raja D, Ranawat AS, Ranawat CS. Correcting fixed varus deformity with flexion contracture during total knee arthroplasty: the “inside-out” technique: AAOS Exhibit Selection. J Bone Joint Surg Am. 2012;94(10):e66. https://doi.org/10.2106/JBJS.K.01444.
Berend KR, Lombardi AV, Adams JB. Which total knee replacement implant should I pick? Correcting the pathology: the role of knee bearing designs. Bone Joint J. 2013;95-B(11 Suppl A):129–32.
Su EP. Fixed flexion deformity and total knee arthroplasty. J Bone Joint Surg Br. 2012;94(11Suppl A):112–5.
Scuderi GR, Kochhar T. Management of flexion contracture in total knee arthroplasty. J Arthroplasty. 2007;22(4 Suppl 1):20–4.
Berend KR, Lombardi AV, Adams JB. Total knee arthroplasty in patients with greater than 20 degrees flexion contracture. Clin Orthop Relat Res. 2006;452:83–7.
Firestone TP, Krackow KA, Davis JD IV, Teeny SM, Hungerford DS. The management of fixed flexion contractures during total knee arthroplasty. Clin Orthop Relat Res. 1992;(284):221–7.
Liu DW, Reidy JF, Beller EM. The effect of distal femoral resection on fixed flexion deformity in total knee arthroplasty. J Arthroplasty. 2016;31(1):98–102.
Vince K. Mid-flexion instability after total knee arthroplasty: woolly thinking or a real concern? Bone Joint J. 2016;98-B(1 Suppl A):84–8.
Okamoto S, Okazaki K, Mitsuyasu H, Matsuda S, Mizu-Uchi H, Hamai S, et al. Extension gap needs more than 1-mm laxity after implantation to avoid post-operative flexion contracture in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2014;22(12):3174–80.
Kim SH, Lim JW, Jung HJ, Lee HJ. Influence of soft tissue balancing and distal femoral resection on flexion contracture in navigated total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2016. https://doi.org/10.1007/s00167-016-4269-9. Epub ahead of print.
Perry J, Antonelli D, Ford W. Analysis of knee-joint forces during flexed-knee stance. J Bone Joint Surg Am. 1975;57(7):961–7.
Harato K, Nagura T, Matsumoto H, Otani T, Toyama Y, Suda Y. Knee flexion contracture will lead to mechanical overload in both limbs: a simulation study using gait analysis. Knee. 2008;15(6):467–72.
Harato K, Nagura T, Matsumoto H, Otani T, Toyama Y, Suda Y. A gait analysis of simulated knee flexion contracture to elucidate knee-spine syndrome. Gait Posture. 2008;28(4):687–92.
Harato K, Nagura T, Matsumoto H, Otani T, Toyama Y, Suda Y. Extension limitation in standing affects weight-bearing asymmetry after unilateral total knee arthroplasty. J Arthroplasty. 2010;25(2):225–9.
Quah C, Swamy G, Lewis J, Kendrew J, Badhe N. Fixed flexion deformity following total knee arthroplasty. A prospective study of the natural history. Knee. 2012;19(5):519–21.
Mitsuyasu H, Matsuda S, Miura H, Okazaki K, Fukagawa S, Iwamoto Y. Flexion contracture persists if the contracture is more than 15 degrees at 3 months after total knee arthroplasty. J Arthroplasty. 2011;26(4):639–43.
Bellemans J, Vandenneucker H, Victor J, Vanlauwe J. Flexion contracture in total knee arthroplasty. Clin Orthop Relat Res. 2006;452:78–82.
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Cushner, F.D. et al. (2018). Fixed Flexion Contracture. In: Tria, A., Scuderi, G., Cushner, F. (eds) Complex Cases in Total Knee Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-319-69380-4_3
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DOI: https://doi.org/10.1007/978-3-319-69380-4_3
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