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General Orthopaedics

RESIDUAL FLEXION CONTRACTURES: THE THING I LEFT BEHIND

Current Concepts in Joint Replacement (CCJR) – Winter 2012



Abstract

Flexion contractures are a common finding in an end-stage arthritic knee, occurring in up to 60% of patients undergoing total knee arthroplasty. Fixed flexion deformities may result from posterior capsular scarring, osteophyte formation, and bony impingement. It is essential to correct this deformity at the time of total knee arthroplasty, as a residual flexion contracture will result in joint overload and abnormal gait mechanics. This may translate to a slower walking velocity, shorter stride length, and pain.

This presentation will discuss a systematic way of dealing with flexion contractures to ensure that the total knee arthroplasty will achieve full extension. The surgical technique for treating fixed flexion deformity about the knee includes release of the posterior cruciate ligament, posterior capsular release, adequate distal femoral bone resection, and removal of osteophytes.

Post-operatively, attention must be divided between obtaining maximal flexion and full extension. Should a flexion contracture be noted upon the post-operative visit, additional measures should be taken to address it.