We hypothesize that tethering adhesions of the quadriceps muscle are the major pathological structures responsible for a limited range of motion in the stiff arthritic knee. Forty-two modified quadriceps muscle releases were performed on 24 patients with advanced osteoarthritis scheduled for total knee arthroplasty. The ranges of motion were documented intraoperatively both before and immediately after the release. Passive flexion improved significantly in all patients (mean, 32.4 degrees of improvement, P < .001) following a modified quadriceps release, despite any presence of osteophytes or severe deformities. These results strongly implicate adhesions of the quadriceps muscle to the underlying femur, which prevent the distal excursion of the quadriceps tendon, as the restrictive pathology preventing deep flexion in patients with osteoarthritis.

60 patient where included in this comparative study. Patients where divided into 3 groups. Group A including TKR done navigation guided in a navigation techniques experienced center. Group B including patient done navigation guided in less experienced center. Group c including patients done conventionally by an experienced surgeon. Accuracy was the primary end point. Where an independent observer was requested to comment on the post operative x-ray blindly and to measure accuracy using software. Result showed no significant difference in post operative radiological accuracy in the 3 groups.