Fixed flexion deformity and total knee arthroplasty

The Bone & Joint Journal (Impact Factor: 3.31). 11/2012; 94-B(11_Supple_A):112-115. DOI: 10.1302/0301-620X.94B11.30512


Fixed flexion deformities are common in osteoarthritic knees that are indicated for total knee arthroplasty. The lack of full extension at the knee results in a greater force of quadriceps contracture and energy expenditure. It also results in slower walking velocity and abnormal gait mechanics, overloading the contralateral limb. Residual flexion contractures after TKA have been associated with poorer functional scores and outcomes. Although some flexion contractures may resolve with time after surgery, a substantial percentage will become permanent. Therefore, it is essential to correct fixed flexion deformities at the time of TKA, and be vigilant in the post-operative course to maintain the correction. Surgical techniques to address pre-operative flexion contractures include: adequate bone resection, ligament releases, removal of posterior osteophytes, and posterior capsular releases. Post-operatively, extension can be maintained with focused physiotherapy, a specially modified continuous passive motion machine, a contralateral heel lift, and splinting.

2 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Fixed flexion deformity is a common accompaniment in advanced arthritis of the knee joint. Complete correction of fixed flexion deformity at the time of surgery remains challenging and technically demanding. The purpose of our study was to assess the result of total knee replacement using a preset algorithm to assess the effect that a preoperative flexion deformity has on postoperative correction. Methods: Sixty patients (85 knees) with advanced arthritis and a flexion deformity underwent total knee arthroplasty. The patients were divided in two groups. Group 1 consisted of all patients with a flexion deformity up to 30°. Group 2 consisted of all patients with a flexion deformity of greater than 30°. All surgeries were performed using a posterior cruciate substituting implant. An attempt to achieve maximal or complete correction of the flexion deformity was made at the time of surgery. Results: The flexion deformity was fully corrected in 69 knees. In knees with a flexion deformity up to 30°, the mean improvement was from 15.5° to 0.54°. In knees with a flexion deformity of more than 30°, mean improvement was from 46° to 3°. Conclusions: Correction of the flexion deformity was significantly different (P<0.0001) between the two groups (mild to moderate, ≤30° and severe, >30°). Total knee replacement was very successful in correcting the flexion deformity. Our hypothesis that the amount of preoperative deformity adversely affects the postoperative result proved to be correct.
    No preview · Article · Nov 2013 · Current Orthopaedic Practice
  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine inter-rater reliability in identifying a knee extension lag using the sitting active and prone passive lag test (SAPLT). 56 patients with a diagnosis of knee pain were randomly assigned and independently examined by two physical therapists at a time, to determine the presence of an active or a passive extension lag at the knee. An active lag was determined by the inability of the erectly seated subject to actively extend the involved knee in maximal dorsiflexion of the ankle to the same level as the normal knee held in maximal extension and ankle in maximal dorsiflexion, as seen by the levels of the toes. A passive lag was determined by placing the subject prone with the knees just past the edge of the table and determining the high position of the heel in a fully resting extension position compared to the heel on the normal side. For the sitting active lag test, the inter-rater reliability was 'good' (Kappa 0.792, SE of kappa 0.115, 95% confidence interval). For the prone passive lag test, the inter-rater reliability was 'good' (Kappa 0.636, SE of kappa 0.136, 95% confidence interval). The SAPLT may be incorporated as a simple yet effective test to determine the presence of a knee extension lag. It identifies the type of restraint, active, passive or both, and is suggestive of the most appropriate management.
    No preview · Article · Apr 2014 · Journal of bodywork and movement therapies
  • [Show abstract] [Hide abstract]
    ABSTRACT: Arthrofibrosis is a major obstacle to restoring joint function after trauma. The objective of this study was to evaluate montelukast, forskolin, and triamcinolone as possible means of prophylaxis against the formation of arthrofibrosis. Forty-eight rats underwent surgical knee trauma with post-operative immobilization in full flexion. The treatment groups were: control (CTL), oral montelukast (3.75 mg/kg/day) (MLK), intra-articular forskolin injections (0.6 mg/kg) (FSK), and intra-articular triamcinolone injections (0.68 mg/kg) (STR). Rats were sacrificed after 14 days and femorotibial contracture angles were measured with the posterior capsule intact and with the posterior capsule cut. A 0.015Nm extension moment was applied to the knee. All treatment groups had significant reductions in contracture angle compared to the control. Mean contractures with the posterior capsule intact were 32°(CTL), 20° (MLK), 22° (FSK), and 7° (STR). Contractures with the posterior capsule cut were 28° (CTL), 19° (MLK), 20° (FSK), and 5° (STR). The STR group was significantly better than FSK and MLK. Triamcinolone injections provided dramatic reductions in stiffness. Both forskolin and montelukast provided significant, though lesser, reductions in stiffness. While the triamcinolone contracture angles were significantly better, the novel treatments of forskolin and montelukast provided encouraging results and should be studied further. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res
    No preview · Article · Nov 2014 · Journal of Orthopaedic Research
Show more