- See:
TKR Menu
- Discussion:
- soft tissue component is most frequently a result of of contracture of
posterior capsule, but
gastrocnemius, hamstrings, and
PCL are also frequently involved;
-
preoperative considerations:
- some surgeons recommend that flexion contractures should be corrected as musch as possible before surgery with serial wedging casts;
- in the study by
A. J. Smith et al, there was no benefit to patellar resurfacing;
- in 22/73 knees (30.1%) with and 18/86 knees (20.9%) without
patellar resurfacing there was some degree of anterior knee
pain (p = 0.183);
- a significant association between knee flexion contracture and
anterior knee pain was observed in those knees with patellar
resurfacing (p = 0.006).
-
intra-operative considerations:
- flexion contracture can usually be corrected at the time of surgery can be managed by judicious resection of bone from the femur and the tibia & stripping of posterior joint
capsule &
gastrocnemius origins from the distal femur;
- after resection of the posterior femoral condyles, flex the knee and have the assistant lift up on the distal femur;
- carefully reflect the
posterior capsule off the posterior femur with a perioteal elevator;
- this may include the origins of the medial and lateral heads of gastrocnemius muscles;
- in moderately severe contractures, consider removing the PCL using a
posteriorly stabilized implant;
- if there is difficulty visualizing plateau surface or if cruciate ligament is contracted (as occurs flexion-varus or flexion
valgus deformities), then cruciate resection is needed;
- inability to obtain full extension intraoperatively should not necessarily be corrected with increased bone resection, although attention should be paid to
posterior capsular release & posterior femoral osteophyte excision;
-
pitfalls:
- way not to release a fixed flexion deformity is to resect large amount of bone from the distal femur;
- if this is done, a very large
flexion space is formed, and the knee may become unstable in flexion;
V-Y quadricepsplasty in total knee arthroplasty.
The management of fixed flexion contractures during total knee arthroplasty.
