Radical Posterior Release for Severe Flexion Contracture of Knee Following Total Knee Arthroplasty: A Case Report.

Abstract

Fixed flexion deformity (FFD) following total knee arthroplasty occurs in approximately 4% of patients undergoing primary total knee arthroplasty. Treatment modalities for significant disabling FFD post-arthroplasty encompass manipulation under anesthesia, osteophyte resection, soft tissue release, peroneal nerve decompression, and revision knee replacement. A 43-year-old lady, a known case of rheumatoid arthritis and psoriasis, presented with fixed flexion contracture of the left knee following total knee arthroplasty. The range of motion (ROM) at the left knee was 60°-110°. With the help of the plastic surgery team, the patient underwent an extensive posterior soft tissue release. Intra-operatively, the ROM achieved was 5°-110°. After 3 weeks, the patient was mobilized with full weight bearing with a knee brace. But unfortunately, there was a gradual recurrence of deformity at 3-month follow-up in spite of adequate and aggressive rehabilitation. Patients with FFD for more than 2 years following a total knee arthroplasty may not benefit from extensive radical posterior soft tissue release. Revision knee replacement may be the better option.