Strategy of total knee arthroplasty in the patients with severe flexion contracture

Abstract

Objective To investigate the clinical characteristics of severe flexion cnntracture and discuss the techniques in correction of severe flexion contractures in total knee arthroplasty. Methods The present study included 8 patients (3 males, 5 females) with knee contractures greater than 60° who underwent total knee arthroplasty. Of these 8 patients, four were osteoarthritis, one was femoral malunion after trauma, one was tuberculosis of the knee, one was rheumatoid arthritis and one was ankylosing spondylitis. The average age of the patients was 63.3 years (range, 42-73 years). Anterior midline incision and medial parapatellar retinacular approach were used in all but one patient, in whom the original incision was used due to femoral malunion after trauma. Rotating hinged prostheses were applied for all patients. The patella was not replaced in all patients. Radiological imaging and HSS score (Hospital for Special Surgery knee score) were used to evaluate the surgical outcomes. Results The average follow-up period was 39.9 months (range, 9-80 months). The radiology indicated that there were no prostheses loosing, the patellofemoral tracking were normal. Before surgery, the average flexion contracture was 96.5° (range, 70°-105°), and the average HSS scores was 10 (range, 3-15), no motion of joint was observed. After surgery, the average residual flexion contractures was 8° (range, 5°-15°), the average HSS scores increased to 85 (range, 74-93), and the average motion of joint improved to 90° (range, 80°-110°). At follow-up, one patient had patellofemoral joint symptom after surgery. No infection and loosing were occurred. Conclusion After sufficient release of the contracted soft tissues, appropriate management of the femoral bone resection combined with the usage of rotating hinged prostheses, satisfactory outcome could be obtained in patients with severe flexion contractures who underwent total knee arthroplasty. Key words: Knee joint; Arthroplasty,replacement,knee; Range of motion,articular