Abstract
Background:Severe postoperative knee contractures after arthroplasty or megaprosthesis reconstruction occur rarely, but are devastating complications. Management of preoperative flexion contractures is well-described, but there is a paucity of literature for surgical treatment of postoperative contractures.A retrospective chart review was performed for a single surgeon of cases between 1996 and 2014.Results:Nine patients (5 of 66 for pediatrics; 4 of 95 for adults) underwent surgical release for severe stiffness after implantation of knee megaprosthesis. The total arc of motion was improved from a preoperative mean of 34° (range, 10° to 70°) to a postoperative mean 89° (63° to 125°). The amount of extension improved by a mean of 27° (range, -3° to +70°) and the amount of flexion improved by a mean of 28° (range, -10° to +75°).Conclusion:Surgical release of severe postoperative knee contracture is a challenging procedure, but in most cases, the amount of extension and flexion can be improved, yielding a greater total arc of motion.
Highlights
Severe postoperative flexion contractures after oncologic megaprosthesis reconstruction occur in 1-10% of cases, but are a serious complication because of the associated functional results [1, 2]
Two patients were excluded from the review due to inadequate documentation or tumor recurrence leading to amputation or death
It is crucial to discuss the risks of revision surgery in patients with megaprostheses infection, injury to nerves or vessels, and recurrent contractures
Summary
Severe postoperative knee contractures after arthroplasty or megaprosthesis reconstruction occur rarely, but are devastating complications. A retrospective chart review was performed for a single surgeon of cases between 1996 and 2014
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