Fixed flexion deformity and total knee arthroplasty.

Area of Science:

• Orthopedic Surgery
• Biomechanical Engineering

Background:

• Fixed flexion deformities are prevalent in osteoarthritic knees requiring total knee arthroplasty (TKA).
• These deformities lead to increased quadriceps force, energy expenditure, slower walking, and abnormal gait, potentially overloading the contralateral limb.
• Residual flexion contractures post-TKA are linked to diminished functional scores and poorer outcomes.

Purpose of the Study:

• To emphasize the importance of correcting fixed flexion deformities during total knee arthroplasty.
• To highlight the necessity of vigilant post-operative management to sustain correction.
• To outline surgical and non-surgical strategies for addressing and maintaining knee extension.

Main Methods:

• Surgical techniques include adequate bone resection, ligamentous releases, posterior osteophyte removal, and posterior capsular releases.
• Post-operative interventions involve focused physiotherapy, specialized continuous passive motion (CPM) devices, contralateral heel lifts, and splinting.

Main Results:

• Correction of pre-operative flexion contractures is essential for successful TKA.
• Post-operative management strategies are vital for maintaining achieved knee extension.
• A substantial percentage of flexion contractures may become permanent if not adequately addressed.

Conclusions:

• Effective management of fixed flexion deformities requires both intraoperative correction and diligent post-operative care.
• Addressing these deformities improves functional outcomes and gait mechanics after TKA.
• A multi-faceted approach combining surgical techniques and post-operative rehabilitation is recommended.