Intraoperative Manipulation for Flexion Contracture During Total Knee Arthroplasty

Area of Science:

• Orthopedic Surgery
• Biomechanical Engineering

Background:

• Joint gap balancing is crucial for stability and motion after total knee arthroplasty (TKA).
• Achieving perfect joint gap balance during TKA can be challenging.
• Shortening of the extension gap can lead to flexion contracture, a common complication.

Purpose of the Study:

• To evaluate the tension required for intraoperative manipulation in TKA.
• To investigate the effect of intraoperative manipulation on the joint gap in cadaveric knees with induced flexion contracture.

Main Methods:

• Total knee arthroplasty (TKA) was performed on 6 cadaveric knees.
• Flexion contracture was simulated using a 4 mm thicker insert.
• Joint gap changes were measured across a range of flexion angles (0-120°) after manipulation.
• Manipulation tension was recorded.

Main Results:

• The tension required to increase the extension gap by 4 mm was 303±17 N.
• Joint gap changes after manipulation were minimal and varied across flexion angles (0.4 mm to -0.6 mm).
• Intraoperative manipulation did not significantly alter the joint gap.

Conclusions:

• Intraoperative manipulation is ineffective in resolving flexion contracture during TKA.
• For cases of flexion contracture in TKA, additional bone cutting or soft tissue release may be more appropriate than manipulation.