Intraoperative manipulation for flexion contracture during total knee arthroplasty

Area of Science:

• Orthopedic Surgery
• Biomechanical Engineering
• Reconstructive Surgery

Background:

• Joint gap unbalancing in total knee arthroplasty (TKA) is a primary cause of flexion contracture, a serious complication.
• Intraoperative manipulation is a common empirical approach to address flexion contracture during TKA.
• The efficacy of intraoperative manipulation on joint gap and contracture remains incompletely understood.

Purpose of the Study:

• To evaluate the impact of intraoperative manipulation on joint gap dimensions.
• To assess the effect of intraoperative manipulation on the resolution of postoperative flexion contracture in TKA.

Main Methods:

• A comparative study involving 136 knees undergoing TKA.
• Intraoperative manipulation was performed in 61 knees, with joint gap measurements taken at various flexion angles.
• Postoperative extension angles were radiographically measured at immediate, 3-month, and 6-month intervals for both manipulated and non-manipulated groups.

Main Results:

• Intraoperative manipulation resulted in negligible changes to joint gap dimensions across all measured flexion angles.
• No statistically significant differences were observed in postoperative extension angles between knees that underwent manipulation and those that did not.
• Both groups showed similar trends in extension angles at all postoperative follow-up points.

Conclusions:

• Intraoperative manipulation is ineffective in significantly altering joint gap or resolving postoperative flexion contracture after TKA.
• Current intraoperative manipulation techniques do not provide a reliable solution for achieving optimal joint balance.
• Further research and development of novel surgical techniques are necessary to improve TKA outcomes and prevent flexion contracture.