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Clinical Course of Residual Flexion Contracture After Total Knee Arthroplasty in Patients With Haemophilic
Seyed Mohammad Javad Mortazavi1,2, Babak Haghpanah3, Mohammadhasan Kaseb1
1Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Aim:
This study aims to evaluate the natural course and resolution of flexion contracture following total knee arthroplasty (TKA) in individuals with haemophilic arthropathy.
Methods:
Between April 2010 and April 2014, 65 patients with haemophilic arthropathy and preoperative flexion contracture underwent TKA at a single institution. Patients were followed for 56 months (range 48-72 months). Range of motion, Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and SF-36 scores were assessed at 3, 6, 12, 24, and 56 months. An intensive physiotherapy protocol included supervised sessions twice weekly for 3 months.
Results:
Mean age was 34.2 ± 8.3 years. Preoperative flexion contracture of 27.6 ± 11.2° improved to 14.3 ± 6.2° postoperatively, then to 6.9 ± 3.3° at 3 months, 4.4 ± 2.2° at 6 months, 2.2 ± 3.2° at 12 months, and 2.1 ± 3.1° at 56 months (p < 0.001). Patients with clinically significant flexion contracture > 5° decreased from 53 postoperatively (81.5%) to 10 at 3 months (15.4%), 6 at 12 months (9.2%), and 5 at 56 months (7.7%). Multivariate analysis identified immediate postoperative flexion contracture > 15° (OR 8.3, p = 0.002) and age > 40 years (OR 4.1, p = 0.019) as independent predictors of residual contracture > 5° at final follow-up. Final flexion contracture ≤ 5° was achieved in 90.8% at 12 months and maintained in 92.3% at 56 months.
Conclusions:
Residual flexion contracture after TKA in haemophilic arthropathy demonstrates significant spontaneous improvement, with 92% correction by 12 months, sustained through 56-month follow-up. This pattern contrasts with commonly reported outcomes in osteoarthritic populations. In haemophilic patients with excellent rehabilitation compliance, surgeons can be confident that mild residual contracture is likely to improve over time.
