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Stepwise Surgical Correction of Fixed Flexion Deformity in Total Knee Arthroplasty: Functional Outcomes
Shravan Kumar Peddamadyam1, Aravind Kumar Bodla1, Shravani Jagadabi1
1Department of Orthopaedics, Nizams Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India.
Introduction:
Fixed flexion deformity (FFD) in advanced knee osteoarthritis (OA) presents a significant intraoperative challenge during total knee arthroplasty (TKA), primarily due to soft-tissue contractures and bony deformities that impede optimal alignment and functional recovery. This study aims to evaluate the effectiveness of intraoperative correction of FFD and to assess short-term functional outcomes following TKA.
Materials And Methods:
In this prospective observational study, 55 knees (mean age 57.28 ± 9.35 years) with Grade 4 OA and FFD underwent TKA between March 2022 and March 2024. Correction was achieved using graded posterior soft-tissue releases and distal femoral resections. Functional outcomes were assessed at 6 months using the Knee Society Score (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).
Results:
The mean pre-operative FFD of 23.04° was significantly corrected intraoperatively. At 6 months, the mean KSS improved from 51.29 to 81.93, whereas the WOMAC decreased from 80.93 to 20.1 (P < 0.001). Full knee extension was achieved in all cases, with excellent/good outcomes in 89.08% of patients. No significant differences were observed between primary and secondary OA groups.
Conclusion:
Systematic intraoperative correction of FFD using algorithm-based soft-tissue release and distal femoral resection during TKA gave reliable deformity correction, excellent functional recovery, and high patient satisfaction in this study. However, longer-term studies with larger sample sizes are needed to confirm the durability of these outcomes.