Complex reconstructions in total knee arthroplasty. Anterior and posterior soft-tissue contracture

Arthritic knee conditions leading to deformities of the anterior and posterior aspects of the knee joint require careful preoperative planning. Constrained condylar implants should be available in the operating room if asymmetrical soft-tissue laxity is produced as the deformities are corrected. The operative approach must be aggressive, and soft-tissue releases often have to be quite extensive to correct severe extension and flexion contractures. Soft tissues should never be released transversely but always in a subperiosteal fashion from the underlying bone. In this fashion, the implant will block open these soft-tissue cavities symmetrically and knee stability will be restored. Asymmetric soft-tissue imbalance from varus or valgus deformity must be corrected in combination with anterior and posterior soft-tissue management. Rehabilitation of these complex knees requires individualization and careful progression of motion and unsupported ambulation. Care must be taken to prevent wound problems, and rapid intervention is necessary should they occur. If the technical and rehabilitative aspects of these severe knee deformities are carried out successfully, excellent function is possible in this disabled group of patients.