The effectiveness of surgical management in knee flexion contracture in primary total knee arthroplasty

Abstract

Objective: This study aimed to compare knee flexion contracture before & after Total knee arthroplasty (TKA) post-intraoperative soft tissue release, posterior osteophytes removal & distal femoral additional cutting.

Methodology: This descriptive study was conducted in the department of orthopedic & spine Hayatabad Medical Complex, Peshawar from 1^st February 2023 to 30^th April 2025. The required sample size was 72. The inclusion criteria included all adult patients having age > 45years & having moderate to severe (Grade-II and III) flexion contracture who were undergoing primary total knee arthroplasty (TKA) and had either osteoarthritis or rheumatoid arthritis. Patients having mild flexion deformities such as Grade-I flexion contractures, and those with hip flexion contractures due to other conditions including psoriatic arthritis, haemophilic arthritis, or post-traumatic arthritis were excluded.

Results: Out of 72 patients included in our study, 41(56.9%) were women & 33(45.8%) were men. 49(68%) patients had age <65years & 23(31.9%) patients had age >65years. The mean flexion contracture in pre-op patients was 16.9 degrees & in post-op patients mean flexion contracture was 5.9 degrees at 1 month of follow up, 5.5 degree at 3 months & 5.3 degree at 6 months of follow up.

Conclusion: Knee flexion contracture is one of the debilitated conditions associated with knee OA & can be corrected in Total Knee Arthroplasty with soft tissue releases, posterior osteophytes removal & capsular release in moderate flexion contracture cases while flexion contracture >30º require additional resection of distal 2-3mm of distal femur.