Flexion contracture in total knee arthroplasty

We retrospectively evaluated a surgical algorithm for treating flexion contracture in total knee arthroplasty using a prospectively collected database of 2898 knees. We asked how many steps were required to obtain correction with increasing severity of the flexion contracture. We further wanted to know whether correction was maintained at two years after surgery, and which complications occurred in relation to the algorithm. Our algorithm consisted of four steps executed until full extension was achieved: (1) mediolateral ligament balancing with resection of all osteophytes and overresection of the distal femur by 2 mm; (2) progressive posterior capsular release and gastrocnemius release; (3) additional resection of the distal femur up to a maximum of 4 mm; (4) hamstring tenotomy. A flexion contracture between 5 degrees and 15 degrees occurred in 794 cases, between 15 degrees and 30 degrees in 95 cases, and greater than 30 degrees in 35 cases. The data suggest 98.6% of the cases with flexion contracture less than 30 degrees could be corrected with Steps 1 and 2. Even in the 35 flexion contractures greater than 30 degrees, additional resection of the distal femur and hamstring tenotomy was performed in only 28.6% and 22.9% of cases, respectively.