The Role of Flexion Contracture on Outcomes in Primary Total Knee Arthroplasty

Ritter, Merrill A.; Lutgring, Joseph D.; Davis, Kenneth; Berend, Michael E.; Pierson, Jeffery L.; Meneghini, R. Michael

doi:10.1016/j.arth.2006.11.009

Cited by 188 publications

(178 citation statements)

References 9 publications

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“…While some studies have reported that the condition does not improve postoperatively [17][18][19][20], other investigators have shown gradual recovery with conservative management [19,[21][22][23][24]. It has been well established that the presence of a preoperative flexion contracture increases the risk of developing a postoperative flexion contracture [5]. However, the incidence and natural history of a newly developed flexion contracture in patients after total knee arthroplasty has not been extensively studied [4,21].…”

Section: Discussionmentioning

confidence: 95%

“…The incidence of fixed flexion deformity after TKA ranges from 1.4 to 17 % [ [1][2][3][4][5][6]16]. While some studies have reported that the condition does not improve postoperatively [17][18][19][20], other investigators have shown gradual recovery with conservative management [19,[21][22][23][24].…”

Section: Discussionmentioning

confidence: 99%

“…Ritter et al demonstrated that in the presence of a preoperative flexion contracture of 5°or more, patients are 2.9 times more likely to develop a postoperative flexion contracture [5]. In addition, flexion contractures can be seen postoperatively in patients without a preoperative flexion contracture [5]. However, the natural history of this unanticipated postoperative feature is unknown.…”

Section: Introductionmentioning

confidence: 96%

“…Flexion contracture is an unwanted complication of total knee arthroplasty (TKA), occurring in 1.4 to 17 % of patients [1][2][3][4][5][6]. Patients with a postoperative flexion contracture have an increased prevalence of anterior knee pain, probably secondary to an abnormal distribution of forces across the prosthetic components with an increased load in the posterior aspect of the tibial plateau and the patellofemoral joint [7].…”

Section: Introductionmentioning

confidence: 99%

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The natural history of a newly developed flexion contracture following primary total knee arthroplasty

Anania¹,

Abdel

Lee

et al. 2013

International Orthopaedics (SICOT)

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Purpose We investigated the incidence, natural history, and functional consequences of a newly developed flexion contracture after total knee arthroplasty (TKA). Methods Forty patients with full knee extension preoperatively who developed a postoperative flexion contracture were match-paired 1:2 with 80 patients who had full extension. The incidence of a newly developed flexion contracture, ROM, and Knee Society scores (KSS) at six weeks, four months, and one year were analysed. Results The incidence of a new flexion contracture at sixweeks was 14 %, but diminished to 5 % and 0.3 % at fourmonths and one year, respectively. One year after surgery, there was no difference in the KSS (p=0.5). Conclusions This study showed that the majority of patients who developed a new flexion contracture after TKA have full knee extension one year postoperatively. Moreover, knee extension and KSS at one year are equivalent to those patients who did not developed a flexion contracture.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The natural history of a newly developed flexion contracture following primary total knee arthroplasty

Anania¹,

Abdel

Lee

et al. 2013

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

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“…Ritter et al reviewed 5,622 TKAs in patients with OA, RA and osteonecrosis, using 22 different knee prostheses performed by five surgeons. He demonstrated that the greater the postoperative FFD the higher the likelihood of a poor outcome [11]. By comparison our study has a homogenous cohort (OA attending for primary surgery with the same implant) assessed by a dedicated research assistant.…”

Section: Discussionmentioning

confidence: 99%

Patients with fixed flexion deformity after total knee arthroplasty do just as well as those without: ten-year prospective data

Cheng

Ridley

Bird

et al. 2009

International Orthopaedics (SICOT)

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Range of motion (ROM) is an important outcome variable after total knee arthroplasty (TKA). This may be compounded by a pre-existing fixed flexion deformity (FFD). We therefore examined the long-term outcomes of patients with a flexion deformity undergoing TKA compared to those without a preoperative fixed flexion deformity. Participants who had undergone TKA at our centre between 1989 and 2002 were examined preoperatively, one, five and ten years after TKA (Kinemax PS; Howmedica, Rutherford, NJ, USA). Examining those with a preoperative FFD of greater than ten degrees with complete ten year follow-up data revealed 77 individuals. Seventy seven age, sex and body mass index matched patients were identified and the effect of TKA on indices of knee function (fixed flexion, maximum flexion, total ROM and Knee Society score (KSS) in both groups were analysed using repeated measures ANOVA. A significant difference between the groups with respect to fixed flexion (p<0.001), total ROM (p=0.001) and KSS (p<0.001) was observed between baseline and year one suggesting that those with a preoperative FFD improved more than those without. A significant difference with regard to fixed flexion was also observed between years one to five (p=0.001) and just failed to reach statistical significance between five to ten years (p=0.052) between the groups. This study demonstrates that patients with a preoperative fixed flexion deformity show continued improvement in their fixed flexion up to ten years post arthroplasty and have similar outcomes to those with no preoperative fixed flexion.

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Knee biomechanics early after knee replacement surgery predict abnormal gait patterns 12 months postoperatively

Levinger

Menz

Morrow

et al. 2011

Journal Orthopaedic Research

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An abnormal flexor moment pattern is often evident following total knee replacement (TKR) surgery. We investigated whether such a pattern at 12 months post-surgery could be predicted using biomechanical gait measures assessed before surgery and at 4 months post-surgery. Thirty two TKR patients were evaluated and classified as normal (biphasic pattern) or abnormal (flexor moment pattern) at each time point. Biomechanical parameters collected before surgery and at 4 months post-surgery were then explored for their ability to predict gait patterns at 12 months post-surgery. The gait pattern at 4 months was significantly associated with the 12 month post-surgery gait pattern, with over half of those with a flexor moment pattern at 4 months retaining this pattern at 12 months. Discriminant function analysis indicated that peak knee flexion during early stance, peak knee extension, and peak knee extension moment at 4 months post-surgery were independent predictors of the gait pattern at 12 months. Thus, an abnormal knee flexor moment pattern at 12 months post-surgery can be predicted by biomechanical analysis 4 months after surgery. Therefore, interventions aimed at improving active extension may need to be implemented early after surgery to restore a normal gait pattern.

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The Role of Flexion Contracture on Outcomes in Primary Total Knee Arthroplasty

Cited by 188 publications

References 9 publications

The natural history of a newly developed flexion contracture following primary total knee arthroplasty

The natural history of a newly developed flexion contracture following primary total knee arthroplasty

Patients with fixed flexion deformity after total knee arthroplasty do just as well as those without: ten-year prospective data

Knee biomechanics early after knee replacement surgery predict abnormal gait patterns 12 months postoperatively

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