Combination of Fusiform Capsulectomy of the Posterior Capsule and Percutaneous Flexion Tendon Release in the Treatment of Fused Knee with Severe Flexion Contracture During Total Knee Arthroplasty-A Report of Six Cases

Overview

Journal Front Surg

Specialty General Surgery

Date 2022 Aug 29

PMID 36034350

Authors

Qun-Qun Chen

Min-Cong He

Zheng Cao

Xiang-Peng Kong

Hai-Bin Wang

Wei Chai

Affiliations

Soon will be listed here.

Abstract

Purpose: This clinical research aims to assess the safety and efficacy of a combination of fusiform capsulectomy of the posterior capsule and percutaneous flexion tendon release in the treatment of a fused knee with severe flexion contracture during total knee arthroplasty (TKA).

Methods: A retrospective analysis was performed in three patients (six knees) who had preoperative severe bony fused flexion contracture (>80°) prior to TKA and received a combination of fusiform capsulectomy of posterior capsule and percutaneous flexion tendon release during TKA between January 2016 and December 2019. The range of motion (ROM), knee functional score, postoperative complications, and radiographic results were evaluated.

Result: Three patients (six knees) were enrolled in this study. The mean duration of follow-up was 42.83 ± 15.77 months. The postoperative knee ROM was 100.0 (76.0, 102.75) (< 0.01). The knee society score (KSS) clinical score increased from a preoperative 30.0 (25.0, 36.0) to a postoperative 64.0 (65.0, 78.0) (< 0.01), and the KSS function score increased from a preoperative 0.0 (0.0, 30.0) to a postoperative 55.0 (40.0, 55.0) (< 0.01). No implant loosening, infection, neurovascular complications, or revision were recorded in the cohort until the last follow-up.

Conclusion: The technique of a combination of fusiform capsulectomy of the posterior capsule and percutaneous flexion tendon release is an effective and safe method during primary TKA for a fused knee with severe flexion contracture.

References

Masuda S, Miyazawa S, Yuya K, Kamatski Y, Tomohito H, Yoshiki O . Posteromedial vertical capsulotomy selectively increases the extension gap in posterior stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2019; 28(5):1419-1424. DOI: 10.1007/s00167-019-05511-5. View

Koh I, Chang C, Kang Y, Seong S, Kim T . Incidence, predictors, and effects of residual flexion contracture on clinical outcomes of total knee arthroplasty. J Arthroplasty. 2012; 28(4):585-90. DOI: 10.1016/j.arth.2012.07.014. View

Lu H, Mow C, Lin J . Total knee arthroplasty in the presence of severe flexion contracture: a report of 37 cases. J Arthroplasty. 1999; 14(7):775-80. DOI: 10.1016/s0883-5403(99)90024-4. View

Kim S, Lim J, Jung H, Lee H . Influence of soft tissue balancing and distal femoral resection on flexion contracture in navigated total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2016; 25(11):3501-3507. DOI: 10.1007/s00167-016-4269-9. View

Kim Y . Total knee arthroplasty for tuberculous arthritis. J Bone Joint Surg Am. 1988; 70(9):1322-30. View

Matsui Y, Minoda Y, Fumiaki I, Nakagawa S, Okajima Y, Kobayashi A . Intraoperative Manipulation for Flexion Contracture During Total Knee Arthroplasty. Orthopedics. 2016; 39(6):e1070-e1074. DOI: 10.3928/01477447-20160421-04. View

Patwardhan S, Shah K, Shyam A, Sancheti P . Assessment of clinical outcome of percutaneous needle quadriceps tenotomy in the treatment of congenital knee dislocation. Int Orthop. 2015; 39(8):1587-92. DOI: 10.1007/s00264-015-2806-7. View

Chai W, Chen Q, Zhang Z, Shi L, Yan C, Guo R . Correcting severe flexion contracture with fusiform capsulectomy of posterior capsule during total knee arthroplasty. Int Orthop. 2020; 45(6):1463-1468. DOI: 10.1007/s00264-020-04792-7. View

Liu H, Wen H, Hu Y, Yu H, Pan X . Percutaneous quadriceps tendon pie-crusting release of extension contracture of the knee. Orthop Traumatol Surg Res. 2014; 100(3):333-5. DOI: 10.1016/j.otsr.2013.12.023. View

10.

Kovalak E, Can A, Stegemann N, Ovul Erdogan A, Erdogan F . Total knee arthroplasty after osseous ankylosis of the knee joint. Acta Orthop Traumatol Turc. 2015; 49(5):503-7. DOI: 10.3944/AOTT.2015.14.0304. View

11.

Taylor D, Connor J, Church C, Lennon N, Henley J, Niiler T . The effectiveness of posterior knee capsulotomies and knee extension osteotomies in crouched gait in children with cerebral palsy. J Pediatr Orthop B. 2016; 25(6):543-50. DOI: 10.1097/BPB.0000000000000370. View

12.

Mihalko W, Whiteside L . Bone resection and ligament treatment for flexion contracture in knee arthroplasty. Clin Orthop Relat Res. 2003; (406):141-7. DOI: 10.1097/01.blo.0000030512.43495.74. View

13.

Rajgopal A, Ahuja N, Dolai B . Total knee arthroplasty in stiff and ankylosed knees. J Arthroplasty. 2005; 20(5):585-90. DOI: 10.1016/j.arth.2005.04.002. View

14.

Kim Y, Kim J, Cho S . Total knee arthroplasty after spontaneous osseous ankylosis and takedown of formal knee fusion. J Arthroplasty. 2000; 15(4):453-60. DOI: 10.1054/arth.2000.4640. View

15.

An V, Scholes C, Fritsch B . Factors affecting the incidence and management of fixed flexion deformity in total knee arthroplasty: A systematic review. Knee. 2018; 25(3):352-359. DOI: 10.1016/j.knee.2018.03.008. View

16.

Bellemans J, Vandenneucker H, Victor J, Vanlauwe J . Flexion contracture in total knee arthroplasty. Clin Orthop Relat Res. 2006; 452:78-82. DOI: 10.1097/01.blo.0000238791.36725.c5. View