Surgical Procedure for Flexion Contracture and Recurvatum in Total Knee Arthroplasty

A specific protocol for dealing with flexion contracture and recurvatum in total knee arthroplasty surgery was evaluated. In cases of flexion contracture, this protocol included choosing the larger femoral size when the femur was between sizes to make the flexion space smaller and to allow overresection of the tibial surface to correct the flexion contracture. In all cases, bone resection was done first, osteophytes were resected next, and ligaments were balanced after the trials were in place. Extra bone was resected from the distal femur to correct residual flexion contracture only if ligament balancing failed to correct the deformity. In cases of recurvatum, the smaller femoral size was chosen to enlarge the flexion space, allowing underresection of the tibia to stabilize the knee in extension. The cutting guides were positioned so that 3 to 5 mm less than the distal thickness of the femoral component was removed to stabilize the knee in extension. To evaluate this protocol, a computerized database was used to review records of 530 patients (552 knees) who had flexion contracture (542 knees) or recurvatum (10 knees) before surgery. Ligament release and correction of varus or valgus contracture corrected flexion contracture to less than 3° in 515 knees (95%). Sixteen knees (3%) had release of the posterior capsule to correct residual flexion contracture, and 11 knees (2%) required overresection of the distal femoral surface to achieve correction of flexion contracture. By 1 year the flexion contracture was 2° ± 1°. In the knees with preoperative recurvatum, none had residual recurvatum at the conclusion of surgery, and none had recurrent deformity. None of the knees required a hinge or a stabilized component with a highly conforming central post.