Total knee arthroplasty in the presence of severe flexion contracture

From 1987 to 1994, 37 total knee arthroplasties were performed in 23 patien ts with severe, fixed flexion contractures averaging 78 degrees (range, 60 degrees-100 degrees). Fourteen of the knees had flexion contractures of gre ater than 90 degrees and 7 were fused at 90 degrees. There were 19 women an d 4 men. The average age at surgery was 42 years (range, 20-57 years). The diagnoses were rheumatoid arthritis in 17 patients, juvenile rheumatoid art hritis in 3, and ankylosing spondylitis in 3. Preoperatively, all patients were knee Society Category C, with 14 being nonambulatory and 9 minimally a mbulatory. Follow-up averaged 4.3 years (range, 2-8 years). Postoperatively , patients were immobilized in extension when not in continuous passive mot ion or physical therapy. Flexion contractures were corrected to an average of 7 degrees postoperatively (range, 0 degrees-15 degrees). Are of motion i mproved from 25 degrees preoperatively to 82 degrees postoperatively. The a verage I(nee Society knee scores improved from 25 points preoperatively to 78 points postoperatively, and the functional scores improved from 0 points preoperatively to 71 points postoperatively. Five knees were manipulated u nder anesthesia postoperatively. Complications included 3 transient peronea l nerve palsies, 1 transient episode of vascular insufficiency, 6 delayed w ound healings, and 1 deep infection. There were no aseptic loosenings. We c onclude that although technically difficult, total knee arthroplasty can be performed successfully in this challenging and highly debilitated subset o f patients, giving them marked improve ment in quality of life.