Fixed flexion deformity and total knee arthroplasty

E. P. Su


Fixed flexion deformities are common in osteoarthritic knees that are indicated for total knee arthroplasty. The lack of full extension at the knee results in a greater force of quadriceps contracture and energy expenditure. It also results in slower walking velocity and abnormal gait mechanics, overloading the contralateral limb. Residual flexion contractures after TKA have been associated with poorer functional scores and outcomes.

Although some flexion contractures may resolve with time after surgery, a substantial percentage will become permanent. Therefore, it is essential to correct fixed flexion deformities at the time of TKA, and be vigilant in the post-operative course to maintain the correction.

Surgical techniques to address pre-operative flexion contractures include: adequate bone resection, ligament releases, removal of posterior osteophytes, and posterior capsular releases. Post-operatively, extension can be maintained with focused physiotherapy, a specially modified continuous passive motion machine, a contralateral heel lift, and splinting.


  • No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

    This paper is based on a study which was presented at the Winter 2011 Current Concepts in Joint Replacement meeting in Orlando, Florida, 7th – 10th December.

  • Received July 27, 2012.
  • Accepted July 27, 2012.
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