Introduction Definition flexion contracture 10-15 degrees flexion < 90 degrees Incidence 1.3%-12% Risk factors preoperative factors poor preoperative ROM most important factor patella baja increased medical comorbidities low pain tolerance technical factors overstuffing patellofemoral joint malrotation tight flexion and/or extension gaps joint line elevation excessive tightening of extensor mechanism during closure closure in flexion (as opposed to extension) may limit this complication tight PCL in cruciate-retaining prosthesis postoperative factors delayed rehabilitation infection HO hamstring spasms usually resolves within 6 months Presentation Symptoms difficulty kneeling Physical exam check preoperative ROM from records Imaging Radiographs rule out prosthesis malposition or alignment CT scan rule out prosthesis malposition or alignment Studies Serum labs ESR/CRP must rule-out infection Treatment Nonoperative manipulation under anesthesia indications flexion <90 degrees within first 12 weeks of operation (timing is controversial) over aggressive manipulation fracture extensor mechanism disruption contraindications stiffness >3 months postoperatively manipulation associated with greater risk and lower benefit Operative arthroscopic lysis of adhesions with manipulation under anesthesia indications persistent late stiffness revision total knee arthroplasty indications identifiable technical cause for stiffness
Revision TKR Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Authors: Orthobullets Team TKA - Parapatellar Approach Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Authors: Derek Bernstein Stephen Incavo TKA - Varus Knee with Anterior Referencing and Gap Balancing Technique Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Authors: Derek Bernstein Stephen Incavo
QUESTIONS 1 of 9 1 2 3 4 5 6 7 8 9 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ11.250) A 64-year-old male underwent the procedure shown in Figures A and B 7 weeks ago. He complains of difficulty with going down stairs. He reports no pain and denies constitutional symptoms. On examination the incision is well healed and no effusion is present. He is able to perform a straight leg raise with 5/5 strength. He lacks 2 degrees of terminal extension and has 80 degrees of active flexion. The knee is stable to varus and valgus stress testing at extension and mid flexion. His C-reactive protein and erythrocyte sedimentation rate are normal. What is the next most appropriate step in management? Review Topic QID: 3673 FIGURES: A B 1 Manipulation under anesthesia 85% (2044/2398) 2 Cortisone injection followed by physical therapy for quadriceps strengthening 2% (56/2398) 3 Aspiration to evaluate for septic arthritis 2% (38/2398) 4 Revise femoral component by downsizing A-P diameter 6% (144/2398) 5 Revise tibial component and add 5 degrees of posterior tibial slope 4% (107/2398) ML 2 Select Answer to see Preferred Response PREFERRED RESPONSE 1