Fixed Flexion Contracture

  • Fred D. CushnerEmail author
  • Andrew A. Freiberg
  • Tiffany N. Castillo
  • Jared S. Preston
  • Dexter K. Bateman
  • Bertrand W. Parcells
  • Alfred J. Tria


Total knee arthroplasty has become a very common procedure over the last decade. Patients are being treated earlier, and the severe deformities seen in previous decade are encountered less frequently. Despite this, there are occasions where the patient presents with a significant fixed deformity. A stepwise approach is required to safely deal with these severe deformities. Failure to do so may lead to skin compromise and further complicate the surgery. Once the arthrotomy is performed, in a stepwise fashion, tight structures need to be released to enable good surgical exposure. Quadriceps snip and an early lateral release are two techniques that can improve exposure. The bone cuts are also important, and often additional distal bone is resected to allow for full extension. A post-capsule release is also often required to enable achievement of full extension. Caution is needed, and patients need to be counseled when there is a severe flexion contracture as well as valgus deformity, since this deformity can be associated with a postoperative foot drop.


Contracture Deformity Quadriceps snip Lateral release Stiff 


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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Fred D. Cushner
    • 1
    Email author
  • Andrew A. Freiberg
    • 2
  • Tiffany N. Castillo
    • 2
  • Jared S. Preston
    • 3
  • Dexter K. Bateman
    • 4
  • Bertrand W. Parcells
    • 5
  • Alfred J. Tria
    • 6
  1. 1.North Shore-Long Island Jewish Medical GroupNew YorkUSA
  2. 2.Department of Orthopaedic SurgeryMassachusetts General Hospital, Harvard Medical SchoolBostonUSA
  3. 3.Department of OrthopedicsRobert Wood Johnson University HospitalNew BrunswickUSA
  4. 4.Department of Orthopaedic SurgerySaint Peter’s University HospitalNew BrunswickUSA
  5. 5.Department of OrthopedicsRutgers – Robert Wood Johnson University HospitalNew BrunswickUSA
  6. 6.Orthopedic Center of New JerseySomersetUSA

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