Supracondylar Extension Osteotomy for the Treatment of Fixed Knee Flexion Contracture in Hemophiliac Patients

Abstract

Articular contractures in patients with hemophilia are the result of recurrent intra-articular and intramuscular hemorrhage [1, 2]. Since the knee is the joint that is most frequently affected in hemophiliac patients, flexion contracture of the knee is a frequent pathology in these individuals [2]. The muscular imbalance caused by repetitive hemarthrosis sometimes results in fixed flexion contracture in the hemophilic knee [3]. The extension deficiency not only leads to pressure peaks and progressive arthropathy, but it also increases the rate of hemarthrosis in the same joint and in the joints of other extremities [4]. On the other hand, this fixed flexion contracture of the knee results in secondary contractures in the same limb, including equinus deformity of the ankle, and flexion contracture of the hip and lumbar hyperlordosis. In addition, fixed flexion contracture of the knee intervenes with the patient’s normal walking. In severe unilateral cases, the patient has to use an assistance device for walking, and in bilateral cases patients may become wheelchair bound. Therefore, flexion deformity of the knee should be corrected as soon as possible. This aim can be achieved conservatively by physiotherapy or mechanical corrective devices such as a wedging cast, and extension de-subluxation devices [2, 5, 6], or if these measures fail, operatively by different surgical methods [3, 4, 6–9].