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Sappey-Marinier E, Fernandez A, Shatrov J, Batailler C, Servien E, Huten D, Lustig S. Management of fixed flexion contracture in primary total knee arthroplasty: recent systematic review. SICOT J 2024; 10:11. [PMID: 38530205 DOI: 10.1051/sicotj/2024007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/12/2024] [Indexed: 03/27/2024] Open
Abstract
INTRODUCTION This study aimed to systematically review the literature and identify the surgical management strategy for fixed flexion contracture in primary total knee arthroplasty (TKA) surgery, pre-, intra-, and post-operatively. Secondary endpoints were etiologies and factors favoring flexion contracture. MATERIALS AND METHODS Searches were carried out in November 2023 in several databases (Pubmed, Scopus, Cochrane, and Google Scholar) using the following keywords: "flexion contracture AND TKA", "fixed flexion deformity AND TKA", "posterior capsular release AND TKA", "posterior capsulotomy in TKA", "distal femoral resection AND TKA". Study quality was assessed using the STROBE checklist and the Downs and Black score. Data concerning factors or strategies leading to the development or prevention of flexion contracture after TKA were extracted from the text, figures, and tables of the included references. The effect of each predictive factor on flexion contracture after TKA was recorded. RESULTS Thirty-one studies were identified to meet the inclusion and exclusion criteria. These studies described a variety of preoperative and intraoperative factors that contribute to the development or correction of postoperative flexion contracture. The only clearly identified predictor of postoperative flexion contracture was preoperative flexion contracture. Intraoperative steps described to correct flexion contracture were: soft-tissue balancing (in posterior and medial compartments), distal femoral resection, flexion of the femoral component, and posterior condylar resection. However, no study has investigated these factors in a global model. DISCUSSION This review identified various pre-, intra-, and post-operative factors predictive of post-operative flexion contracture. In practice, these factors are likely to interact, and it is therefore crucial to further investigate them in a comprehensive model to develop an algorithm for the management of flexion contracture. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Elliot Sappey-Marinier
- Département de chirurgie orthopédique et de médecine du sport, FIFA medical center of excellence, Hôpital de la Croix-Rousse, Centre Hospitalier Universitaire de Lyon, Lyon, France - Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, Lyon, France
| | - Andréa Fernandez
- Service de chirurgie Orthopédique, Centre chirurgical Emile Gallé, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Jobe Shatrov
- Département de chirurgie orthopédique et de médecine du sport, FIFA medical center of excellence, Hôpital de la Croix-Rousse, Centre Hospitalier Universitaire de Lyon, Lyon, France
| | - Cécile Batailler
- Département de chirurgie orthopédique et de médecine du sport, FIFA medical center of excellence, Hôpital de la Croix-Rousse, Centre Hospitalier Universitaire de Lyon, Lyon, France - Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, Lyon, France
| | - Elvire Servien
- Département de chirurgie orthopédique et de médecine du sport, FIFA medical center of excellence, Hôpital de la Croix-Rousse, Centre Hospitalier Universitaire de Lyon, Lyon, France - LIBM - EA 7424, Interuniversity Laboratory of Biology of Mobility, Université Claude Bernard Lyon 1, Lyon, France
| | - Denis Huten
- Chirurgie Orthopédique, Réparatrice et Traumatologique, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Sébastien Lustig
- Département de chirurgie orthopédique et de médecine du sport, FIFA medical center of excellence, Hôpital de la Croix-Rousse, Centre Hospitalier Universitaire de Lyon, Lyon, France - Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, Lyon, France
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Yeh KT, Wu WT, Lee RP, Wang CC, Wang JH, Chen IH. Long-Term Incidence of Total Knee Arthroplasty after Open Reduction and Internal Fixation of Proximal Tibial and Distal Femoral Fractures: A Nationwide Cohort Study. J Clin Med 2021; 10:jcm10235685. [PMID: 34884389 PMCID: PMC8658582 DOI: 10.3390/jcm10235685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 11/16/2022] Open
Abstract
Knee fractures often require open reduction internal fixation (ORIF) for knee function recovery. More than one fifth of patients with knee fractures subsequently develop posttraumatic arthritis, and over 5% of them need total knee arthroplasty (TKA). We conducted this nationwide retrospective cohort study using the data of 2,000,000 people in the general population who received TKA and were followed up in the 17-year period 2001-2017, through random sampling of the Taiwan National Health Insurance Research Database. We matched the ORIF and non-fracture groups by a propensity score, based on age, sex, index date of surgery, and comorbidities enrolled in CCI calculated at a 1:1 ratio. The average proportion of subjects receiving TKA after ORIF for distal femoral or proximal tibial fractures was 2.0 per 1000 person-years, which was significantly higher than that in the non-fracture group. Patients aged 20-65 years and males represented a significantly higher proportion of subjects receiving TKA after ORIF than that in the non-fracture group. The proportion of subjects receiving TKA for the 20-65-year subgroup of the ORIF group was 4%, and that for the male subgroup was 1.5%; both rates increased over the 17-year follow-up period. More aggressive intraoperative and postoperative adjuvant therapies may be necessary for these subgroups.
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Affiliation(s)
- Kuang-Ting Yeh
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan; (K.-T.Y.); (W.-T.W.)
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan;
| | - Wen-Tien Wu
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan; (K.-T.Y.); (W.-T.W.)
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan;
- Institute of Medical Science, Tzu Chi University, Hualien 970374, Taiwan;
| | - Ru-Ping Lee
- Institute of Medical Science, Tzu Chi University, Hualien 970374, Taiwan;
| | - Chen-Chie Wang
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan;
- Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231405, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan;
| | - Ing-Ho Chen
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan; (K.-T.Y.); (W.-T.W.)
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan;
- Correspondence: ; Tel.: +886-3-8561825 (ext. 14713)
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