Releasing fixed flexion contractures during total knee arthroplasty has significant risks that increase with increasing deformity. The most serious ones include nerve and vascular injury. When recognized the knee should be immediately flexed and allowed to resume part of the preoperative deformity. Clayton reported that 2 of 20 patients with rheumatoid arthritis who had significant preopera-tive flexion contractures developed a peroneal nerve palsy.5 Other soft tissue problems include poor wound healing, recurrent deformity, ligament instability, and residual laxity in flexion.
The possibility of posterior subluxation from instability in flexion is a mechanical problem that should be recognized intra-operatively and corrected with appropriate bone resections or prosthetic choice. if the imbalance persists, then a total condylar iii style prosthesis should be selected to prevent subluxation.
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