Firestone and colleagues9 evaluated their results of total knee arthroplasty in 51 knees that had flexion contractures greater than 20 degrees. A posterior cruciate-retaining device was used. The residual flexion contracture measured 3.1 degrees at the completion of the arthroplasty, 10.1 degrees at 3 months, and 7 degrees at 2 years. At 55 months postoperatively the average flexion contracture for the osteoarthritic group had improved from 25.5 degrees to 3.6 degrees, whereas the rheumatoid arthritis group improved from 28.7 degrees to 8.6 degrees. The average Knee Society Score for the osteoarthritic group was 89 as compared to 81 for the rheumatoid group. Knees that were left with greater residual flexion contracture at the completion of the arthroplasty were found to have greater residual flexion contractures at the latest review.

Some authors feel that it is not necessary to fully correct the flexion contracture at the time of surgery. McPhearson and associ-ates8 studied 29 patients who had relatively mild preoperative contractures, less than 30 degrees, but were not fully corrected to neutral following their total knee arthroplasty. They noted that the mean value of flexion contracture in the immediate postoperative period went from 10 degrees immediately postoperatively to 1 degree at 24 months. It may appear that complete intraoperative correction may not be necessary for small contractures up to 30 degrees.

Similar findings were noted by Tanzer and Miller.10 Their study included 35 knees with less than 30 degrees of preoperative flexion contracture. All the patients had residual immediate postoperative contractures of 15 degrees. Eventually they went to an average of 2.9 degrees at their last follow-up. They felt that mild fixed flexion contractures do not have to be fully corrected at the time of arthro-plasty and that intraoperative removal of excessive bone from the distal femur is not indicated. It should be emphasized that the reports are for mild contractures and probably not applicable to large contractures.

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