Department of Orthopaedic Surgery and Traumatology, Bichat-Claude-Bernard Teaching Hospital center, Paris-Diderot University, 46, rue Henri-Huchard, 75877 Paris cedex 18, France.
Orthop Traumatol Surg Res. 2011 Feb;97(1):28-33. doi: 10.1016/j.otsr.2010.06.016. Epub 2010 Dec 16.
The objective of this study is to investigate the results of total knee arthroplasty (TKA) in traumatic osteoarthritis cases with flexion restriction and to describe the technical details of their management. A multicentre series comprising 40 patients with limitation of flexion less than or equal to 90° was selected from 152 cases of post-traumatic knee arthritis with malunion. We hypothesized that the arthroplasty complication rate would be higher than in other etiologies of limitation of flexion and would require specific management strategies.
In 23 cases, intra-articular malunion was present, in 15 cases extra-articular, and in two cases combined. The mean flexion was 72±23°, extension was 6±6°, and total range of motion (ROM) 66±23°. Eight cases of flexion restriction were severe (flexion<50°), six intermediate (flexion, 50-70°) and 26 moderate. In 14 cases, the anterior tibial tuberosity was osteotomized (43% intra-articular malunion and 6% extra-articular malunion). Five simultaneous realignment osteotomies were necessary. In severe cases of limitation of flexion, five extensive quadriceps releases were associated.
Four mobilizations under general anesthesia were performed. In the cases of severe limitation of flexion, we noted three avulsions of the patellar tendon, two cases of cutaneous necrosis, one of which was associated with deep infection, and another case of deep infection. In the cases of moderate limitation of flexion, we noted one case of nonunion of the tibial tuberosity and two cases were revised for loosening, one aseptic and the other septic. With a mean follow-up of 5±4 years, the mean flexion was 99.4°±23 for a gain of 26.7±20°. The final flexion and the gain in flexion were correlated with preoperative flexion (r=0.62 and r=-0.47, respectively). The final amplitude was 99±27° for a gain of 33±21°. The flexion gains were comparable for both types of malunion, whether they were intra- or extra-articular.
Arthroplasty provided a substantial gain in flexion. Osteotomy of the tibial tuberosity and the realignment osteotomies should be performed if necessary, with no risk of compromising the result. Superior gains can be sought in severe cases of limitation of flexion by releasing the extensor apparatus, in absence of cutaneous scar tissue retractions and recent infection.
Level 4. Noncomparative retrospective study.
本研究旨在探讨膝关节屈曲受限创伤性骨关节炎全膝关节置换术（TKA）的结果，并描述其管理的技术细节。从 152 例对线不良的创伤后膝关节关节炎病例中选择了 40 例屈曲受限小于或等于 90°的多中心系列病例。我们假设，关节置换术的并发症发生率将高于其他屈曲受限的病因，并需要特定的管理策略。
23 例存在关节内对线不良，15 例存在关节外对线不良，2 例存在混合对线不良。平均屈曲度为 72±23°，伸展度为 6±6°，总活动度（ROM）为 66±23°。8 例屈曲受限严重（屈曲<50°），6 例中度（屈曲，50-70°），26 例轻度。14 例胫骨结节切开（43%关节内对线不良和 6%关节外对线不良）。需要进行 5 次同时的对线矫正截骨术。在严重的屈曲受限病例中，我们还联合进行了 5 次广泛的股四头肌松解术。
在全麻下进行了 4 次关节松动术。在严重的屈曲受限病例中，我们注意到 3 例髌腱撕脱、2 例皮肤坏死，其中 1 例合并深部感染，另 1 例合并深部感染。在中度屈曲受限病例中，我们注意到 1 例胫骨结节骨不连和 2 例松动病例，1 例无菌性松动，另 1 例感染性松动。平均随访 5±4 年后，平均屈曲度为 99.4°±23°，增加了 26.7±20°。最终的屈曲度和屈曲增加度与术前屈曲度呈正相关（r=0.62 和 r=-0.47）。最终的活动度为 99±27°，增加了 33±21°。无论是关节内还是关节外对线不良，关节置换术都能获得相当的屈曲增加度。如果需要，应进行胫骨结节截骨和对线矫正截骨术，且不会影响手术效果。在严重的屈曲受限病例中，如果没有皮肤瘢痕组织回缩和近期感染，可以通过松解伸肌装置来获得更大的屈曲增加度。
4 级。非对照回顾性研究。
