Sappey-Marinier Elliot, Fernandez Andréa, Shatrov Jobe, Batailler Cécile, Servien Elvire, Huten Denis, Lustig Sébastien
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.
Service de chirurgie Orthopédique, Centre chirurgical Emile Gallé, Centre Hospitalier Universitaire de Nancy, Nancy, France.
SICOT J. 2024;10:11. doi: 10.1051/sicotj/2024007. Epub 2024 Mar 26.
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.
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.
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.
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.
IV.
本研究旨在系统回顾文献，确定初次全膝关节置换术（TKA）手术中固定性屈曲挛缩术前、术中和术后的手术管理策略。次要终点为导致屈曲挛缩的病因和因素。
2023年11月在多个数据库（PubMed、Scopus、Cochrane和谷歌学术）中进行检索，使用以下关键词：“屈曲挛缩与TKA”、“固定性屈曲畸形与TKA”、“后关节囊松解与TKA”、“TKA中的后关节囊切开术”、“股骨远端切除术与TKA”。使用STROBE清单和唐斯-布莱克评分评估研究质量。从纳入参考文献的文本、图表中提取有关TKA后导致或预防屈曲挛缩的因素或策略的数据。记录每个预测因素对TKA后屈曲挛缩的影响。
确定有31项研究符合纳入和排除标准。这些研究描述了多种术前和术中因素，这些因素有助于术后屈曲挛缩的发生或纠正。术后屈曲挛缩唯一明确的预测因素是术前屈曲挛缩。描述的纠正屈曲挛缩的术中步骤包括：软组织平衡（在后侧和内侧间室）、股骨远端切除术、股骨假体屈曲和后髁切除术。然而，没有研究在整体模型中研究这些因素。
本综述确定了多种术前、术中和术后预测术后屈曲挛缩的因素。在实践中，这些因素可能相互作用，因此至关重要的是在综合模型中进一步研究它们，以制定屈曲挛缩管理算法。
IV级。
