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December 10, 2021
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Stretching exercises, gaining extension key after treatment of fixed flexion contractures

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Patients with a fixed flexion contracture should be carefully evaluated and educated on stretching exercises and how to gain extension, according to a presenter at the Current Concepts of Joint Replacement Winter Meeting.

Perspective from Nicholas A. Bedard, MD

Adolph V. Lombardi Jr., MD, said preoperative evaluation of a patient with a flexion contracture should include assessment of the patient’s ambulation, passive and active range of motion and a radiographic evaluation.

Adolph V. Lombardi

“I think you need to discuss with the patient that they have a flexion contracture [and] that you are going to do everything you can do to correct that,” Lombardi said.

Surgeons need to think about bony, soft tissue and prosthetic considerations to accomplish a total knee arthroplasty that achieves full extension among patients with a fixed flexion deformity greater than 25°, according to Lombardi.

“You have to think about an increase in the degree of constraint in the real severe [flexion contractures], and postop passive stretching is important,” Lombardi said.

Postoperatively, patients are usually placed in a knee immobilizer or plastic splint at full extension for about 24 hours, Lombardi said.

“We’re going to discuss the fact that we spend a lot of time sitting during the day and watching television or reading a book, etc., and that, when they are doing that, they need to put their leg up on an ottoman or another chair and focus on extension,” Lombardi said.

He advises patients to place a bolster under their ankle when lying in bed and to avoid using a recliner, which places the knee in 20° to 30° of flexion. To gain full extension of the knee, patients can place a shoe lift under the contralateral limb, place the seat of a stationary bicycle in the high position and use extension bracing, according to Lombardi.

“It’s a slow stretch that seems to work better than trying to take this patient back to the OR and manipulate them,” he said.