A 68-year-old patient with end-stage rheumatoid arthritis of the knee requires total knee replacement. Intraoperatively, a flexion contracture of 25° is noted. The most appropriate intraoperative technique to achieve full extension is:

• A Increase the size of the tibial insert to fill the gap
• B Resection of a larger tibial bone cut posteriorly
• C Increase the posterior femoral condyle resection
• D Posterior capsule release and additional distal femoral bone resection to balance flexion gap ✓

Explanation

Flexion contracture in TKR is corrected by: (1) posterior capsulotomy/posterior osteophyte removal, and (2) additional distal femoral resection (1 mm of distal femur = 1° of extension correction). Increasing the tibial insert size fills both flexion and extension gaps equally, worsening the contracture. Increasing posterior condyle resection affects the flexion gap but not the extension gap. For contractures >15-20°, sequential releases (posterior capsule, PCL, semimembranosus) combined with additional distal femoral resection are performed.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.