Stretching exercises, extension key gain after treatment of fixed flexion contractures

December 10, 2021

1 min read

Source / Disclosures


Lombardi AV Jr. Preoperative flexion contracture: technical advice. Presented at: Current Concepts in Joint Replacement Winter Meeting; from December 8 to 11, 2021; Orlando (hybrid reunion).

Disclosures: Lombardi claims to have been a consultant for Zimmer Biomet; receive royalties from Zimmer Biomet and InnoMed; Zimmer Biomet research support; participation in SPR Therapeutics, Joint Development Corporation, Elute Inc., VuMedi, Prescribe Fit and Parvizi Surgical Innovation; be a member of the editorial board of Arthroplasty Journal, Journal of Bone and Joint Surgery, Clinical orthopedics and related research, Journal of the American Academy of Orthopedic Surgeons, Journal of Orthopedics and Trauma, International surgical technology and Knee; and a board member of Operation Walk USA, The Hip Society, Central Ohio Orthopedic Management Company and Current Concepts in Joint Replacement.

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

Adolph V. Lombardi Jr., MD, The noted preoperative evaluation of a patient with flexion contracture should include an evaluation of the patient’s gait, passive and active range of motion, and radiographic evaluation.

Adolphe V. Lombardi

“I think you need to discuss with the patient that he has flexion contracture [and] that you’re going to do whatever you can to fix that, ”Lombardi said in his presentation.

According to Lombardi, surgeons must consider bone, soft tissue and prosthetic aspects to perform total knee replacement surgery that allows full extension in patients with fixed flexion deformity greater than 25 °.

“We must think of an increase in the degree of constraint in the real severe [flexion contractures], and postoperative passive stretching is important, ”Lombardi said.

Postoperatively, Lombardi noted that patients are typically placed in a fully extended knee immobilizer or plastic slit for about 24 hours.

“We’re going to discuss that we spend a lot of time sitting down during the day watching TV or reading a book, etc., and when they do that they have to put their leg on an ottoman. or another chair and focus on extending, ”Lombardi said.

He advises patients to place a bolster under their ankles when lying in bed and to avoid using a recliner that places the knee at 20 ° to 30 ° of flexion. To achieve full knee extension, patients can place a shoe lift under the contralateral limb, place the seat of a stationary bike in the high position, and use an extension brace, according to Lombardi.

“It’s a slow stretch that seems to work better than trying to get this patient back to the operating room and manipulate him,” Lombardi noted.

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