Soft tissue releasing and serial casting for management of flexion contracture after primary total knee arthroplasty in a patient with hemophilia

Abstract

Introduction and importance Flexion contracture following total knee arthroplasty (TKA) in patients with hemophilia is not uncommon, and this complication reduces knee range of motion and produces morbidity for the patient. This report states the success of treatment of flexion contracture after primary TKA in a patient with hemophilia; by open soft tissue contracture releasing and serial casting. Case presentation A 20-year-old-man presented with hemophilia type A. He had undergone TKA for treatment of secondary osteoarthritis, following chronic hemophilic arthropathy of his right knee. After surgery, the patient had progressive flexion contracture posture, until he had 45 degrees of knee flexion contracture at his 3 month follow up. The patient received open soft tissue releasing, then serial casting for 6 weeks. After this, the cast was removed and he continued with a home rehabilitation program. At 1 year follow, his knee flexion contraction contracture had improved up to 10 degrees. The patients function had recovered and he was satisfied with this treatment. Clinical discussion The complications after TKA in patients with hemophilia are very challenging in there management; with flexion contracture after TKA being a common complication in patients with hemophilia. Conclusion In severe flexion contracture following TKA, soft tissue releasing combined with serial casting is effective, and might be an option that is less invasive than revising all of the TKA components.

Complications and Implant Survival of Total Knee Arthroplasty in People with Hemophilia

“…In 2021, Liawrungrueang et al reported the successful treatment of flexion contracture after primary TKA in a 20-year-old-man with hemophilia A by open soft tissue contracture releasing and serial casting [ 36 ]. Table 2 summarizes the complications of TKA in PWH.…”

Flexor tenotomies for the treatment of bilateral wrist contracture after traumatic brain injury: A case report

“…Mainstay treatment for flexion contractures is nonoperative management with passive stretching through serial casting, splints, and physical therapy. While these nonoperative measures have been successful in pediatric patients with congenital deformities and in some cases after soft tissue injury, they have not been well examined in other populations 12–14 . Surgical treatment for contracture following TBI, although potentially beneficial, has not been addressed thoroughly in the literature 15 …”

“…While these nonoperative measures have been successful in pediatric patients with congenital deformities and in some cases after soft tissue injury, they have not been well examined in other populations. [12][13][14] Surgical treatment for contracture following TBI, although potentially beneficial, has not been addressed thoroughly in the literature. 15 A few studies have reported on surgical treatments for flexor tendon contracture, especially in the knee.…”