Flexion contractures: A stepwise algorithmic approach

Flexion contractures of the knee result from a variety of perpetual insults in end-stage arthritis. They cause inefficient ambulation and pose a number of challenges for the surgeon who is performing the total knee arthroplasty. The most important aspect of the procedure is establishing the posterior recess of the knee. We provide a grading system for flexion contracture, as well as an algorithm for correcting the deformity in the operating room. Surgery is the best time to obtain full extension, so the surgeon should not leave the operating room if full extension has not been achieved.