Preoperative percutaneous hamstring tenotomy in a patient with severe flexion deformity undergoing primary total knee replacement: Case report and literature review

Fixed flexion deformity may accompany severe knee osteoarthritis in patients with long-standing pathology. This makes it difficult to achieve complete knee extension intraoperatively during total knee replacement surgery. Various options of treatment are available including preoperative serial knee extension and casting, intraoperative additional distal femoral resection to increase extension gap, and extensive soft tissue releases. We present this technique of on-table percutaneous medial hamstring tenotomy that we found helpful in achieving complete or near-complete knee extension intraoperatively, thereby minimizing the need for extensive bone resection and soft tissue dissection. An M is a 78-year-old man who presented with inability to walk for a 2-year duration due to pain and deformity of both knees. Complete clinical evaluation revealed the diagnosis of bilateral severe knee osteoarthritis with fixed flexion deformities. Ranges of knee motion were 90 degrees -120 degrees on the right and 80 degrees -125 degrees on the left. On-table percutaneous medial hamstring tenotomy + extension exercise under spinal anesthesia was carried out first and subsequently had posterior stabilized semi-constrained knee replacement. Knee extensions of 160 degrees and 180 degrees were achieved preoperatively after tenotomy and exercise and intraoperatively following distal cuts and soft tissue releases, respectively. This technique may be additive to various attempts at achieving adequate knee extension preoperatively for successful knee replacement. May be further evaluated to assess its effectiveness or otherwise to selected patients with severe flexion contractures undergoing primary total knee replacement.