What Can I Do About Knee Buckling?

In rheumatoid arthritis, flexion contractures of the bilateral knee joints are common. When flexion exceeds 30 °, the patient has to live in a wheelchair. Therefore, for different patients: synovectomy; proximal tibia osteotomy; joint fusion; total joint replacement. The above methods are all conducive to preventing and improving flexion contractures of the knee joint, restoring and improving their self-care and working ability.

Surgical treatment of knee flexion contracture deformity

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In rheumatoid arthritis, flexion contractures of the bilateral knee joints are common. When flexion exceeds 30 °, the patient has to live in a wheelchair. Therefore, for different patients: synovectomy; proximal tibia osteotomy; joint fusion; total joint replacement. The above methods are all conducive to preventing and improving flexion contractures of the knee joint, restoring and improving their self-care and working ability.

Surgical treatment of knee flexion contracture deformity

Orthopedics / Non-traumatic joint disease surgery / Surgery treatment of rheumatoid arthritis / Surgery treatment of knee joint rheumatoid arthritis

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In rheumatoid arthritis, flexion contractures of the bilateral knee joints are common. When flexion exceeds 30 °, the patient has to live in a wheelchair. Therefore, for different patients: synovectomy; proximal tibia osteotomy; joint fusion; total joint replacement. The above methods are all conducive to preventing and improving flexion contractures of the knee joint, restoring and improving their self-care and working ability.

Surgery related anatomy.

Use spinal anesthesia or continuous epidural anesthesia. Take the prone position and perform the operation under the balloon tourniquet.

Incision

Posterolateral and posteromedial longitudinal arc incisions are available. The posterolateral incision starts from the head of the fibula and runs up the tight biceps femoris. The incision is about 10 cm long. The posteromedial incision starts from below the internal condyle of the tibia and runs along the tense medial hamstring muscle with the same length of incision.

2. Extend the severed hamstring tendon

The posterior lateral incision was used to separate the tense iliotibial bundle and the biceps femoris tendon, and the former was transected, and the latter was extended by Z-shaped extension. The posterior medial incision is used to separate the tendons of the tense sartorius, gracilis, semitendinosus, and semimembranosus, and perform Z-shaped extended cuts at different levels. At this point, you can try to straighten the affected knee. If the straightening is satisfactory, you can end the operation and prolong the suture of the severed tendon. If the deformity correction is insufficient, a posterior joint capsule incision should be performed.

3. Incision of the posterior joint capsule

Through the lateral incision, the severed biceps femoris tendon was turned up and down, and the common peroneal nerve was separated and pulled to the midline with a rubber band. The lateral head of the gastrocnemius muscle was bluntly separated and cut off at the point of hindrance behind the femoral condyle, exposing the posterolateral articular capsule. The fibrous layer of the posterolateral articular capsule was cut transversely to avoid breaking the synovium and entering the joint cavity. The fibrous layers of the medial head of the gastrocnemius muscle and the posteromedial joint capsule were treated in the same way.

At this point, the knee flexion deformity has been largely corrected. The severed tendon is extended and sutured.

4. suture incision

Loose the tourniquet, rinse the incision, stop bleeding, and suture the incision in layers.

Bandage the knee joint with an elastic bandage. If the correction of the deformity is satisfactory, only skin traction can be used; if there are more residual deformities, the tibial tuberosity can be used to fix the affected knee in the straight position. Traction was performed 3 weeks after the operation, and knee exercises were started.