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Ilizarov treatment of severe type I fixed flexion deformities of the knee joint

Background Two types of flexion contracture of the knee can be distinguished: the one associated with joint destruction and ankylosis, and the other in which joint anatomy and mobility are preserved. In the first type, the aim of treatment is to obtain an ankylosed knee in a functional position, and in the second is the correction of deformity and preservation of movements. Treatment of severe deformities is associated with serious complications such as insufficient correction, skin necrosis, neurovascular problems, leg-length discrepancy, posterior subluxation of the tibia, fractures of the femur and the tibia, and recurrence of the deformity. The Ilizarov method offers a minimally invasive procedure that allows gradual correction of the deformity with relatively few complications. Aim This study was carried out to assess the results of gradual correction of severe type I fixed flexion deformities of the knee joint using Ilizarov external fixator. Patients and methods This study included eight patients having severe type I fixed flexion deformity of the knee joint. The preoperative fixed flexion deformity ranged from 50 to 80° (mean: 67.5±8.3°). All knees were stiff preoperatively. The cause of the deformity was juvenile rheumatoid arthritis in four (50%) patients, infection following open reduction and internal fixation of a tibial plateau fracture in three (37.5%) patients, and repeated hemarthrosis of the knee in one (12.5%) patient. Results Full correction was achieved in all patients following removal of the fixator. The follow-up period ranged from 12 to 36 months (mean: 24±4.3 months) following removal of the brace. Two (25%) patients had no recurrence of the deformity, whereas the remaining six (75%) cases had partial recurrence of the deformity that ranged from 5 to 25° (mean: 11.25±9.5°) during the follow-up period. Conclusion Ilizarov gradual distraction is an option to improve the quality of life of patients having severe type I fixed flexion deformities of the knee joint despite the high rate of partial recurrence.