Postoperative Management

The degree of initial deformity affects the postoperative management. For the lesser deformities in which there is less anterior capsular stretching and quadriceps elongation with reasonable muscle tone, then routine care and management is all that is required. On the other hand, with a large preoperative deformity, the anterior capsular will be stretched, the quadriceps elongated, and there will be a prolonged extensor lag and subsequent tendency to develop recurrent deformity. These patients should be casted in full extension during the postoperative period. The duration of the casting will be determined by the deformity. The greater the deformity, the longer the postoperative cast. The duration of our postoperative casting will range from 3 to 28 days.

There is a tendency for the patients to assume the flexion position because of the extensor lag and muscle weakness. Physical therapy must insist that they obtain full extension passively every day in order to prevent fixation and recurrent deformity. It may be several months before patients can achieve full active extension. After discharge the patient should be carefully instructed on how to achieve full passive extension. If patients begin to develop recurrence of their flexion contracture, then a manipulation should be performed within the first few weeks. Occasionally a second manipulation will be required. However, it is very important not to allow a recurrent deformity to become fixed. The patient should always be able to maintain the degree of correction that was achieved at surgery.

in general, achieving motion in flexion in this group of patients is relatively easy and therefore attention should be carefully focused on the maintenance of full extension.

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