Soft tissue releasing and serial casting for management of flexion contracture after primary total knee arthroplasty in a patient with hemophilia

INTRODUCTION AND IMPORTANCE: Flexion contracture following total knee arthroplasty (TKA) in patients with hemophilia is not uncommon, and this complication reduces knee range of motion and produces morbidity for the patient. This report states the success of treatment of flexion contracture after primary TKA in a patient with hemophilia; by open soft tissue contracture releasing and serial casting. CASE PRESENTATION: A 20-year-old-man presented with hemophilia type A. He had undergone TKA for treatment of secondary osteoarthritis, following chronic hemophilic arthropathy of his right knee. After surgery, the patient had progressive flexion contracture posture, until he had 45 degrees of knee flexion contracture at his 3 month follow up. The patient received open soft tissue releasing, then serial casting for 6 weeks. After this, the cast was removed and he continued with a home rehabilitation program. At 1 year follow, his knee flexion contraction contracture had improved up to 10 degrees. The patients function had recovered and he was satisfied with this treatment. CLINICAL DISCUSSION: The complications after TKA in patients with hemophilia are very challenging in there management; with flexion contracture after TKA being a common complication in patients with hemophilia. CONCLUSION: In severe flexion contracture following TKA, soft tissue releasing combined with serial casting is effective, and might be an option that is less invasive than revising all of the TKA components.