Severe Bilateral Flexion Contractures after Total Knee Arthroplasty: A Palliative Revision Arthroplasty Restoring Basic Function

Introduction: Flexion contracture following total knee arthroplasty (TKA) is an uncommon but debilitating complication that can result in profound functional limitation and reduced quality of life. Severe deformities after TKA are particularly challenging to manage, especially when associated with prolonged immobilization and extensor mechanism disruption. In selected elderly patients with significant disability, the treatment goal may shift from anatomical reconstruction to restoration of basic function. To the best of our knowledge, severe bilateral flexion contractures approaching 75° following primary TKA have rarely been reported. This report highlights the concept of palliative revision arthroplasty aimed at improving function and quality of life rather than restoring normal knee biomechanics. Case Report: A 78-year-old male presented with severe bilateral knee flexion contractures (75°) and inability to ambulate 8 months after bilateral primary TKA performed elsewhere. The post-operative course was complicated by patellar dislocation on the left side requiring revision surgery and prolonged immobilization. At presentation, the patient was wheelchair-bound with marked muscle atrophy and severe limitations in daily activities. Radiographs demonstrated well-fixed implants without loosening, and infection and neurological etiologies were excluded from the study. The patient underwent staged bilateral revision TKA using rotating hinged prostheses. Surgical correction required extensive synovectomy, posterior capsular release, distal femoral resection, gastrocnemius origin release, and extensor mechanism realignment with vastus medialis obliquus advancement. At 3 months following the second revision procedure, the flexion contractures improved from 75° preoperatively to 10° bilaterally. The patient regained the ability to stand and ambulate with assistance and reported marked improvement in comfort and ability to sleep. Conclusion: Severe flexion contracture after TKA is rare but profoundly disabling. In selected patients with severe deformity and prolonged immobility, revision arthroplasty may be performed with palliative functional goals, prioritizing restoration of standing ability and basic ambulation rather than complete biomechanical reconstruction. Extensive soft-tissue releases combined with hinged implants can provide meaningful functional recovery and improved quality of life.