The outcome of supracondylar femoral extension osteotomy has not been extensively studied. Caviglia et al. [16] published the most extensive series with 19 patients who underwent extension osteotomies during a 30-year period. In six patients with fixed knees in flexion, the ROM was not regained. The arc of movement did not change in six, decreased in four

and increased in the three remaining patients by only 10°. Postoperative bleeding, temporary peroneal nerve paralysis, genu recurvatum and relapsed flexion deformity were the reported complications. They concluded that although this operation aligns the limb, it hardly influences the ROM. LDK378 Mortazavi et al. [17] reported the outcome of 11 trapezoid supracondylar extension osteotomy during a five-year period. The patients were followed up for an average 43.4 months after surgery. Investigators showed that all of the patients gained the ability to function more independently after the operation; they could walk, climb the stairs, bathe and use public means of transportation by themselves. The

arc of motion increased in all of the knees, which had some ROM before surgery. This was in contrast to results of previous studies on V-shaped osteotomies. Using rigid internal fixation and early physiotherapy ROM may well be a reason, but investigators proposed that the higher degrees of release of extensor mechanism SCH727965 gained by femoral shortening in trapezoid osteotomy compared with V-shaped ones could be another mechanism for this difference. This shortening may also reduce the risk of neurovascular complications. There were few minor postoperative complications and this operation seems to be safe. The trapezoid supracondylar femoral extension learn more osteotomy could be considered an alternative in the management of severe, fixed flexion contracture of the knee joint that is unresponsive

to conservative measures in patients with haemophilia. The knee is the most commonly involved joint in haemophilia and certainly the one most responsible for pain and disability. The indications for knee replacement in haemophilia are incapacitating pain and impaired function. Many of these patients have severely restricted ROM, putting increased stress on other involved joints like the ipsilateral ankle and contralateral knee. Regaining a functional ROM following knee replacement in haemophilia patients is one of the greatest challenges in reconstructive orthopaedic surgery. With severe arthrofibrosis, extensive releases, as well as debridement, are necessary to evert the patella and get adequate flexion to prepare the distal femur. In severe cases of fibrous ankylosis, making the tibial cut first can greatly facilitate exposure [15]. However, this must be done very cautiously to avoid damage to popliteal neurovascular structures which may be adherent to the posterior capsule.