Happy New Year List!
I hope everyone had a safe and happy holiday!
I have an interesting case that came to me just before Christmas – I am hoping the experience of the forum will have some ideas or perhaps someone has treated this before.
70 yr old woman presenting with knee 30deg flexion contracture after 2 knee replacements (one failed June 2013, replaced Nov 2013) I would not call this a true contracture since she can get to neutral when lying supine after massage and ROM exercise for a few minutes – but as soon as she tries to weightbear the knee immediately flexes to 30+ degree and she is on her toes. She says there is no pain but she is unable to extend – and I cannot force her into a corrected neutral position. The surgeon is allowing weightbearing activities but doesn’t want excessive weight bearing in a flexed position.
Some of her doctors and therapists feel this is a neurological flexion synergy – she is being tested more throughly for this. She reports having neck surgery in 1990 and her leg started to circumduct during swing for several months post-op. It self-corrected but she says the leg always felt different. Prior to the TKR she had no issues but immediately post-op of the first surgery she could not straighten the knee. No clonus but extreme tone. No history of CVA but this is being investigated.
I have just been asked to consult at this point since they are still doing neuro evaluations. I am just wondering what options may be possible for his situation – At this point I feel a locking knee joint with maximal correction is the only option strong enough to reduce the flexion. Any other suggestions? Which joint? I am considering a ratcheting joint – any preferences? I have called some of the contracture management orthotic providers – I may consider an Ultraflexx KAFO but I would prefer something that can be made in-house for funding reasons.
Any suggestions or ideas would be appreciated! Thanks!
Cheryl Lewis BSc(HK), CO(c)
Certified Orthotist
Owner, CK Ortho Inc
Ph 519-436-9670
