Tuesday, June 18, 2024

Responses; amputee knee flexion contracture.

Hello,

Thanks to all for your responses. Below are a list of responses I received.

I will recommend that the patient be fitted with a custom KO with a BK socket

serving as the distal component and a dynamic (ultraflex) knee joint. Some of

the responses alluded to the fact that getting reimbursed may be a problem,

but that’s another subject.

The patients residual limb is 4.75 inches and EMPI does not recommend their

device for residual limbs less than 5.5 inches.

It should also be noted that the patient has been fitted with a preparatory

prosthesis but limited progress is being made. A couple of responses made

suggestions concerning the proper alignment of the prosthesis. It will be

reevaluated with these suggestions in mind. The patient is ambulatory and

wearing the prosthesis approx. 4 hrs/ per day at present. The doctor and the

physical therapist are looking for a brace to aid in the reduction of the

contracture and maintain ROM gains at night.

Original post:

A physician has asked that we evaluate a patient, (BKA) in a local skilled

nursing facility, for an orthosis to improve 30-35 degree knee flexion

contracture. The patient is approx. 6 months post-op. Upon seeing the patient

I immediately think of a custom molded brace with essentially a BK socket and

dynamic (i.e., ultraflex) joint. The problem; there is quite a bit of

osteoarthritis and the patient complains of knee pain with mild stretching. I

am a bit skeptical that the orthosis will be tolerated and/or reduce the

contracture significantly, but in my opinion it is worth a shot.

If you have a preferred, cost effective strategy or opinion on the treatment

suggested in a case like this I would appreciate any feedback.

Thank you,

Eddie White, CP

Beacon P&O

Raleigh, NC

Responses:

Check out a prosthoses made by Empi specifically for this

problem.

**********

We used a posterior turn buckle attached to a bk socket used thick pelite or

plastizote liner to make like a hinged thigh lacer type prosthesis & pylon

with lightfoot so pt can ambulate. Used a poly a shell low density with a

pelite front with 2 11/2 inch velcro straps, time and patience it what it

takes

**********

I’ve made a device as you described through Ultra Flex. The tension on the

extension springs can be adjusted to a mild stretch, and increased as

tolerated. Good luck getting paid!

*********

EMPI has a BK contracture brace that I used once with good sucess.

**********

EMPI Corp makes a Bk Contracture Splint.

***********

If the patient is ambulatory, fitting with a prosthesis aligned with a short

heel lever arm will be much more effective in reducing the contracture than

any orthosis. If the patient is not ambulatory, why put the patient through

the pain and the health care system to the expense!! A 30-35 degree knee

flexion contracture does not necessarily prevent ambulation with a

prosthesis. Does the patient also have a hip flexion contracture?

**********

I use the Monodos (static, not dynamic joint), Becker Orthopedic. It’s

pretty slick: the joint only goes in one direction, unless released.

There’s probably more info on the Becker web site.

**********

EMPI have an Orthotic system called the Advance Dynamic ROM. There is a

version for the BK amputee. The principle is that it applies gentle low load

force to the joint acting upon connective tissue. The force is adjustable

and is a coiled spring so that there is no peak drop off. The brace is

adjustable and so is universal size. I t does however come in L&R, its not a

hassle to use it for both. Price is Xy, you can however reuse in a clinical

situation. The contact details are below:

**********

I have successfully treated numerous patients as you describe. In addition to

the usual regiment of PT stretching and exercise and clear instructions on

need

to maintain extended position when not wearing a prosthesis, I fit the patient

with either a temporary (USMC Gold unit or similar) or a modular prosthesis.

The

alignment is such that the patient cannot achieve heel contact during foot

flat

stage of gait or while standing. This exerts a continuous slight extension

moment to the knee. The more the patient walks the more active stretching is

achieved. As the patient is able to achieve heel contact I re-align (extend

the

socket). This process is continued, often having to transfer the socket back

to

a neutral jig when the mechanical end of range is reached, until no further

range

is noted. Slow process, which may be problematic from a funding angle.

Hope this helps.

*********

Empi makes an off-the-shelf product for trans-tib amputees. Tension is

adjustable. It does not work well on short limbs.

*********

Could you please post responses. Your situation has always be a problem.

********

The FLO-TECH-TOR portion of the APOPPS by FLO-TECH can reduce this type of

contracture fairly effectively with a slight modification. When ordering

state you want it for a flexion contracture and the modification will be made

to your specifications.

The best part about this type of reduction is the patient (if able) can

ambulate without changing sockets. The FLO-TECH-TOR remains on the patient

while the pylon and foot are removed after ambulation.

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