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Custom knee device, physical therapy an effective combination after femoral lengthening
Recently published data indicated use of a custom knee device along with specialized physical therapy offered an effective, economical and noninvasive treatment option for patients following internal femoral lengthening.
Researchers retrospectively evaluated 100 patients (121 limbs) treated for femoral lengthening with the Intramedullary Skeletal Kinetic Distractor (ISKD) as well as underwent mid-diaphyseal osteotomy. After postoperative day 1, patients were mobilized and given permission for a weight bearing of 50 lbs., slowly reaching full weight bearing after two or four cortices were healed completely. In an inpatient setting, the patients attended physical therapy daily. After being discharged, patients had physical therapy in an outpatient setting five times a week. Once a knee flexion contracture of at least 10° was observed, a custom knee device was applied.
The researchers obtained patients’ demographics, limb-shortening etiology and lengthening parameters. Additionally, outcome measures such as knee range of motion — which was measured with a standard goniometer with the patient in the supine position with 10° to 15° of hip flexion — were recorded.
Results showed after ISKD femoral lengthening, 27 of the 121 limbs had knee flexion contractures. Bilateral knee flexion contractures were found in three patients. In 16 patients, femoral lengthening was secondary to congenital shortening, four patients due to short stature, two patients due to posttraumatic shortening and one patient was due to shortening from childhood poliomyelitis.
Mean lengthening was 5.4 cm. The custom knee device was applied for an average of 7.9 weeks, and two knees did not reach full resolution knee flexion contracture. There was an association between limb lengthening amount and knee contracture, according to the researchers.
Patients with lengthening of 5 cm to 8 cm had an average flexion contracture of 43°, whereas an average flexion contracture of 30° was observed in patients with lengthening of 4.9 cm or less. Additional soft tissue release was required in seven of the 27 limbs, according to the researchers. ‒ by Monica Jaramillo
Disclosures: Bhave reports he is a paid consultant for DJO Global, Ongoing Care Solutions and OrthoSensor and receives royalties and has patents with Guardian. Please see the full study for a list of all other author’s relevant financial disclosures.