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Knee disarticulation and hip release for severe lower extremity contractures
Cara Cipriano1, Mary Ann E Keenan
1Neuro-Orthopaedics Service, Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
Clinical Orthopaedics and Related Research
|May 22, 2007
Summary
Surgical hip release and knee disarticulation effectively treated severe lower extremity contractures in nonambulatory adults. This surgery improved patient positioning, hygiene, and quality of life, enabling wheelchair use and resolving pain.
Area of Science:
- Orthopedic Surgery
- Reconstructive Surgery
- Neurology
Background:
- Severe lower extremity contractures significantly impair patient mobility, hygiene, and quality of life.
- Management of rigid, spastic lower extremity contractures presents surgical challenges with limited published outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of surgical hip release and knee disarticulation for severe lower extremity contractures in nonambulatory adults.
- To assess improvements in patient function, hygiene, positioning, and pain following surgical intervention.
Main Methods:
- Eight nonambulatory adult patients with severe, rigid lower extremity contractures (≥90 degrees hip/knee flexion) underwent hip release and knee disarticulation on 14 extremities.
- Patients had underlying neurologic disorders with spasticity, and surgery was indicated due to functional limitations and reduced quality of life.
Main Results:
- Average preoperative flexion contractures were 106° at the hips and 139° at the knees.
- Postoperative hip flexion contracture averaged 6°, with no serious complications or recurrence.
- All patients experienced universal improvements in positioning and hygiene, enabling wheelchair mobility.
Conclusions:
- Surgical hip release and knee disarticulation is a viable and effective treatment for severe lower extremity contractures in neurologically impaired adults.
- The procedure significantly enhances patient quality of life by improving functional outcomes, enabling mobility, and resolving pain.
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