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Beneficial Effects Of Dynamic Splint After Total Knee Arthroplasty

Table 2:

Study identification (authors, year, title) Objectives Methods Results Main conclusions
Finger & Willis, 2008. Dynamic splinting for knee flexion contracture following total knee arthroplasty: a case report Assess the benefits of using dynamic splinting in a 61 years old patient with contracture after total knee arthroplasty Dynamic splinting was used as a secondary intervention. Subsequently to a course of 28 physical therapy sessions (12 weeks), a Knee Extension Dynasplint (KED) was prescribed for nightly wear to increase the patient´s time at total end range knee extension. After 28 physical therapy sessions, the active range of motion in knee extension had progressed from a deficit of -20º to -12º. Once the physical therapy was finished and the KED was worn for 8 weeks (during night), the patient regained full active range of motion (AROM, from -12º to 0º). Subsequently to use the Dynasplint for two added months, the patient was discharged with full extension (AROM of 0º). This permitted the patient to avoid a manipulation under anaesthetics to reduce the postoperative contracture.
Pace, Nasreddine, Simoni, Zurakowsky & Kocher, 2016.Dynamic Splinting in Children and Adolescents With Stiffness After Knee Surgery The aim of the study was to investigate the indications and outcomes of using dynamic splinting (DS) in the paediatric population with arthrofibrotic knee. Seventy-four patients (41 males, 33 females) with postoperative diagnosis of arthrofibrosis that had not resolved with physical therapy, required the application of a DS. These patients were assessed at least 3 months’ follow-up after DS removal and the range of motion of the knee (both in flexion and extension) was measured. A total of 57 patients with flexion deficits presented median improvement of 30º in flexion (95% confidence interval, 0-90º; P<0.001) and 51 patients with extension deficits showed median improvement of 7º in extension (95% confidence interval, 0-60º, P<0.001). DS was related to range of motion (ROM) improvement in 84% and avoided the need for surgery in 58% of all 74 patients included in the study. DS is an effective method to increase knee ROM and to decrease the need for subsequent manipulation under anaesthesia/ surgical lysis of adhesions in the paediatric and adolescent patient with arthrofibrosis following an index knee surgery.
Vulcano, Markowitz, Fragomen & Rozbruch, 2016.Gradual correction of knee flexion contracture using external fixation Assess the clinical outcomes of patients with knee flexion contractures (KFC) and associated ankle equinus using gradual correction with a circular external fixator (CEF). Twenty-one patients with knee flexion contraction were treated with CEF. Seven participants were also treated for ankle equinus at the same time. All but two patients underwent an association of open or arthroscopic knee arthrolysis, distal hamstrings lengthening and gastrocsoleus release. Mean follow-up was 13 months. The mean ROM at final follow-up was -10ºextension, 64º flexion, 9º ankle dorsiflexion and 29º ankle plantar flexion. The difference between preoperative and postoperative ROMs was statistically significant (P<0,05). Gradual distraction using a CEF is a safe and effective method in the management of KFC and coexisting ankle equinus. The postoperative correction with braces should be maintained for at least 1-3 months.
Hwang, Moon, Kim & Park, 2016.Total Knee Arthroplasty for Severe Flexion Contracture in Rheumatoid Arthritis Knees Analyse through a case report a total knee arthroplasty for severe flexion knee contractures in a patient with rheumatoid arthritis (RA). This report describes a 26-year-old female patient diagnosed with RA 10 years ago. She had chronic joint pain, severe flexion contracture, valgus deformity and limited ROM in both knees. She underwent a total knee arthroplasty (TKA) and serial casting and physical therapy to restore stable joint movement and correct knee joint deformity. After TKA and serial casting and physical therapy, the patient’s pain was effectively relieved and she could walk after surgery. During the follow-up period, full extension was achieved in both knees and the thigh quadriceps muscles ang hip and trunk muscles rapidly gained strength. A TKA was performed to correct severe knee flexion contractures without a preoperative application of serial casting and physical therapy, that only have been implemented postoperatively to correct the remaining flexion contracture.
Bhave, Shabtai, Ong, Standard, Paley & Herzenberg, 2015.Custom Knee Device for Knee Contractures After Internal Femoral Lengthening This study had 3 goals: to determine the incidence of knee flexion contracture in patients after femoral lengthening with the Intramedullary Skeletal Kinetic Distractor (ISKD), to report on the management of knee flexion contracture with a customized knee device and to determine factors that predict the development of knee flexion contractures in these patients. It was a retrospective study that included 23 patients (27 limbs) who underwent femoral lengthening with an internal device for the treatment of limb length discrepancy. All participants had a knee flexion contracture range from 10º to 90º during the lengthening process and were treated with a custom knee device and physical therapy. The mean amount of lengthening was 5,4cm. Following an average of 3,8 weeks of use of the custom knee device, only 2 of 27 limb (7,5%) had not achieved full resolution of the flexion contracture. The average final extension was 1,4º and only 7 of 27 limbs (26%) required extra soft tissue release. The custom knee device is a low-cost and effective technique for treating knee flexion contracture subsequent to lengthening with an internal device.
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