Name of the Procedure:

Custom Fabricated Knee Ankle Foot Orthosis (KAFO) with Stance Control (HCPCS Code: L2005)

Summary

A Knee Ankle Foot Orthosis (KAFO) is a medical device that supports and stabilizes the knee, ankle, and foot. This custom-fabricated orthosis uses automatic locking mechanisms and swing phase release to help individuals with significant lower extremity weakness or instability stand and walk more normally.

Purpose

The KAFO is designed to assist individuals who have difficulty controlling their lower limbs due to medical conditions such as spinal cord injury, stroke, multiple sclerosis, or other neurological or musculoskeletal disorders. The primary goals are to improve mobility, enhance gait stability, reduce energy expenditure while walking, and prevent joint deformities.

Indications

• Conditions like spinal cord injury, stroke, multiple sclerosis, or cerebral palsy that result in lower limb weakness or paralysis.
• Significant instability or weakness in the knee, ankle, or foot.
• Patients who require both stance phase control (locking during weight-bearing) and swing phase release (unlocking for stepping).

Preparation

• A thorough clinical evaluation, including gait analysis, joint range of motion, and muscle strength assessment.
• Imaging studies if needed to assess the underlying condition.
• No specific preparation like fasting or medication adjustments is typically required for the fitting process.

Procedure Description

1. Assessment and Casting: The orthotist performs a detailed assessment and takes a cast or 3D scan of the patient's lower limb to ensure a proper fit.
2. Fabrication: The KAFO is custom-fabricated from materials such as metal, plastic, or carbon fiber, tailored to the patient's specific needs.
3. Fitting and Adjustment: The patient returns for fitting, where the orthotist adjusts the KAFO to ensure comfort and proper function.
4. Training: The patient undergoes training to learn how to use the KAFO effectively for walking and daily activities.

Tools and equipment include casting materials, 3D scanners, lightweight durable materials for fabrication, and various adjustment tools. Local anesthesia or sedation is generally not necessary, as the procedure is non-invasive.

Duration

The entire process, from assessment to final fitting, typically spans several weeks, with each appointment ranging from 30 minutes to a few hours.

Setting

The procedures are usually performed in an outpatient orthopedic or rehabilitation clinic.

Personnel

• Certified Orthotist.
• Physical Therapist (for gait training).
• Physician (for evaluation and prescription).

Risks and Complications

• Skin irritation or pressure sores.
• Joint discomfort or pain.
• Orthosis malfunction or failure.
• Risk of falling if the device is not used correctly.

Benefits

• Improved mobility and gait stability.
• Reduced risk of fall-related injuries.
• Enhanced quality of life through increased independence.
• Benefits may be realized immediately after proper adjustment and training.

Recovery

• Post-procedure care involves regular follow-up appointments to adjust the KAFO as needed.
• Expected recovery from initial discomfort or adaptation is within weeks.
• Patients may have activity restrictions and will need to attend physical therapy sessions.

Alternatives

• Ankle Foot Orthosis (AFO), which provides support only to the ankle and foot.
• Functional Electrical Stimulation (FES) devices to stimulate muscle activity.
• Surgical interventions in severe cases (e.g., tendon transfers or joint fusions).
• Each alternative has its own pros and cons related to efficacy, invasiveness, and suitability for different conditions.

Patient Experience

• Patients might initially feel discomfort or awkwardness while adapting to the KAFO.
• Pain management involves adjusting the fit and using padding.
• Overall increased confidence in mobility and independence is expected after adaptation.