Name of the Procedure:

Knee Ankle Foot Orthosis (KAFO), Double Upright, Free Ankle, Solid Stirrup, Thigh and Calf Bands/Cuffs (Double Bar 'AK' Orthosis), Custom Fabricated (HCPCS L2020)

Summary

A custom-fabricated knee-ankle-foot orthosis (KAFO) is a brace designed to support the knee, ankle, and foot. This specific orthosis has double uprights (bars on each side), an ankle that remains free to move, a solid stirrup for stability, and bands/cuffs that secure around the thigh and calf.

Purpose

This orthosis helps patients with lower limb weakness or instability by providing structural support. It aims to improve mobility, alignment, and overall function while reducing pain and the risk of falls.

Indications

Patients may need this orthosis for:

• Muscle weakness or paralysis in the lower limb.
• Neurological conditions (e.g., spina bifida, cerebral palsy, multiple sclerosis).
• Post-surgical recovery.
• Severe arthritis.
• Fractures or injuries requiring immobilization and support.

Preparation

• No specific preparation required for fitting.
• A thorough clinical evaluation by an orthotist or physician.
• Measurements and moldings of the limb to ensure a custom fit.

Procedure Description

1. Clinical assessment to determine the orthosis design.
2. Custom measurements or casting of the patient’s leg.
3. Fabrication of the orthosis using materials like metal, plastic, and foam.
4. Fitting and adjustments to ensure comfort and effectiveness.
5. Patient education on how to wear and care for the orthosis.

Duration

• Initial assessment and measurement: 1-2 hours.
• Fabrication: 1-2 weeks.
• Fitting and adjustment: 1-2 hours.

Setting

• Typically performed in an orthotic clinic or specialist center.

Personnel

• Orthotist (specialist in brace fitting)
• Physician (for initial prescription and assessment)
• Physical therapist (for rehabilitation guidance)

Risks and Complications

• Skin irritation or pressure sores.
• Discomfort or improper fit requiring adjustments.
• Potential for reduced muscle function if overused without therapy.

Benefits

• Enhanced stability and mobility.
• Pain relief and improved quality of life.
• Prevention of deformities and further injuries.
• Short-term benefits noticeable within days; long-term benefits with consistent use.

Recovery

• Initial adjustment period for wearing the brace.
• Follow-up visits for adjustments.
• Physical therapy may be recommended to strengthen the limb and improve gait.

Alternatives

• Ankle-foot orthosis (AFO) for less severe conditions.
• Surgical interventions for structural corrections.
• Physical therapy and exercise programs alone.

Patient Experience

• During fitting: mild discomfort from casting or measurements.
• After fitting: adjustment period to get used to the brace.
• Possible minor discomfort or inconvenience initially.
• Improved mobility and less pain over time.
• Pain management with padding and regular adjustments for comfort.