Name of the Procedure:

Hip Knee Ankle Foot Orthosis (HKAFO), Torsion Control, Bilateral Rotation Straps, Pelvic Band/Belt, Custom Fabricated (L2040)

Summary

This procedure involves fitting a custom-fabricated orthotic device that extends from the hip to the foot, designed to control torsion and alignment. It includes bilateral rotation straps and a pelvic band or belt to provide better stability and function for the lower limbs.

Purpose

The HKAFO with torsion control is used to manage various lower limb conditions that affect stability and alignment. The goal is to improve mobility, ensure proper alignment, reduce pain, and prevent further complications by providing external support to the affected areas.

Indications

• Patients with neuromuscular disorders such as cerebral palsy or spina bifida.
• Severe joint or skeletal deformities that affect walking.
• Post-surgical stabilization after orthopedic surgeries involving the hip, knee, ankle, or foot.
• Conditions resulting in significant muscle weakness, contractures, or spasticity.

Preparation

• Patients may need to undergo imaging tests like X-rays or MRIs for precise measurement and customization.
• No specific fasting or medication adjustments are usually required.
• A detailed medical and physical assessment to evaluate the condition and functional requirements.

Procedure Description

1. Evaluation and Measurement: A complete physical assessment and precise measurements of the lower limbs are taken.
2. Custom Fabrication: The orthotic device is custom fabricated based on the measurements and specific needs of the patient.
3. Fitting Session: Once the orthosis is ready, the patient attends a fitting session to ensure proper fit and alignment.
4. Adjustment and Training: Adjustments are made as necessary, and the patient is instructed on how to use the device, including putting it on, taking it off, and daily care.
5. Follow-up: Regular follow-up visits to monitor progress and make any necessary adjustments.

Duration

The entire process, from initial evaluation to final fitting and adjustment, may take several weeks. Individual fitting sessions usually last about 1-2 hours.

Setting

The procedure is typically performed in an outpatient orthopedic or rehabilitation clinic.

Personnel

• Orthotist: Specialized in designing and fitting orthotic devices.
• Physician/Orthopedic Specialist: Supervises the treatment plan and addresses medical concerns.
• Physical Therapist: Assists in training and rehabilitation.

Risks and Complications

• Skin irritation or pressure sores at contact points.
• Discomfort or improper fit requiring additional adjustments.
• Potential for muscle atrophy if the orthosis is over-relied upon.
• Limited range of motion if not used properly.

Benefits

• Improved stability and mobility.
• Reduced pain and discomfort.
• Prevention of further deformities or complications.
• Enhanced quality of life and independence.

Recovery

• Patients may experience mild discomfort as they adapt to the device.
• Ongoing physical therapy may be recommended.
• Regular follow-up appointments to ensure proper fit and function.
• Most patients adapt to the device within a few weeks.

Alternatives

• Non-custom orthotic devices.
• Surgical options depending on the specific condition.
• Physical therapy alone or in conjunction with less complex orthotic devices.

Patient Experience

• During fitting: Minimal discomfort, similar to trying on a new shoe.
• After fitting: Initial period of adjustment; may require patience and practice.
• Pain management: Over-the-counter pain relief if needed in the initial days.
• Comfort: Custom design aims to maximize comfort and functionality, but routine monitoring and adjustments are critical.