Name of the Procedure:

Hip Knee Ankle Foot Orthosis (HKAFO) with Torsion Control, Custom Fabricated
Common Names: Custom HKAFO, Torsion Control Orthosis
Medical Term: HCPCS L2080

Summary

This procedure involves the fabrication and fitting of a custom-made orthosis for the hip, knee, ankle, and foot. It includes a torsion control mechanism and components to stabilize and support the hip joint, pelvic area, and lower limbs.

Purpose

Medical Conditions:

• Muscular dystrophy
• Cerebral palsy
• Spinal cord injuries
• Other neuromuscular or musculoskeletal disorders

Goals:

• Improve limb alignment and function
• Enhance mobility and gait
• Prevent deformities and joint contractures
• Reduce pain and increase comfort

Indications

• Severe weakness or instability in the hip, knee, ankle, or foot
• Chronic orthopedic issues affecting lower limb function
• Neurological conditions impacting gait and limb control
• Recurrent joint dislocations or subluxations

Preparation

Pre-Procedure Instructions:

• No specific fasting required
• Continue prescribed medications unless directed otherwise by the healthcare provider

Diagnostic Tests:

• X-rays or MRI scans to assess limb structure and alignment
• Gait analysis and functional assessment

Procedure Description

1. Initial Consultation: Patient evaluation and measurements taken.
2. Casting/Scanning: Impressions or 3D scans of the lower limbs and pelvic area.
3. Fabrication: Custom orthosis created in a specialized lab using durable materials.
4. Fitting Session: Patient tries on the orthosis; adjustments are made for optimal fit.
5. Instruction: Patient and caregiver are educated on use and maintenance of the device.

Tools and Equipment:

• Casting materials (e.g., plaster, fiberglass)
• 3D scanner (optional)
• Orthosis fabrication tools and components

Anesthesia:

• Generally not required, procedure is non-invasive.

Duration

• Initial consultation: 1-2 hours
• Fabrication: 2-4 weeks (varies)
• Fitting and adjustments: 1-2 hours

Setting

• Orthopedic clinic
• Rehabilitation center
• Prosthetics and orthotics facility

Personnel

• Orthotist
• Physical therapist (for gait training)
• Physician (for initial consultation and follow-up)

Risks and Complications

Common Risks:

• Skin irritation or pressure sores
• Discomfort during initial adjustment period

Rare Risks:

• Allergic reactions to materials
• Mechanical failure of orthosis components

Management:

• Regular follow-up appointments for adjustments
• Skin care instructions to prevent irritation

Benefits

• Improved stability and balance
• Enhanced walking efficiency
• Pain reduction
• Greater independence and mobility in daily activities

Recovery

Post-Procedure Care:

• Regular wear as per the prescribed schedule
• Skin inspection and hygiene
• Follow-up visits for adjustments

Recovery Time:

• Immediate use post-fitting, adapt over several weeks
• Gradual increase in wearing time as tolerated

Restrictions:

• Avoid high-impact activities initially
• Regular check-ups to monitor progress

Alternatives

Treatment Options:

• Physical therapy
• Other types of orthotic devices (e.g., ankle-foot orthosis, knee orthosis)
• Surgical interventions (in severe cases)

Pros and Cons:

• Physical Therapy: Less invasive, but may not provide the required support.
• Other Orthotic Devices: May not offer comprehensive limb support.
• Surgical Interventions: More invasive with longer recovery, but potentially more permanent solutions.

Patient Experience

During Procedure:

• Generally painless fitting process
• May experience mild discomfort during adjustments

After Procedure:

• Initial adjustment period may include mild discomfort or skin irritation
• Gradual improvement in comfort and mobility with regular use
• Pain management through over-the-counter pain relief if needed

By adhering to the provided guidelines and following up as directed, patients can achieve significant improvements in mobility and quality of life.