High-intensity mechanical therapy for loss of knee extension for worker's compensation and non-compensation patients

<p>Abstract</p> <p>Background</p> <p>Knee flexion contractures have been associated with increased pain and a reduced ability to perform activities of daily living. Contractures can be treated either surgically or conservatively, but these treatment options may not be as successful with worker's compensation patients. The purposes of retrospective review were to 1) determine the efficacy of using adjunctive high-intensity stretch (HIS) mechanical therapy to treat flexion contractures, and 2) compare the results between groups of worker's compensation and non-compensation patients.</p> <p>Methods</p> <p>Fifty-six patients (19 women, 37 men, age = 51.5 ± 17.0 years) with flexion contractures were treated with HIS mechanical therapy as an adjunct to outpatient physical therapy. Mechanical therapy was only prescribed for those patients whose motion had reached a plateau when treated with physical therapy alone. Patients were asked to perform six, 10-minute bouts of end-range stretching per day with the ERMI Knee Extensionater^(r)(ERMI, Inc., Atlanta, GA). Passive knee extension was recorded during the postoperative visit that mechanical therapy was prescribed, 3 months after beginning mechanical therapy, and at the most recent follow-up. We used a mixed-model 2 × 3 ANOVA (group × time) to evaluate the change in passive knee extension between groups over time.</p> <p>Results</p> <p>Regardless of group, the use of adjunctive HIS mechanical therapy resulted in passive knee extension deficits that significantly improved from 10.5° ± 5.2° at the initial visit to 2.6° ± 3.5° at the 3 month visit (p < 0.001). The degree of extension was maintained at the most recent follow-up (2.0° ± 2.9°), which was significantly greater than the initial visit (p < 0.001), but did not differ from the 3 month visit (p = 0.23). The gains in knee extension did not differ between worker's compensation and non-compensation patients (p = 0.56).</p> <p>Conclusions</p> <p>We conclude that the adjunctive use of HIS mechanical therapy is an effective treatment option for patients with knee flexion contractures, regardless of whether the patient is being treated as part of a worker's compensation claim or not.</p

Arthroscopically Assisted Retrograde Intramedullary Nailing for Periprosthetic Fracture of the Femur after Posterior-Stabilized Total Knee Arthroplasty

Retrograde intramedullary nailing (RIMN) has been used for periprosthetic fracture of the distal femur after total knee arthroplasty (TKA), yielding good fracture union rates and satisfactory outcomes. However, RIMN for posterior-stabilized- (PS-) TKA risks malpositioning the entry point and disturbing the post of the tibial insert, and the surgeon therefore usually requires knee joint arthrotomy. We report a case of a 79-year-old male who was involved in bicycle accident resulting in periprosthetic fracture of the distal femur after PS-TKA. We performed osteosynthesis with arthroscopically assisted RIMN to define an appropriate entry point. RIMN for posterior-stabilized- (PS-) TKA risks malpositioning the entry point and disturbing the post of the tibial insert. Because arthroscopy can directly visualize the entry point and the tibial post without arthrotomy, arthroscopically assisted RIMN offers a useful technical option for periprosthetic fracture of the distal femur after PS-TKA