Knee Disarticulation and Hip Release for Severe Lower Extremity Contractures

Abstract

Severe lower extremity contractures cause many problems for patients and their caregivers. Hygiene, skin and perineal care, positioning, and dressing are severely compromised. Surgical management of such deformities is challenging and results have not been published. We treated eight nonambulatory adults with severe and rigid lower extremity contractures with hip release and knee disarticulation of 14 extremities. The patients had neurologic disorders with spasticity. The indications for surgery were fixed contractures of at least 90 degrees at the knee and hip that interfered with passive function and quality of life. All patients were bed-bound secondary to their contractures. The average age at surgery was 57 years; the minimum followup was 6 months (mean, 34 months; range, 6-102 months). The average preoperative flexion contractures were 106 degrees at the hips and 139 degrees at the knees. The average postoperative hip flexion contracture was 6 degrees , and there were no serious complications or recurrent contractures. Positioning and hygiene problems were universally improved, enabling all of the patients to become wheel-chair users, and all patients or their caretakers reported resolution of pain.