RehabEdge homepageHost a course at your facilityCEU by topic and providerSearch for CEU by state, topic, format, etc.Comprehensive therapy products and supplies catalogRehabEdge Forum main pageReach thousands of therapists to show off your products and CEUAsk us. We're here to help.

TKR's and Knee immobilizers

  		Logged in as: Guest
Users viewing this topic: none
  Printable Version
All Forums >> [RehabEdge Forum] >> Orthopedics >> TKR's and Knee immobilizers Page: [1]
Login
Message << Older Topic   Newer Topic >>
TKR's and Knee immobilizers - July 24, 2007 5:01:19 PM   
Ahlecs76

 

Posts: 33
Joined: March 16, 2005
Status: offline 		I have been noticing lately ihow patients s/p TKR's come in in the SNF where I work wearing knee immobilizers. Is there anything in the book about pt's having to wear these immobilizers s/p TKR? Is this just something physicians order and get for patients to maintain good knee extension ROM? If so how long do we keep it on? Just want to know your thoughts. Thanks y'all!!
Post #: 1
RE: TKR's and Knee immobilizers - July 24, 2007 6:13:58 PM   
SJBird55

 

Posts: 2467
Joined: May 10, 2004
From: Michigan
Status: offline 		I've never treated a patient post TKA with a knee immobilizer.  I'd ask the surgeon why a knee immobilizer is being utilized for the patients.  There are studies out there on continuous passive motion machines which is completely the opposite of what you are seeing - knee immobilizers?  Hmmm... strange.  I wonder if there is a scheme where some durable medical equipment company made a deal to take care of a surgeon's patients for durable medical equipment needs and they slap on a knee immobilizer to basically make some cash.  I'd question how a patient will be able to achieve 90 degrees 2 weeks post op if the patient is wearing a knee immobilizer.  You have issues over there....

(in reply to Ahlecs76)
Post #: 2
RE: TKR's and Knee immobilizers - July 24, 2007 7:44:49 PM   
jma

 

Posts: 2432
Joined: August 24, 2000
From: NY
Status: offline 		I have seen a few and the surgeon's rationale was to minimize the amount of knee flexion contracture that would ensue but it would not be worn for a long period of time.

(in reply to SJBird55)
Post #: 3
RE: TKR's and Knee immobilizers - July 25, 2007 8:25:39 AM   
orthotherapist

 

Posts: 219
Joined: February 6, 2007
Status: offline 		It used to be fairly common practice for TKA patients to have knee immobilizers post op when up and about until they were able to do a SLR without lag (good quad control) - have not seen this for many years though so I would question MD

(in reply to jma)
Post #: 4
RE: TKR's and Knee immobilizers - July 25, 2007 8:36:34 AM   
ragempt

 

Posts: 111
Joined: August 14, 2006
From: linden, michigan
Status: offline 		Sjbird55

do you usually have problems getting flexion back with patients? i dont but have had some problems with extension. To me the extension splint is a logical idea although i have never seen one where i practice, so i have no experience

(in reply to jma)
Post #: 5
RE: TKR's and Knee immobilizers - July 25, 2007 12:08:32 PM   
USAPT

 

Posts: 278
Joined: January 14, 2004
Status: offline 		I see the same thing in this rural community hospital I'm currently at. I actually had two post-ops upstairs with immobilizers on. Communication with the MD is key. I agree with SJ, you can't get the 90* in 2 weeks if their sleeping in the brace. I'm used to outpt ortho and having pt going 2 days post op. maybe it's an education thing, but one would hope Orthopedic MD would be very aware of this.     

(in reply to ragempt)
Post #: 6
RE: TKR's and Knee immobilizers - July 25, 2007 4:34:10 PM   
Ahlecs76

 

Posts: 33
Joined: March 16, 2005
Status: offline 		USAPT
Talk about rural healthcare facilities, I am in Clinton, NC. Middle of nowhere right now. I see you are from Raleigh, NC. That ain't too rural to me. Unless you just live there and work somewhere else. All points taken to consideration above. Will talk to the MD and see what's up with the knee immobilizer. Thanks y'all

(in reply to USAPT)
Post #: 7
RE: TKR's and Knee immobilizers - July 25, 2007 6:10:29 PM   
SJBird55

 

Posts: 2467
Joined: May 10, 2004
From: Michigan
Status: offline 		rage, I can't say that patients in this area have problems achieving 0 extension or 110 flexion.  The surgeons in this area do not use immobilizers.  I've recommended a dynamic splint once in my career.  This particular patient was not achieving 0 extension and was lacking 20.  He was somewhat demented and I knew he was sitting around all day not doing a darn thing.  If he was lying around I can guarantee he was propping his knee on something.  I really don't see a clinical rationale.  Even when patients have an extensor lag I wouldn't recommend an immobilizer.  They need to learn to turn on their muscles and tighten up their quads.  If they wear an immobilizer, I'm sure they'd be lazy and just use hip flexors to get their leg on the bed if moving from sit to supine.  An extensor lag isn't going to damage the components or cause any huge harm to patients (especially since they all start with walkers).  I see more of a financial benefit for some DME company.

(in reply to Ahlecs76)
Post #: 8
RE: TKR's and Knee immobilizers - July 26, 2007 9:21:27 AM   
Tom Reeves DPT ATC

 

Posts: 470
Joined: March 14, 2006
Status: offline 		Our surgeons usually have the patients in an immobilizer for 24 hours post op then the battle begins for the patient to maintain the ROM.  Remember the best predictor of post op ROM is pre-op ROM so if your patient had a 30 degree flexion contracture for 15 years before surgery, you are probably not going to get them straight.  And if by some chance you do, they will probably gravitate back to some type of flexion once they are discharged.

(in reply to SJBird55)
Post #: 9
RE: TKR's and Knee immobilizers - July 26, 2007 10:56:58 AM   
USAPT

 

Posts: 278
Joined: January 14, 2004
Status: offline 		Ahlecs76

You were correct, I live in Raleigh but work elsewhere...Oxford, NC. A nice little country drive.

(in reply to Tom Reeves DPT ATC)
Post #: 10
RE: TKR's and Knee immobilizers - July 27, 2007 8:50:16 AM   
AdamP

 

Posts: 23
Joined: July 27, 2007
Status: offline 		I work with 1 MD who uses the immobilzer frequently. He states that he prefers to add a slight flexion bias into the replacement then immobize into extension. Most of his pts achieve 0-125 passively.

(in reply to Ahlecs76)
Post #: 11
RE: TKR's and Knee immobilizers - July 27, 2007 1:26:51 PM   
ragempt

 

Posts: 111
Joined: August 14, 2006
From: linden, michigan
Status: offline 		SJ,
i agree with your statment. i just meant for the first 48 hours or so. just a thought

(in reply to AdamP)
Post #: 12
RE: TKR's and Knee immobilizers - July 28, 2007 8:41:35 AM   
jma

 

Posts: 2432
Joined: August 24, 2000
From: NY
Status: offline 		Yes, the surgeons I worked with sometimes have the patients were them for 2-3 days post op and then they are no longer needed.

(in reply to ragempt)
Post #: 13
Page:   [1]
All Forums >> [RehabEdge Forum] >> Orthopedics >> TKR's and Knee immobilizers Page: [1]
Jump to:





New Messages No New Messages
Hot Topic w/ New Messages Hot Topic w/o New Messages
Locked w/ New Messages Locked w/o New Messages
 Post New Thread
 Reply to Message
 Post New Poll
 Submit Vote
 Delete My Own Post
 Delete My Own Thread
 Rate Posts



Google Custom Search
Forum Software © ASPPlayground.NET Advanced Edition 2.5.5 Unicode

0.125