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HIP AND KNEE CONTRACTURES

HIP AND KNEE CONTRACTURES

It is essential that the patient is assessed in detail before any operative procedures

to get the child up and mobile. In the case of adults, operative procedures are only i
CONTRAINDICATIONS TO OPERATION IN CHILDREN

1.

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Both legs severely involved with one or both arms, particularly the triceps, week. ie.
2. Minimal contracture of the hip alone of less than 3 In all other circumstances the
CONTRAINDICATIONS TO OPERATION IN ADULTS

1. Where one or both arms are weak in addition to both legs being severely paralys

2. When there is only a minimal degree of contracture and the patient is managing t

3. When there is severe contracture of both knees and the patient earns his liveliho

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4. Where operative facilities are poor and contractures severe.

In an adult with polio contractures it is essential to consider the patient as a whole a

often better off than one who can only progress very slowly upright with stiff knees a

Serious consideration must be given to the future occupation and mobility before bil
Isolated hip contractures of less than 30

No treatment is required for these when there are no other contractures. The stabili
Isolated knee contractures of less than 30

In a child these are best treated by fortnightly manipulations under anaesthesia unti
INDICATIONS FOR OPERATION
Hip and knee contractures of over 30

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HIP AND KNEE CONTRACTURES

These will all require operation, with the exceptions already mentioned. In a young c
OPERATIVE DETAILS
(Fig. 23(a))
Sterility and position on operation table

The operation must be done under full sterile precautions with adequate skin prepa
First incision

This is situated on the lateral side of the thigh about 1 inch above the knee joint. Th
Second and third incisions

These are situated one-third up the thigh and two-thirds up the thigh on the lateral a

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Fourth incision

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This is situated about one finger's breadth below the anterior superior iliac spine. Th

If the hip contracture is severe all the tight structures lateral to the femoral nerves a

The anterior tight structures having been cut, the blade is then twisted so that it cuts

The hip must-be kept in as much adduction and extension as possible while the tigh
POST OPERATIVE(Fig.
TREATMENT
23(b))

It is important that all blood clot is squeezed out periodically during the operation an

Subcutaneous elongation of the tendo Achillis, if necessary, should be carried out a

With plaster correction the hip and knee should be manipulated every two weeks un

Backward subluxation of the knee should be corrected or avoided, and lateral rotati

The final plaster is left on for two weeks, and then replaced by an above-knee calipe

The use of turnbuckles to straighten a severely contracted knee after operation, or w

Intensive physiotherapy and Russell traction may be required for severe intractable

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OTHER PROCEDURES FOR KNEE CONTRACTURES


Russell traction

(Fig. 23(c))

Russell traction, if used alone post-operatively, for severe knee contractures, should

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Open biceps tenotomy


(Fig. 23(d) )
The biceps tendon should be divided in all knee contractures of over 30 degrees. It

The lateral intermuscular septum and the posterior part of the iliotibial band will ofte

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CORRECTION OF OTHER DEFORMITIES


Genu recurvatum

In children this should be treated by an above knee caliper with a tight posterior stra
Valgus deformity of the knee

This is common and seldom requires specific treatment in polio except for adjustme
Tibial rotation and backward and lateral subluxation of the tibial plateau

These are usually but not always associated with a flexion deformity of the knee. Th
Fractures

These are common in polio, and should be treated in the same way as fractures in p
Dislocation or subluxation of the hips

This is occasionally seen with severe paralysis of the hip muscles. It is more usual,
SEVERE FLEXION DEFORMITY OF THE KNEE

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HIP AND KNEE CONTRACTURES

This may be associated with backward and lateral subluxation of the tibia, and also

In children the subcutaneous methods of correction already described should be trie

In adults with one deformed knee a compression arthrodesis (Fig. 23(g)) may be ind

In adults with both knees severely contracted, there is a definite indication for leavin

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