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.