A NEW COST-EFFECTIVE AND CUSTOMIZED KNEE DEVICE FOR KNEE FLEXION CONTRACTURES IN PATIENTS WHO HAD UNDERGONE TOTAL KNEE ARTHROPLASTY. Anil Bhave1; Michael Mont2; Carla Brown2; Joseph A. Zeni*1; Scott Tennis1; Etienne Gracia2 1. outpatient physical therapy, Sinai hospital - Rubin Institute for Advanced Orthopedics, Baltimore, MD; 2. Orthopedic Medicine, Sinai hospital - Rubin Institute for Advanced Orthopedics, Baltimore, MD UNIQUE: The Custom Knee Device (CKD) is a new method of bracing that is molded and customized to each patient and designed to improve knee flexion contractures (KFC). This device utilizes effective principles of prolonged stretching, but unlike some other commercially available splints, is cost effective and easy to use by the patients. PURPOSE: Treatment of KFC can be problematic. Conservative treatment includes physical therapy modalities, serial casting and low load prolonged stretch with commercially available splinting systems. Commercially available splinting systems are expensive (1800-2400 dollars) and time consuming. The authors have developed a custom molded low cost (70 dollars) CKD using polyester and fiberglass synthetic casting material that is rigid yet pliable, two hinges and an elastic band. The purpose of the study was to determine the effectiveness of using the CKD in conjunction with manual stretching and modalities to improve knee extension in patients who had undergone total knee arthroplasty. FOUNDATION: Current concepts in contracture management utilize the principles of static progressive and low load prologned stretching as an effective means to improve range of motion. Use of the CKD employs these principles in a patient friendly and cost effective manner. DESCRIPTION: The study consisted of 47 patients with knee flexion contractures that were followed for a mean of 2 years. The etiology in 29 patients was primary TKA and in 18 of the cases the contracture occurred after a revision of TKA. The mean pre-operative KFC was 22 degrees. Standard treatment protocol was implemented that included maximal knee extension positioning with CKD followed by physical therapy and electric stimulation to the quadricep muscles. Patients used the CKD 2-3 times a day for 30 to 45 minutes at a time. OBSERVATIONS: Full knee extension was achieved in 27 out of 29 patients in the primary TKA group at a mean of 8.5 weeks (range 6-15 weeks). In the revision group 13 out of 18 patients achieved full extension at a mean of 11 weeks (range 9-16 weeks). CONCLUSIONS: The custom molded knee device created with new casting material is less expensive than other commercially available splints, is easier to customize for individual patients, and was effective in the majority of the cases. Patients after revision of the TKA required greater time and also had a higher failure rate than the group that had primary TKA. This low cost, viable approach should be incorporated into the daily treatment for contracture management after a TKA. FUNDING SOURCE: none KEYWORDS: orthopedic, contracture, splint, total knee, stretching Copyright 2009 by the American Physical Therapy Association. Requests for reprints should be directed to the corresponding author of the article. Educators, students, and other academic customers may receive permission to reprint copyrighted material from Physical Therapy (ISSN 1538-6724) by contacting the Copyright Clearance Center Inc, 222 Rosewood Dr, Danvers, MA 01923. Other types of customers who want permission to reprint should contact the APTA Editorial Office, Attn: Physical Therapy.