Keywords : serial manipulation and casting

The Treatment of Flexion Contracture of the Knee Joint in Hemophilic Patients Using Gradual Manipulation and Serial Casting

Ali Bakir Al-Hilli

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 3, Pages 407-412

Hemophilia is a bleeding disorder caused by deficiency of clotting factor VIII or IX; it is inherited as sex linked recessive pattern. Musculoskeletal complications in haemophilic patients are disabling. Bleeding in to the large joints and soft tissues are associated with arthritic changes in the joints and contractures in the soft tissues. Deformities of the large joints especially flexion contractures are commonly seen in knee joint. It is important to prevent deformities, treat existing contractures and prevent recurrence to improve the patient's quality of life.
This is a retrospective study analyzing the effectiveness of gradual manipulation and serial casting for treatment of knee joint flexion contracture in Hemophilic Iraqi patients.
We included ten Hemophilic patients type A, treated between 2006-2008, six with unilateral and four with bilateral knee joint flexion contractures, excluding patients with multiple joint contractures other than knees, have severe arthritic changes, have subluxated unstable knees or have acute bleeding. Their age is between 16-22 years, the duration of deformity is 4-9 months, knee flexion contractures between 20-80 degrees and all of them don’t have significant pain but their daily life is severely restricted by the deformity. Under factor cover, general anaesthesia and haematological care, we started serial manipulations and plaster of Paris casting, the number of casts is between 2-6 casts, till we get straight knees. After that splints are prescribed for the patient and followed up for a minimum 6 months, physiotherapy to strengthen the muscles around knee is initiated from the start and gradually increasing after the application of the removable splints.
We have ten patients with fourteen deformed knees, after manipulations and serial casting 8 knees get full correction, and 6 knees still have less than 10 degrees of flexion which is acceptable for the patients, all the patients have improvement of their quality of life and walk free of pain after 2 months.
Serial manipulation and casting under general anaesthesia is a very good maneuver to correct knee joint flexion contractures in hemophilic patients.