Case Study of an Interprofessional Approach to Restore Function for a Rare Left Knee Contracture Post Left Hip Arthroscopy

Introduction/Backgroun Immobilization or paresis decreases the normal turnover of the extracellular matrix, increasing its concentration within and between muscular compartments [1]. The increased viscosity of the loose connective tissue may cause decreased gliding between layers of collagen ffibers, which may be perceived as stiffness by patients [2]. We describe a case study of a 66 year old man with the inability to flex his left knee past 38 degrees at 7 days post a left total hip arthroplasty treated successfully with an interprofessional approach. Methods Physical Therapy initiated 4 weeks post-surgery with 7 degrees improvement in left knee flexion range of motion (ROM) after 2 months. PT services included dynamic splinting, joint mobilization, active/passive stretching, soft tissue mobilization, movement pattern retraining. Physiatry delivered a high volume steroid injection into the left knee joint followed by a series of trigger point injections to the left lower extremity. Medical massage therapy was performed for Stecco Fascial Manipulation in the frontal plane. Lymphatic physical therapy was initiated to resolve chronic post-operative edema with interarticular joint restric- tion at the left knee and hip. Results Functional Outcomes Measure: Lower Extremity Functional Scale: 40% improvement with 9 months of interpro- fessional treatment. Supine passive knee flexion ROM improved by 89 degrees. Conclusion This rare case of a post left total hip arthroplasty left knee contracture required an interprofessional approach to address the joint, muscle, fascial restrictions and lymphatic influence on the knee joint range of motion.