HIP KNEE ANKLE FOOT

ORTHOSIS
LAARAIB NAWAZ
HKAFO
• The HKAFO is a KAFO (knee-ankle-foot-orthosis) with an
extension of hip joint and pelvic components. This device
is used on patients requiring more stability of the hip and
lower torso, due to paralysis and weakness, in addition to
the lower extremity involvement. The brace will provide
pelvic stability in several planes, from rotation, to side-to-
side, and front-to-back motions.
Cont..
• . Primarily the hip section and hip joint of the brace
stabilizes and aligns the lower leg underneath, reducing
unwanted motion, while increasing steps per minute and
reducing energy expenditure.
• HKAFO’s are used for patients with paraplegia, spina
bifida, recurrent hip dislocation and other high
neurological impairments.
Cont..
The addition of the hip joint and pelvic section provide
control to selected hip motions.
These selected motions about the hip are front to back,
side to side, and rotation.
One reason the hip section is added to a KAFO is to
reduce or minimize the risk of the hip moving out of
proper position or dislocating.
Another common reason is to stabilize the hip and lower
spine in cases where the patient is weak or paralyzed.
 Indications
•  Assist gait
•  Decrease weight bearing
•  Control Movement
•  Minimize progression of a deformity
Principles
•  Use only as indicated and for as long as necessary
•  Allow joint movement wherever possible and
appropriate
•  The orthotic ankle joint should be centered over the tip
of the medial malleolus
•  The orthotic knee joint should be centered over the
prominence of the medial femoral condyle
•  The orthotic hip joint should be in a position that allows
the patient to sit upright at 90 degrees
•  Patient compliance will be enhanced if the orthosis is
comfortable, cosmetic and functional
Principle of Equilibrium
 This system applies corrective and assertive forces
which are implemented at surface of orthosis through skin
and transmitted to underlying soft tissue and bones
To remain stable ,the body has to have one point of
pressure opposed by two equal points of counter pressure
 Hip joint: F3 =F2+F4
Knee joint: F2=F1+F3
 Forces F1, F2, and F3 control knee flexion, while forces
F2, F3, and F4 control hip flexion
Cont.
 The corrective force is directed towards the angular or
deformed area to be corrected and other two counter
forces are applied distal and proximal to the corrective
forces
 The greater the distance between the force and the
counter force ,the less counter force required
Components
HKAFO is extension of KAFO which contains
1. AFO
2. 2. knee joint
3. 3. two upright
4. 4. calf band
5. 5. quadrilateral thigh section.
6. 6. Hip joint
7. 7. Pelvic band
AFO component
It may be metallic AFO or plastic AFO.
Metalic AFO components are
1)proximal calf band
2)two medial and lateral bar
3)ankle joint
4)two stir up.
Fabrication process of plastic AFO
• Step 1: Creating a negative plaster mould of patient's
lower leg and foot
• Step 2: Cutting and removing plaster mold from patient
• Step 3: Pouring liquid plaster into the negative plaster
mold
• Step 4: Modifing the positive plaster cast
Cont..
• Step 5: Moulding the HDPE plastic
• Step 6: Removing & Cutting the plastic from positive cast
• Step7: Finishing the plastic shape
• Step 8: Fitting the patient
Cont..
• Two upright (medial and lateral) attached to the drop
lock knee joint from above and below and connects AFO
& lower thigh band respectively.
• Straight set knee joint allows free flexion and prevents
hyperextension.
• It is used with drop lock which is a wedge shaped metal
piece that is placed on upright bar. When knee extends it
drops over the joint and locks it
• Width at knee joint = Anatomical knee width + 10 to 12
mm
Quadrilateral thigh sections

• Quadrilateral thigh sections

• The quadrilateral thigh section is designed
to permit partial transfer of the patient’s
weight through the KAFO during stance
phase which is made of HDPE plastic .
• This brings more effective balance to the
patient’s gait as the resultant stance period.
Hip joint
• Hip joint is attached to KAFO which allows flexion
extension only. Movement of hip with a uniaxial
hip joint with drop lock which is locked during
walking
• Distance between knee axis to greater trochanter
is measured.
• Hip joint is placed on the lateral side of brace till
the axis of hip joint is at the measured distance
from knee joint axis to greater trochanter
• Hip joint bar attached to knee joint bar with nails
HIP JOINT AXIS KNEE JOINT AXIS
Pelvic band
• A pelvic band which is padded rigid steel band extending
posteriorly and laterally which fits between iliac crest and
greater trochanter
• In front it is fastened with a soft Velcro or buckle strap
fastener .on the lateral side it is attached to hip joint

• Cutting off excess length of pelvic band if required equally

from both side & banding is done
Indication
• Bilateral HKAFOs designed for
standing and ambulation in adults with
paraplegia. It provides the paraplegic
patient who has a complete
neurological level at L1 or lower with
a more functional and comfortable gait
Reciprocal Gait Orthosis (RGO)
• A reciprocating gait orthosis (RGO) is an
HKAFO that uses a mechanical system that
connects the two sides of the brace by
• 1. Isocentric bar (IRGO)
• 2. Double cable (LSU RGO from Louisiana
State University)
• 3. Single push/pull cable system (advanced
RGO [ARGO] )
Components
• 1. AFO
• 2. Knee joint
• 3. Uprights
• 4. Thigh cuff
• 5. Hip joint
• 6. Pelvic band
• 7. Cables (In the isocentric RGO (IRGO), the cord is
substituted by a pelvic band attached to the posterior
surface of the molded thoracic section)
• 8. Thoracic straps
Cont..
• In all RGOs, the hip joints are coupled together with
cables(pelvic band in the IRGO) which provides
mechanical assistance to hip extension while preventing
simultaneous bilateral hip flexion
•  As a step is initiated and hip flexion takes place on one
side, the cable coupling induces hip extension on the
opposite side, producing a reciprocal walking pattern
Cont..
•  Forward stepping is achieved by active hip flexion,
lower abdominal muscle
•  Using 2 crutches and an RGO, paraplegics can
ambulate with a 4-point gait. A walker may also be used
Hip Orthoses
• Hip orthoses (HpOs) may be prescribed for isolated
problems in the acetabular region, which may be the
result of
• (1)Dysplastic disorders
• (2) traumatic injury
• (3) surgical procedures (total hip replacement)
Orthosis in dislocation of hip joint

• When the femoral condyle and acetebular are stable and

well positioned then dislocation of hip joint can be
preventer.
• In the past, hip spica casts have been shown to be useful
for this purpose. Currently, orthoses offer several
advantages over casts. Orthoses weigh less, which
makes them easier to tolerate during ambulation
•
Posterior dislocations
• Violence directed along shaft of femur with hip
flexed is the mechanism of injury
• The hip orthosis used to treat a hip that
dislocates in a posterior direction is generally
proximal to the knee
• A pelvic band suspends the orthosis and provides
an attachment point for the hip joint.
Cont..
• A laterally placed, adjustable range of motion hip joint
capable of controlling flexion, extension, abduction, and
adduction which attaches to a thigh cuff that holds the hip
in 10 to 20 degrees of abduction and allows 0 to 70
degrees of flexion
Anterior dislocation
• When patients have anterior wall weakness or instability
• external rotation and abduction usually is the mechanism
of dislocation
• To provide rotational control, a knee–ankle–foot orthosis
(KAFO) rather than a simple thigh cuff is suspended from
the pelvic band
Posterior (right) anterior (left)
Pediatric hip orthosis
• Conditions that fall within this category include
Developmental dysplasia of the hip (DDH)
 Legg-Calve´-Perthes disease (LCP)
cerebral palsy (CP)
 lower limb weakness or paralysis associated with
neuromuscular disorders, myelodysplasia, and spinal cord
injury
Developmental dysplasia of the hip (DDH)
• In 1941, Bedrich Frejka introduced a soft abduction pillow
for treatment of DDH in infants .
• The Frejka pillow was designed to maintain abduction.
the pillow is soft nature, infants could easily overcome the
abduction pressure. The pillow subsequently was
modified to create a firmer construct
• The most recent version consists of a 9- 9- ¾ inch foam
pillow that is placed around the child’s buttocks, much like
a diaper, and secured in place with a cloth harness and
straps
Pavlik harness
• The Pavlik harness has two shoulder straps that cross in
the back and are secured to a wide chest strap
• The anterior stirrup straps are located at the anterior
axillary line and the posterior straps overlie the scapulae
• The anterior straps should maintain the hips in 90 to 110
degrees of flexion. posterior straps are designed to
maintain wide abduction
• The straps should be tension to maintain 20 to 30 degrees
of abduction only
DDH, pavlik harness
Plastazote hip abduction orthosis
• Braces are made of a Plastazote foam that wraps around
the legs and waist, maintaining the hips in approximately
70 to 90 degrees of flexion and wide abduction. Both
allow free motion of the knee
The SWASH (standing, walking, and sitting hip)
orthosis
• It is designed to allow the wearer to transition from sitting
or crawling to standing or walking
• By providing variable hip abduction according to the
degree of flexion or extension, it maintains the hips in
abduction while the child is seated and holds the legs
almost parallel while the child is standing
• The brace not only positions the hips in abduction,
providing maximal coverage to the femoral head, but also
helps with sitting balance and preventing scissoring with
ambulation
Standing frame orthoses
• The standing brace allow independent
standing and free use of the upper
extremities for the very young child with
good head control .It does not permit hip or
knee flexion
• The brace comes as a kit that consists of
an unhinged upright frame with footplates,
knee supports, and a chest/abdominal
strap. It can be extended to accommodate
growth
Parapodium
 It enables the child to sit or stand as well to
change between these two positions. The original
design included only hip locks; however,
subsequent models include locking and unlocking
joints at both the knee and hips, which allow the
child to sit in a wheelchair as well as to stand
 The parapodium is indicated for children older
than 3 years. It is worn over clothing. It provides
an exoskeleton that consists of a spring-loaded
shoe clamp, aluminum uprights, foam knee block,
and back and chest panels
Standing frame orthosis, parapodium