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General Rehabilitation

Double Amputee Veteran Receives Custom Flexion Prosthesis due to Hip & Knee Contractures: A Case Report

Saturday, October 25, 2025
12:00 PM - 1:30 PM MT
Location: Case Report Theater
Disclosure(s):
Zack Levine, MD: No financial relationships to disclose
Akhil Aerra, Student: No financial relationships to disclose
Campbell Goldsmith, Other: No financial relationships to disclose
Case Diagnosis: 67 year old male veteran with history of right transmetatarsal amputation and left below-knee amputation was readmitted to acute inpatient rehabilitation for custom bent-knee prosthetic gait training after developing left hip and knee flexion contractures during recovery from left femur fracture and diabetic foot ulcer.

Case Description or Program Description: A 67-year-old Navy veteran with history of R TMA (2016), L BKA (2019), L femur fx with ORIF (2022), T2D with polyneuropathy, chronic low back pain with intrathecal morphine pump, and COPD (active smoker) was admitted for gait training. After a 2022 fall causing a L distal femur fracture, he was unable to don his prosthesis. Prolonged immobility and wheelchair use led to moderate L hip and severe L knee flexion contractures, preventing prosthesis use. P&O assembled a unique custom knee-flexion prosthesis with exoskeletal support and single-axis foot, plus a diabetic shoe with a rocker sole and R toe filler. PM&R managed phantom limb pain, chronic low back pain, R diabetic foot ulcer, T2D, and COPD during admission.

Setting: VA Inpatient Gait Training

Assessment/Results: Patient was admitted with severe deconditioning, significant left knee ROM limitations (maximum extension of 60° and flexion of 105°), and a maximum left hip extension of -35°. Through targeted gait training focusing on ROM, strength, and endurance, patient successfully ambulated 400 feet with modified independence and improved joint mobility, gaining 10° of ROM in both the hip and knee.

Discussion (relevance): Patients with this severity of flexion contracture would typically be confined to a wheelchair. However, with VA health benefits, this patient received a specialized prosthesis designed to provide sufficient clearance during swing phase, offering an opportunity to regain daily activity independence.

Conclusions: Patients often present with unique physical limitations due to medical setbacks; however, with an interdisciplinary approach between P&O, PT/OT, nursing, and physiatry, patient safety and functional independence can be optimized with adaptive equipment.