Rehabilitation after intramedullary skeletal kinetic distractor implantation: a report of two cases and a suggested therapy program

Adult limb lengthening occurs via distraction osteogenesis and traditionally involves use of an external fixator. Complications after placement of hardware often disrupt rehabilitative efforts and hinder patients' progress. A completely internal limb-lengthening device has been developed and increasingly used, and it may more commonly be seen by a physiatrist in consultation for postoperative rehabilitation. We present two cases of patients who underwent implantation of the intramedullary skeletal kinetic distractor and required acute inpatient rehabilitation. One patient had previously suffered a malunion deformity with a resultant limb shortening, and the second patient was born with a congenital leg-length inequality. Both patients had successful femoral intramedullary skeletal kinetic distractor implantation and were transferred for acute inpatient rehabilitation. Distraction occurred daily, based on the patient's level of physical activity in therapy, and was measured using a hand-held monitor. Both patients were successfully discharged home, without complications throughout the hospital stay. Knowledge of the theory and mechanism of action of the device is important to guide both the amount and type of therapy prescribed and to follow patient progress. We present general guidelines during the acute rehabilitation of a patient after intramedullary skeletal kinetic distractor surgery.