Workers compensation Scheduled Loss of Use

for Determining Hip and Femoral Impairment

If you were injured while on the job and are questioning what effect “Scheduled Loss of Use” (SLU) means for your hip, look no further!

You could be eligible for a compensation payment that is determined by the Workers’ Compensation Board’s regulations.

Our SLU report will conclude that you have permanently lost function in the injured body part due to your work-related accident. The determination of impairment is based on New York state workers compensation guidelines.

Walking, climbing stairs, and sprinting are all daily tasks made possible by the hip joint and its support structures. Where the femur and pelvis meet is where the hip, a ball and socket joint, is placed. The ball and socket design offer the hip the second-largest range of motion after the shoulder.

The goal is to precisely determine the long-term physical deficits that a patient experienced as a result of their accident. Our assessment is based on factual information obtained from the history and physical examination, as well as any relevant diagnostic test results.

Techniques for Measuring Permanent Impairment

At the point of greatest medical improvement, when further healing is not anticipated, the degree of a permanent residual physical deficit should be assessed. Based on the results of the clinical course of treatment, the medical provider’s experience, and any additional treatment alternatives accessible to the patient, the maximum medical improvement should be assessed.

The mechanism of the damage has almost no effect on how severe the permanent residual physical deficit is. In addition to physical injury to bone, muscles, cartilage, tendons, nerves, blood vessels, and other tissues, it can also reflect the permanent residual physical deficit at the point of maximum medical improvement.

We evaluate the contralateral extremity and expected/normal values when determining the degree of persistent residual physical deficiency, if applicable. Although the time between a wound and the moment of greatest medical advancement can differ, it is typically one year following the wound or the most recent surgery.

Range of Motion in the Hip

Motions includes:

  1. Abduction – Coronal plane range of motion rotating about an imaginary line of an axis passing through the head of the femur. Through 45 degrees is the typical range of motion. (The lower extremity pivots away from the centre.)
  2. Adduction: A range of motion in the coronal plane that revolves around an imaginary axis that passes through the femoral head. A 35-degree range of motion is considered normal. Moving across the midline is the lower extremity.
  3. Internal Rotation – With the foot firmly planted on the examination table, the lower extremity is partially flexed. The knee crosses across the opposing extremity as a result of the hip rotating. A 45-degree range of motion is considered normal.
  4. External Rotation – With the foot firmly planted on the examination table, the lower extremity is partially flexed. The knee is moved away from the opposing extremity by rotating the hip. A 45-degree range of motion is considered normal.
  5. Flexion (forward elevation) – Range of motion with the flexed knee moving in front of and above the waist while rotating about an axis of an imaginary line through the acetabulum in the sagittal plane. A 120-degree range of motion is considered normal

Hip Flexion

6. Extension – A 30-degree range of motion in the sagittal plane with the leg travelling behind the body on an imaginary axis through the acetabulum. Lower extremity is raised off the examination table while the patient is lying on their back.

Determining Loss of Use

First, evaluate whether any special circumstances need to be taken into account before calculating the total timetable loss of hip use. If not, add abduction/adduction (A) + internal/external rotation (B) + flexion (C), to the extent there are deficits in these ranges of motion, to calculate the overall schedule loss of hip usage. As noted below, other deficits may be taken into account. The schedule cannot exceed the value for ankylosis when evaluating based on range of motion.

Hip
Percent Loss of Use of Hip
Instructions: To the extent there are deficits add A+B+C; for other deficit values see notes.
Maximum value cannot exceed the value for ankylosis.
Schedule loss of use percentages for ranges of motion values above/below
those depicted here should be adjusted proportionally.

 

 

 

 

 

 

 

 

 

 

 

*Use lower figure for one deficit and higher figure when both are affected

A doctor usually determines the percentage loss of use of affected body part which in this case is the hip. The table above shows the comparison of the severity of injury based on percentage loss of use. A well experienced physician must carry out the medical examination to ensure that the appropriate award for schedule loss of use is given

Notes:

  • Adduction and abduction: Total loss of both implies a 33½ loss of leg function
  • Internal and external rotation: Total loss of both implies a 30% loss in leg function.
  • A deficit in posterior extension implies in a7½ –10% loss of leg function.

Special Considerations we use for evaluation of SLU

Special considerations with enumerated schedule loss of use values include the following. When indicated or when no schedule value is given, other deficits may be introduced. However, the value of ankylosis cannot surpass the maximum schedule loss of use value.

  1. Femur head and neck removal without prosthetic replacement results in 50% anatomical loss of leg function. Include any mobility issues.
  2. An MRI revealed synovitis of the hip and bursitis in the trochanteric, ischiogluteal, and iliopsoas bursas; the schedule reward is a loss of leg function of 0-7½%. Date of assessment two or more years after the injury date
  3. If there is a residual hip impairment, such as limited hip joint movement and thigh muscle atrophy, a fractured pelvis may be eligible for a schedule award at the end of two years. Scheduled leg usage loss could range from 15 to 20 %.
  4. Leg lengthening or shortening causes a loss of use of the leg of 5% for a half-inch, for a third-inch, and 10% for a full-inch.
  5. In the event of a quadriceps rupture, account for 15 to 20% of deformity and weakness. Include any mobility issues. An average schedule results in a 20 to 25 % of leg function. A higher schedule should be taken into consideration if the knee is lax.
  6. A 10% reduction in leg function results from quadriceps atrophy and weak knee extension.
  7. An additional schedule award may be given to an amputee who has completely lost use of a leg following a second accident or injury as a result (e.g., hip fracture).
  8. Two years must pass after a hip fracture, with or without surgery, before the schedule award is finally evaluated. Request a recent X-ray of the femoral head to evaluate the bone stock and check for hardware displacement, loosening, and misalignment. If metallic hardware is removed, schedule evaluation must occur at least six months following removal and no earlier than two years after the date the hardware was installed.
  9. Restoring joint function is the goal of whole or partial osteotomies, hip replacements, or both. Results are evaluated at least twelve months following surgery since functional changes that are clinically important can happen earlier.
    The schedule is provided based on a medical evaluation of
  • hip flexion range of motion,
  • leg position (including leg length discrepancy [measured, in the supine position, from the umbilicus to the tip of the distal medial malleoli] and/or mal-rotation),
  • atrophy (measured at the mid-thigh as a comparison for the contralateral side),
  • and the presence of chronic complications, as shown in the table below (unless appropriate for classification).

The chart below is used to calculate the schedule loss of usage values. A % schedule loss of use is a good result (as shown in Row A below). Add the value for the additional deficit (using the number that most closely fits the deficit in each column) to the base of 35 % to determine the total schedule loss of usage award where deficits are greater than those described in Row A.

Full or Partial Hip Replacement Schedule Loss of Use

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Example:

A patient undergoes hip replacement surgery. The medical professional concluded that a fair outcome existed at the point of maximum medical improvement
The individual has a 20-degree mal-rotation, a .8-inch leg length difference, and a more constrained range of motion in flexion (ROM to 45 degrees).

  • The replacement’s value would begin at 35%.
  • Increase by 10% for a greater flexion deficit (45 degrees).
  • Increase by 10% for the incorrect rotation (20 degrees).
  • This person would have a % SLU value overall.

Amputation

Amputation at any point, from the knee joint to the hip joint, results in a complete loss of limb function.

Please refer to the Workers Compensation Board website of your state or speak with your Workers Compensation attorney for more information.

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Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
Sam
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18
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