6
All or part of ilium is removed
Hemipelvectomy
What are the three phases of PT care with patients with amputations?
1. Post operative
2. Pre-prosthetic
3. Prosthetic
Type of transfemoral amputation:
- Suturing muscles and tendons directly to the bone
- Causes lot more play and comfort in the joint
Myodesis **
Where at in the timeline:
Fit with temporary prosthesis, begin prosthetic gait training
2-4 months
Where at in the timeline:
Apply post-op protector, limb shaping, pre-prosthetic training
0-2 weeks
Preservation of femur and patella
- Patellar tendon is sutured to remnants of cruciate ligaments
- Gastroc muscle bellies are used as cushion
Advantages:
- very few muscles are no bones cut
- good comfort and function
Disadvantages:
- poor cosmesis
- limited prosthetic options
Knee disarticulation "through knee amputation"
- Symphysis pubis is divided
- Anterior skin flap: above and patellar to inguinal ligament
- Posterior skin flap: preserves variable portion of gluteus maximus
Blood loss is of concern and mortality rate is high during surgery
Hip disarticulation
Where at in the timeline:
Sutures are removed, patient is evaluated for first prosthesis
3-4 weeks
- Resect part of the leg, rotate it 180 degrees. Then the talocrural joint becomes the knee.
- Indication: osteosarcomas near the knee -- children and teenagers
- In children, the reattached bones continue to grow as they grow
Rotationplasty
Type of transfemoral amputation:
- Suturing muscle to muscle
- Stability is good with this procedure
Myoplasty **
Where at in the timeline:
Incision is fully healed, cast for prosthesis
5-8 weeks
25.8% of dysvascular amputations performed in the US
- equal length anterior and posterior flaps
- Nerves cut at level to ensure good coverage by soft tissue
- Minimal length of residual limb
- Junction of middle third and proximal third of femur, below the level of the lesser trochanter
Transfemoral amputation
Where at in the timeline:
Receive definitive prosthesis
6-12 months
- Optimize medically
- Optimize function
- Address impairments
- Education
- Protect the sound limb **
Pre-operative management
Where at in the timeline:
Limb volume stabilization, frequent therapy and prosthetic adjustments
4-6 months
Advantages:
- More control of prosthesis
- No perspiration, pain from socket, lighter
- Easy don and doff
Disadvantages:
- Previously 2 surgeries required -- long rehabilitation period
- Deep infection risk
Osseointegration (implant into the bone) (not common in the US)
Which type of socket interface/liner:
- off the shell gel liners
- Custom silicone liners are for uniquely shaped and/or scarred limbs
Soft liner
What are the three types of suspension systems for transtibial amputees?
1. Elevated vacuum
2. Suction
3. Pin lock
Which type of socket interface/liner:
- minimizes bulk
- Durable
- May not be appropriate for those with fragile skin or bony prominences
Hard: rigid plastic interface
- Helps accommodate volume
- Measured in ply
- New socket is needed after patient is required to wear 12-15 ply
Socks
Which type of suspension system:
- Pin is incorporated into liner and guided into shuttle at distal socket
- Doffing is by pushing button on outside of socket
- Secure
- Suspension forces concentrated distally
Pin lock
Which type of suspension system:
- ONe way valve into socket that allows air to escape
- Gel suspension sleeve that seals top of socket prevention air from entering
- Pressure is not concentrated on residual limb
- Limited knee flexion
Suction
6-12
1 -- limb may be too big for prosthetic
14 -- may need another sock because limb is going too far into socket
Which type of suspension system:
- A pump creates a negative pressure that pulls the liner and residual limb toward the socket wall
- Least amount of pistoning, more secure fit
- May decrease daily limb volume fluctuations
- Not universally indicated: user must be aware and comply with proper wearing sequence; studies from systematic review were mostly males with transtibial amputations, many of traumatic origin
Elevated vacuum
What are the 2 types of suspension systems for transfemoral?
1. Suction
2. Lanyard/strap