Original post was too long to include. Jist- burning sensation at distal tibia after revision where infx’d tissue removed, invagination remains. Easy liner, sheath fit, expulsion valve/gel sleeve suspension, no signs of excessive pressure on the R.L. Burning reported in & out of prosthesis, worsens with perspiration.
RESPONSES were awesome…
Sounds like a medical problem that still needs to be addressed by the physician. Given the first revision and the surgical result can understand the physician being self protecting this second time.
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I am having great outcomes with the Ertl Procedure primary and
revisional>>>>>>>>>>>>>>
It looks as if you have covered every prosthetic aspect…
What outer sleeve are you using?
What kind of seal do you have?
By chance do you have the diagnostic socket or mold this socket was fabricated from? You may be able monitor and/or register the expulsion rate and path in the diagnostic socket. It is a long shot, but if there is a seal or blockage in the socket it may cause discomfort. Just a thought.
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Try a custom molded silicone soft pad , just like a distal cup .I had
success with one of my patients, instead of plastazote one because of
the abrasion .
I wish you luck.
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Not so much a solution, but something to consider trying…
How about the use of vacuum? If cost is an issue for the vass/ harmony, you could
probably retrofit an external system. I’ve used this occasionally at walter reed.
It’s helped particularly well for invaginated areas. Set the socket up in the vass/ harmony
fashion with barb and tygon tubing. Run tubing to a one way valve. Use the e-vac
system (~$1000) or a low cost brake bleeder (let me know if you need the address where
to order). The longer the tubing, the less pumping required throughout the day.
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Smoetimes this sort of problems occur especially when
using gel sleeve in a humid or little hot weather I
usually advice my patient to use a small fine cotton
socks or pad only at itching area of the stump or
an anti persipiraration spray. I am sure problem will solved
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Excellent post and I have experienced some of the same occurrences with prescribing physicians. I have about abandoned the TSB socket because it seems to load distally a whole lot more then it should, irrespective of the so called hydrostatic effect. I have gone back to the PTB design, using liners (Ossur), without destroying them. I put more emphasis on the ML reduction, especially the medial condyle, than the AP. The PTB design will reduce distal weighting of the stump. Radcliffe recently posted his 1961 manual on line. Forty-five years later it is still an excellent read and it is always a benefit to view the original source material. I recognize that the PTB design is now heresy, but when all else fails.
Good luck,
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This sounds very much like adhesion caused.
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sounds like “dumb doctor syndrome”!!!
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bone scan may be a good idea to eliminate any osteo.
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THANKS to all who responded. One thing I neglected to mention originally is that this individaul reports a long Hx of petalla tendonitis and we tried a PTB test socket w/locking pin on 1st test socket. He instantly and totally refused the feel of the triangular shaped socket and pressure on the patellar tendon. He claimed it increased the distal burning. Therefore the TSB.
Saturday I put a 1/4 firm pad at MPT and an 1/8″ firm pad in the popliteal and so far so good. He reported instant relief, but appears to expect something to begin hurting at any moment. Put him on a conservative wear schedule to try to eliminate the reoccurance of his petalla tendonitis. We’ll see.
Rick Milen, CPO
Pennsylvania
