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TF/IPOP Responses

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RE: Transfemoral Immediate Post-Op Prosthesis (IPOP)

POSTED: October 26, 1999

The following are the responses I received to the above subject. The orginal

post is also included following the response.

Thanks to those who who took the time to responded! Some questions were

raiased by the respondents which might lead to further responses on this

subject.

RESPONSES:

Date: 10/26/99 12:09:17 PM Eastern Daylight Time

From: [email protected] (zach harvey)

Have you considered using a silesian belt on the IPOP for rotation ctrl and

suspension? Incorporate into the plaster: one strap with a buckle, a second

strap to go around the waist (with attached ring), and a third strap to feed

through the ring and back through the buckle. The second strap can be

adjusted by embedding an attachment plate on the lateral side. Positioning

of the first and second straps affects rotation control. We learned this

method at UT-Southwestern. I hope this helps.

Zach Harvey, O&P Student

Date: 10/26/99 2:12:55 PM Eastern Daylight Time

From: [email protected] (John W. Michael)

Your comments and observations coincide with mine.

My fundamental question is: why do an AK IPOP? In my experience, aggressive

early fitting with an endoskeletal definitive offers the same long term

result as an AK IPOP with a lot less aggravation for everyone involved, most

particularly the patient. Particularly with a frame system, socket changes

as necessary are straightforward and cost little or no more than an IPOP and

prep would.

For what it’s worth, the various pneumatic bag devices that have come and

gone over the years are adequate for mobilizing patients in the week or two

before they can be fitted with a prosthesis. I have rarely felt that was

necessary either, however.

Hi level IPOPs seem to me more driven by one’s philosophy than by any

documentable need. Or, do you see it differently?

Date: 10/26/99 2:41:41 PM Eastern Daylight Time

From: [email protected] (Don Cummings)

In some cases on smaller patients, a TES pre-fabricated neoprene belt may

work, with same concerns of compliance, necessary understanding of

importance of suspension and rotational control. Also, because of the bulk

and high-friction of plaster or fiberglass, it can be a challenge to pull

this over a direct-applied rigid dressing. Some sort of interface usually

has to be applied over the cast to facilitate pulling on the TES belt (like

duct tape).

Date: 10/27/99 1:45:14 PM Eastern Daylight Time

From: [email protected] (Susan Kapp)

CC: [email protected]

John: What Zach Harvey described to you is the method I’ve always used, it

is simple and easy to apply. I’m not aware of any published reference for the

use of the Silesian belt specific to post op prostheses. In fact other than

Joe Zettl’s book there isn’t a lot on the application of post op prostheses.

I’ve always preferred the double anterior attachement points for the

Silesian, such as the style you get from Fillauer. I think it gives you more

control. Of course the primary indication for a Silesian is rotational

control. Let me know if this method works for you.

Date: 10/27/99 6:27:07 PM Eastern Daylight Time

From: PFBJKD

I usually use a combination of an over the shoulder strap (no bowden

cables- simply attached mid line ant and pos socket) and a TES belt that has

been split down the side and velcro added for ease of donning after the cast

is applied. I think overall this works fairly well, particularly bearing in

mind that I am not overly critical of control I can get on an IPOP.

Just thinking outloud here- I wonder what would happen if you used an

Ischial containment brim?

Paul Burnette, CP

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From: [email protected]

Full-name: JNBillock

Message-ID: <[email protected]>

Date: Tue, 26 Oct 1999 11:51:15 EDT

Subject: Transfemoral Immediate Post-Op Prosthesis (IPOP)

To: [email protected]

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X-Mailer: AOL 4.0 for Windows 95 sub 215

Colleagues:

For those of you who are doing Transfemoral IPOP procedures, you are aware of

the problems with achieving appropriate suspension and rotational control of

the prosthesis.

Given that, I would be interested in hearing your thoughts and experiences on

how you are addressing this problem.

My brief thoughts and experiences have been as follows:

HIP SPICA TECHNIQUE – The IPOP rigid dressing extends circumferencially

around the pelvis and over the contralateral hip and iliac crest.

EXPERIENCE: This technique is great for suspension and rotational control,

but limits hip flexion to approximately 45 degrees or less for sitting and is

not well tolerated by the patient. It is also not well suited for the obese

patient. Further, it extends time in the OR and elevating the patient for

the application of the hip spica extension presents problems.

HIP JOINT, PELVIC BAND AND BELT TECHNIQUE – A traditional single axis hip

joint, pelvic band and pelvic belt is secured to IPOP rigid dressing.

EXPERIENCE: This technique can work fine on individuals who are slender,

understanding of the importance of suspension and rotational control, as well

as compliant with monitoring this.

SHOULDER STRAPS WITH BOWDEN CABLE SHEAVES – Medial and lateral bowden cable

sheaves are incorporated into the IPOP rigid dressing then secured to length

adjustable over-the-shoulder straps for suspension.

EXPERIANCE: The techniques works well for suspension but does little for

rotational control.

MOLDED PELVIC SEGMENT WITH HIP JOINT – A prefabricated and sized molded

pelvic segment with single axis hip joint is attached to the IPOP rigid

dressing.

EXPERIENCE: None yet – In theory, I feel this might be the best overall

approach, however the availiability and timliness of acquiring a properly

sized pelvic segment complicates coordination of the procedure with the

physician, as well as the possible urgency of the surgery. Has anyone

attempted this approach? What molded pelvic segment did you use? Did you

incounter any billing issues as the molded pelvic segment is not covered

within the IPOP coding procedure?

Thank you in advance to whomever responds to the above with your thought and

experinces, of which I will repost to the OANDP-L.

John N. Billock, CPO, Clinical Director

Orthotics & Prosthetics Rehabilitation Engineering Centre

700 Howland-Wilson Road, SE

Warren, Ohio 44484 USA

Voice: 330-856-2553

Fax: 330-856-4619

E-Mail: [email protected] or [email protected]

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