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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)
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)
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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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