Thanks to all who replied to my request on this subject. Following is
my original question, followed by the replies I received.
———————-
I have been asked to provide a prosthesis for a seventy-year-old female
who sustained a transtibial amputation as a consequence of complications
following a total knee replacement. The knee itself appears to be
satisfactory, and the patient is pain free and has normal knee range of
motion, without contracture. There is modest anterior scarring from the
knee surgery. The patient is, incidentally, on kidney dialysis.
I propose to use a pressure-cast ICEROSS fitting so as to minimize
socket pressure in the patellar tendon area, but I have not previously
fitted a prosthesis on a limb which has had a total knee replacement. I
would appreciate comments from anyone who has had experience with this
type of case, or who has suggestions to offer.
Charles Martin, CPO
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Dear Charles,
I have fitted two such patients and on both I ended up fitting the
patients with a low profile PTB fitting with a tight leather thigh
corset (lace up).
Both my patients could not take the pressure on the patella tendon very
well so the introduction of a thigh corset to take some of
the weight off the stump area specifically the patella tendon.
I hope this helps. You could always start with an Iceross / PTB fitting
as you suggested and if needs be add the BK joints and
thigh corset later if necessary.
Errol Lishman (CPO)
http://www.pix.za/os/index.htm
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Charles
This is a technique I use with geri patients who need a little extra
weight bearing assist or a little extra M-L knee support.
If your patient is not too heavy (or high activity) you might try this
simple geri-design.
Cast from distal stump to as high on the thigh as the corset will go.
Fill and modify the cast building up posterior brim flares. Cover the
socket portion with pelite (or nickelplast… it’s great). Place large
Oklahoma joints or Gaffney’s Clydesdale joints at the knee centers and
pylon adapter hardware at the distal end (I use M+INDless’s 4-hole
delrin donut). Pull 5/23″ co-poly over the whole thing (posterior seam
if drape molding) and trim it out. Try a Dycor single or multi-axis foot
from Knit-Rite: they are incredibly light and have good A-P movement.
The result should be a 2 or 2 1/2 pound joints-and-corset light duty
leg. Using an Alpha cushion sleeve or Iceross’s new Comfort sleeve
should keep your lady pretty comfy.
Good luck
Dave Procter, CPO
OmniCare Labs
e-mail: [email protected]
phone: 217-347-2800
fax: 217-347-2812
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In my experience a total knee arthroplasty has little impact upon a BK
prosthetic fitting.
Ted A. Trower C.P.
A-S-C Orthotics & Prosthetics
Jackson, Michigan, USA
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I just fitted a 70 yr old gentleman who had similar amputation from
cancer..He has a total knee. I also used Iceross. He did not have good
knee motion thou. Good flexion, but could not extend fully. Fit so far
seems to be going OK. He has only had for a couple of weeks. His
biggest complaint is the weight. He has acrylic socket with Pin
connection, Endolite Ankle, and
Seattle Lite Foot… The ankle does add weight, but I felt the extra
motion would be helpful….I think the poor knee function is
contributing to it feeling heavy…He is also a retired engineer and he
wants to know why everything cant be made of plastic, drill holes in the
foot, etc…
Earl Fogler, CP
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Charles,
I have had two patients that I have fitted that have also total knee
replacements. I used TEC liners on both due to all of the extra little
bumps and grinds of the joint replacement. I would get a couple of days
of circumferences before taking an impression, and maybe even a few
trial casts to see how much day to day differences there are due to the
kidney dialysis. Another option would be Alpha liners.
Steve Childs
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Charles,
I had a similar experience with a trans tibial patient. I used a total
surface bearing type socket with a pelite liner and a suspension sleeve.
This was years ago before I began using silicone liners. She was very
sucessful. If I had to do it today I would use a silicone liner and
pressure cast for a total surface fit.
Best of luck,
Bill Beiswenger, CPO
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Hi Charles,
I have fit pt who have had total knee replacements. The most recent
being a bilateral AK / BK.
The most important thing is not to let the knee replacement cause you to
deviate from the basic principles.
As you pointed out, the most noticeable difference is that you can not
apply pressure over the patella tendon area. IceX showed us that patella
tendon pressure is not an essential, in reality those great big patella
tendon bars are more sadistic than anything else.
I would caution you against using the IceX system on a primary amputee.
I have try it and it was painfully unsuccessful. It appeared that a
stump that is not matured can’t tolerate the pressures that the system
requires to provide hydrostatic weight bearing. I further observed that
since the IceX system produces an elongation forcel, distal edema became
a problem.
I suggest the use of a gel liner, following the normal principles for
trans tibial fitting and eliminating the patella bar. If you have an
accurate fit and normal range of motion in the hip and knee, you should
have no problem.
Good Luck!!
Terrance Bloom C.P.(c)
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Mr Martin
I had a 40 something yo female transtibial s/p total knee replacement
several years ago. She unfortunately had an extention contracture which
severly limited knee flexion. She also had some remarkable scarring
around the knee and a noticable firmness there. I also fit her with an
iceross socket to reduce pressure in the proximal socket.. She
unfortunately did not do as well as expected secondary to unresolvable
pain. The knee replacement was stable and never demonstrated any
problems which caused me to question the socket trim lines. I lost
track of her several years ago don’t have any long term information. I
hope this is helpfull.
Keith Cornell CP
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End of replies.
