Factors affecting prosthetic
rehabilitation following hemipelvectomy and hip disarticulation amputations
Ahmad Saif, Rehabilitation Medicine Doctor, RNOH, Stanmore, UK - Ahmadsaif@hotmail.co.uk
Other authors: Imad
Sedki, John Sullivan, Richard Francis
Background:
Hip disarticulation and hemipelvectomy amputations are rare operations and
the subsequent rehabilitation challenging; many opt to forego a prosthetic
limb long-term due to the considerable energy requirements or discomfort from
the cumbersome socket. Evidence is limited on the optimal characteristics
that result in successful prosthetic use in this population. Aim: This study
aimed to characterise those patients referred to a UK tertiary prosthetic
rehabilitation centre following hip disarticulation or hemipelvectomy
procedures to help inform determinants for successful prosthetic use, and
guide priorities during rehabilitation.
Methods:
A search was performed of patients seen at the centre in the last 5 years
with hip disarticulation or hemipelvectomy amputations, and data recorded
regarding details and aetiology of amputation. Similarly, the date of
assessment and delivery of prosthesis, goals, reasons for abandonment, and
projected and achieved outcomes (SIGAM/K level) were noted. Patients who did
not entirely complete the rehabilitation process at the centre were excluded.
Results:
27 patient notes were analysed; 42% were female and 58% male. Most amputation
were at ages 11-30 (30%) and 51-60 (37%). 8/27 (30%) had a hemipelvectomy,
19/27 (70%) had a hip disarticulation. 78% were due to neoplasia, 15% trauma
and 7% infected endoprosthesis. 67% trialled a walking prosthesis; 33% of
these stopped eventually and subsequently used a wheelchair for mobility.
9/27 (33%) patients initially used a sitting socket, of whom only 4/9 (44%)
subsequently used a walking prosthesis. Mean days between amputation and
primary assessment was 148 (IQR 103-185), and between amputation and
prosthetic limb delivery 426 (IQR 366-492). Delays were usually due to
co-morbidities requiring active treatment. Older patients were less likely to
have a trial of a walking prosthesis (Pearson’s correlation coefficient of
increasing age vs prosthetic delivery was -0.9015) but there was no
correlation with increasing age and goal attainment or continued prosthetic
use. Median projected K-level prior to prosthetic use for all age groups was
3, however mean achieved SIGAM and K levels were 1 less than predicted across
all ages; 33% patients above age 40 achieved K2 while 75% patients below age
40 did.
Conclusion:
While younger patients are more likely to be given the opportunity to trial a
walking prosthesis, age does not appear to affect overall outcome and goal
attainment. In cases of neoplasia there is often a delayed start to
rehabilitation and prosthetic use which may affect eventual success. Sitting
socket use aids with expectation management for socket comfort, with the
majority of patients opting not to have a walking prosthesis. While 67% of
our cohort had a trial of a prosthetic limb there is a study limitation due
to selection bias towards those with higher projected outcomes. Many patients
are reviewed by the prosthetic multi-disciplinary team pre and post-surgery
and discharged if they do not have the potential or motivation to use a
walking prosthesis. Further studies are required to define the optimum
characteristics for successful prosthetic use at higher amputation levels.
References:
1. FernÁNdez A, Formigo J. Are Canadian Prostheses Used? A
Long-Term Experience. Prosthetics and Orthotics International.
2005;29(2):177-181.
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