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At least 19 recordsLinked to original sources
PubMed1987

Disarticulation of the knee in children. A functional assessment.

We assessed the functional abilities of six patients who had had disarticulation of nine knees during childhood by analyzing their gait using electrocardiographic telemetry. Those who were more than five years old were further studied by timing them as they ran the fifty-yard (45.7-meter) dash and by testing the strength of the musculature of the hip girdle using a Cybex dynamometer. The physiological cost-index of Butler et al. was used to assess energy consumption. Three patients had had unilateral disarticulation and three had had bilateral disarticulation. Kinematic studies showed persistent bilateral abduction of the hip throughout the gait cycle in all six patients. The flexion-extension arc of the hip was decreased in the three who had had bilateral disarticulation. Increased flexion of the hip was noted on the normal side and decreased flexion, on the affected side in those who had had unilateral disarticulation. Phase reversal of pelvic obliquity was noted in the amputees who had had bilateral disarticulation. The prosthetic knee showed good flexion during the swing phase. All patients showed a mild decrease in the velocity of gait and in the length of step and stride. The patients who had had unilateral disarticulation showed decreased duration of the bilateral stance and single stance phases and increased duration of the swing phase. Those who had had bilateral disarticulation of the knee had a normal distribution of the components of the gait cycle: bilateral stance, single stance, and swing. The physiological cost-index for all six was within the normal range, indicating minimum energy handicap.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Hip disarticulation: factors affecting outcome.

Hip disarticulation, especially in patients with peripheral vascular disease, has been associated with high morbidity and mortality rates. This report describes patient characteristics that influence the clinical outcome of hip disarticulation. The medical records of all patients undergoing hip disarticulation from 1966 to 1989 were reviewed for surgical indication, perioperative wound complications, and postoperative deaths. Fifty-three patients underwent hip disarticulation for limb ischemia (10), infection (12), infection and ischemia (14), or tumor (17). The overall incidence of wound complications was 60%, and no significant differences were found among the groups. Prior above-knee amputation and urgent/emergent operations were significantly associated with increased wound complications (p less than 0.05). The overall mortality rate was 21%, ranging from 0% (tumor) to 50% (ischemia) and differed significantly among the groups (p less than 0.02). Mortality was significantly associated with urgent/emergent operations (p less than 0.01). Age, diabetes mellitus, and previous inflow procedures did not influence mortality rates. The presence of limb ischemia influenced mortality rates to a greater extent than did infection, and a history of cardiac disease was statistically predictive of death. Wound complications frequently accompanied hip disarticulation, regardless of operative indication, and were significantly increased by urgent/emergent operations and prior above-knee amputation. Hip disarticulation can be performed with low mortality rates in selected patients. Both limb ischemia and infection substantially increase operative mortality rates.

Adult↗
PubMed1987

Therapeutic value of scapular and pelvic girdle disarticulations in sarcoma.

The authors have reviewed 22 cases of proximal disarticulations with the aim of assessing the therapeutic value, taking into account previous radio- and chemotherapy. The following criteria were especially examined: recurrences, survival, quality of life. There were 13/22 soft tissue sarcomas, 9/22 bone sarcomas. In 10 instances, the tumour was primary and treated for the first time whilst, in 12 cases, it was recurrence. Eighteen patients had been previously treated by non radical surgery, 11 by radiotherapy and 10 by chemotherapy. For upper limb tumours, six patients underwent an inter-scapulo-thoracic disarticulation and three an inter-scapulo-thoracic resection according to Tykhor-Lindberg. For lower limb tumours, seven patients were submitted to inter-ilio-abdominal disarticulation, three to coxo-femoral disarticulation and one to internal hemipelvectomy according to Eilber. Mean disease free interval has been 34.5 months and mean survival 38.5 months. Three out of 20 evaluable patients (15%) recurred locally although most of them benefited from second surgery. Quality of life has been excellent in general despite the fact that only seven patients accepted wearing a prosthesis. Karnofsky index ranged between 60 and 100%. No significant difference was seen, whether or not previous radiotherapy and/or chemotherapy had been administered.

Bone Neoplasms↗
PubMed1988

[Extensive coxo-femoral resection with preservation of the thumb for prosthesis. An alternative to disarticulation at the hip].

To avoid the severe mutilation of a hip disarticulation and to improve limb-fitting, a method of partial limb preservation is proposed. Two cases of septic arthritis of the hip with neurological and atrophic lesions sufficient to justify disarticulation are described. Disarticulation was avoided by partial conservation of the thigh with an extensive resection of the upper end of the femur, a through-knee amputation and a large posterior musculo-cutaneous flap including the triceps surae whose muscle provided a good cover for an end-bearing myoplasty. The stump obtained was of good quality which, though a little unstable, was firm and well provided with muscle which allowed early mobilization with a temporary prosthesis and later limb-fitting with much more satisfactory function than that in a hip disarticulation.

Adult↗
PubMed1990

Knee disarticulation with intercondylar patellofemoral arthrodesis. An improved technique.

As compared to an above-knee amputation, the knee disarticulation has several marked advantages that are well known and accepted by most surgeons. However, it has not gained popularity because it leaves a double condylar, bulbous, uneven stump, which is difficult to fit into the base of the socket. In ten patients, a modified surgical technique included moderate trimming of the femoral condylar prominences and patellofemoral arthrodesis in the intercondylar notch. This produces a conical stump with a large area for end bearing, and at the same time allows the standard suction-socket fitting without ischial weight bearing. The average age was 33.1 years (range, ten to 75 years). The indication for amputation was trauma in four cases, tumor in three cases, chronic osteomyelitis in one, ischemia of the leg in one, and congenital malformation in one. Average length of follow-up study was four years (range, one to 9.8 years). Complications were stump ulceration in one case and fistula formation in two cases. Nine patients achieved full weight-bearing ambulation with an end-bearing type of prosthesis. The remaining patient was not fitted with a prosthesis prior to his death from a systemic medical illness. Union of the patellofemoral arthrodesis was achieved in all ten cases. This procedure is recommended whenever knee disarticulation is indicated and ambulation expected. Significant improvement over standard knee disarticulation or distal above-knee amputation can be achieved.

Adolescent↗
PubMed1991

Acute and chronic hemodynamic impact of total right ventricular disarticulation.

Right ventricular disarticulation is a radical operation to control ventricular arrhythmias in patients with arrhythmogenic right ventricular dysplasia. This report describes the acute and chronic hemodynamic impact of the procedure based on our experience of five patients with life-threatening arrhythmias unresponsive to medical therapy who have undergone total disarticulation of the right ventricle. Although all patients suffered acute postoperative hemodynamic problems, all survived and returned to an excellent functional class. Right ventricular disarticulation should be considered in patients with drug refractory ventricular tachycardias due to arrhythmogenic right ventricular dysplasia when the arrhythmia either poses a life threat or results in chronic morbidity.

Adult↗
PubMed1979

Knee disarticulation versus above-knee amputation.

If below-knee amputation is impossible, knee disarticulation should be considered before above-knee amputation, regardless of age and etiology. Knee disarticulation which leaves the femur and patella untoched offers many advantages. The surgical technique is simple and non-traumatic since no bone or muscle tissue is to be dissected. The thigh muscles are completely preserved and thus there is no muscular imbalance. The stump permits total end bearing and its bulbous shape permits easy and firm attachment of the prosthesis. A specially designed double-wall socket and various types of knee joints are presented. Modern prostheses are superior to above-knee prostheses with regard to function, comfort and cosmesis. Results of 72 patients of all age groups are presented and discussed.

Adolescent↗
PubMed1989

Double disability of hemiplegia and hip disarticulation: rehabilitation outcome.

Double disability of hemiplegia and hip disarticulation is uncommon. To our knowledge, there are no reports of such patients and their rehabilitation outcomes. We report on a patient with hemiplegia and hip disarticulation who became independent in prosthetic ambulation and activities of daily living. Motivation, age, good neuromuscular status, and past successful prosthetic use favored the excellent rehabilitation outcome in this patient.

Adolescent↗
PubMed1977

Disarticulation of the knee. A modified technique.

Knee disarticulation provides an excellent level of amputation in the lower extremity, particularly of the younger, active male amputee. Many surgeons, particularly in England, still prefer knee disarticulation when major amputation is required for peripheral vascular disease. Its use has been restricted over the years, largely because of certain prosthetic problems associated with fitting the standard prosthesis. Modification in surgical techniques to allow the incorporation of modern prosthetic design and materials will enlarge the range of usefulness of through-knee amputation. This is particularly true as it relates to the knee control mechanism of the prosthesis. The surgical modifications presented in this report allow modern prosthetic application to the amputation, with maximum functional benefit and retention of the basic functional advantages of amputation at this level.

Amputation, Surgical↗
PubMed1990

Hip disarticulation. An 11-year experience.

Thirty-eight hip disarticulations performed in 34 patients were retrospectively reviewed. The indications were ischemia secondary to atherosclerosis in 17 cases, femoral osteomyelitis in 10, and trauma in 11. Patient ages ranged from 20 to 95 years. The mortality was 60% in patients with ischemia with preoperative infection, 20% in patients with ischemia without preoperative infection, 22% in patients with femoral osteomyelitis, 100% in patients with trauma with preoperative infection, and 33% in patients with trauma without preoperative infection. The overall mortality was 44%. Postoperative wound infections were frequent (63%) and had poor correlation with the presence of a preoperative wound infection. No patient was able to use a prosthesis after hip disarticulation, but most were independent in wheelchairs.

Activities of Daily Living↗
PubMed1992

Initial experience with the disarticulated (one-half) Palmaz-Schatz stent: a technical report.

We developed an alternative method to stent suitable lesions located in anatomical settings considered to be too complex for regular Palmaz-Schatz stent placement. This method consists of using a disarticulated (one-half) Palmaz-Schatz stent. Eight patients underwent stenting utilizing this method. The left anterior descending was stented in five patients, the right coronary artery in one patient, the proximal and mid shaft of a vein graft in one patient, and a protected left main coronary artery in one patient. In all patients the stents were placed in addition to full stents. In four patients, 1 1/2 stents were placed; two patients had 2 1/2 stents; one patient had 3 1/2 stents and the last patient had a total of 5 stents placed (1 full stent and 8 half stents). One patient had 8 disarticulated stents placed. All half stents prepared for delivery were successfully deployed to the pre-designated angiographic site without complication.

Angioplasty, Balloon, Coronary↗
PubMed1986

Computed tomography of the disarticulated incus.

Complete incus disarticulation may be a complication of trauma, chronic otitis, or prosthetic stapedectomy. Purposeful incus disarticulation (with incus interposition) is used as a method of ossicular reconstruction. CT has been a valuable diagnostic tool for preoperative location of the incus in the former disorders and for determination of the status of the ossiculoplasty in the latter.

Ear Ossicles↗
PubMed1987

Hip disarticulation in peripheral vascular disease.

The authors had to perform hip disarticulation on vascular patients in an increasing number - in spite of the general amputation principles. In the majority of the cases hip disarticulation followed other, more distal amputations of the same lower limb. Results of wound-healing, prosthetic fitting and mortality are poor, nevertheless this operation may lengthen life, relieve pain and lead to a tolerable life, usually bound to wheel-chair.

Adult↗
PubMed1992

Surgery for ventricular tachycardia associated with right ventricular dysplasia: disarticulation of right ventricle in 9 of 10 cases.

Ten patients (nine men, one woman; mean age 39 years) with arrhythmogenic right ventricular dysplasia underwent surgery to control life-threatening drug refractory ventricular arrhythmias. All had ventricular tachycardia causing syncope and six had a history of cardiac arrest. In all a minimum of three antiarrhythmic drugs (mean five) had been ineffective. At operation, the right ventricle was grossly diseased in all patients. Ventricular tachycardias were induced and mapped intraoperatively in all patients. The surgical plan was to ablate the arrhythmogenic focus if it was less than 4 cm2; one patient was so managed. Of the remaining nine, four underwent partial (approximately 40% of the right ventricular free wall) and five underwent total right ventricular disarticulation. All survived the operation and are alive at a mean follow-up interval of 24 months (range 5 to 67). Two patients developed new sustained ventricular tachycardias. These were well tolerated and, unlike the original arrhythmias, were easily controlled by drug treatment. All patients who underwent right ventricular disarticulation manifested signs of right heart failure in the early postoperative period, but these lessened progressively with the development of systolic septal movement into the right ventricular cavity. All 10 patients are in New York Heart Association class I or II at last review. In selected patients with arrhythmogenic right ventricular dysplasia, surgery offers a curative treatment for ventricular tachycardia and should be considered for patients whose arrhythmias are life-threatening and refractory to drug treatment.

Adolescent↗
PubMed1990

Atlanto-occipital disarticulation. Accident characteristics.

A retrospective study of cases of atlanto-occipital disarticulation was conducted to describe incident characteristics: 24 cases were identified, including nine motor vehicle drivers, two passengers, seven pedestrians, and five motorcyclists; one other person had fallen four stories. The highest rates were found among motorcyclists and pedestrians. Atlanto-occipital disarticulations occur in high-energy impacts and collisions and are associated with aortic laceration in 25% and basilar skull fracture in 21% of such cases. Current restraint systems and motorcycle helmets do not appear to prevent this generally rapidly fatal injury.

Accidental Falls↗
PubMed1987

Bilateral hip disarticulation in paraplegics with decubitus ulcers.

A small percentage of paraplegic patients develop chronic decubitus ulcers that are unresponsive to the usual plastic surgical maneuvers. We used anatomic and nonanatomic (filleting) approaches to hip disarticulation in three patients with severe chronic cavernous decubitus ulcers. All patients were rehabilitated to wheelchair ambulation, with subsequent healing of the operative sites. This type of therapy might be considered in paraplegics with less compelling reasons for amputation, because of the associated rehabilitation potential.

Colostomy↗
PubMed1992

Hip disarticulation for recurrent vulvar cancer in the groin.

A patient with squamous cell carcinoma of the vulva treated with a radical vulvectomy and bilateral inguinal and femoral lymphadenectomies utilizing separate groin incisions, subsequently developed a recurrence in the skin bridge between the vulvar and groin excisions. Following groin irradiation with chemosensitization, the tumor progressed to involve the superior public ramus and femoral vessels. A left hip disarticulation and resection of a portion of the superior pubic ramus was performed. The patient has been free of disease for 3 years. The advantages of this procedure over a hemipelvectomy include shorter operative time, reduced blood loss, better fascial closure of the abdomen, and the creation of a stump which is more amendable to prosthetic fitting.

Carcinoma, Squamous Cell↗