[Lower-leg amputation and prosthesis fitting in patients with vascular diseases with special reference to immediate prosthesis fitting].
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The authors describe a modified technique for knee joint disarticulation surgery. Their approach provides two flaps, one medial and one lateral, which result in a posterior, longitudinal scar that remains outside the contact areas of the prosthesis. They abrade the lateral and posterior aspect of each condyle, peeling out the articular cartilage and re-covering the condyles with the joint capsule. This technique allows a satisfactory stability in prosthetic rotation, and improves the appearance of the artificial limb. For post-operative rehabilitation the authors use a tridimensional alignment jig and a prosthetic ankle with three degrees of freedom: flexion-extension, lateral-medial motion and rotation, making easier the swing phase while maintaining the obvious advantages of a pilon-type prosthesis.
Migration and lucencies around the acetabular component were evaluated in serial roentgenograms of patients with osteoarthritis treated with total hip arthroplasty (THA); 207 were Charnley and 114 were Brunswik THAs. In this consecutive series of THAs followed for nine to ten years, the loosening rate (corrected for deaths and revisions) was significantly higher (35%-45%) in the Brunswik snap-fit sockets (bearing surface 35 mm in diameter) than in the Charnley sockets (5%-12%). Presumably, mechanical factors, i.e., friction torque and impingement, are responsible for the difference in durability between the two designs.
93 subjects (age = 65 +/- 10 years) with lower limb amputation ensuing from peripheral vascular disease performed a graded exercise test on arm cranking ergometer with an electromagnetic braking to assess their physical fitness and cardiac condition before starting a prosthetic training programme. The protocol was continuous with a workload increment of 10 watts every two minutes. Heart rate, blood pressure and ECG were recorded at each stage. Reasons to stop the test were 1) arm muscle fatigue, 2) reaching of target heart rate, 3) cardiovascular abnormalities. At the end of the test, the mean percentage of maximum heart rate was 53%, 92%, and 66% for each of these reasons, respectively (p less than .0001). Results showed that subjects who received a prosthesis had a higher exercise capacity than those who did not get a prosthesis (39.0 watts vs 18.5 watts, p less than 0.001). Furthermore, maximal oxygen uptake (4.4 METs vs 3.0 METs, p less than 0.001) and reached maximal heart rate (131 vs 110 bpm, p less than .005) were both higher in subjects of prosthesis group. Results suggest that a graded exercise test at the beginning of prosthetic training allows a rehabilitation team 1) to predict the success of the prosthetic process and 2) to identify subjects for which this process could increase the risks of health problems.
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