This case study is the first study done in this regard. As can be seen from Table 4 , the mean value of excursion of COP was 4.
It seems that the subject was more stable than normal subjects. However, it should be emphasized that in this study the stability was evaluated during quiet standing. The results of stability of quiet standing also represented the suitability of crutch to improve standing stability.
It should be emphasized that as there was no muscular support around the hip, knee, and ankle joints the subject was not able to have a dynamic stability. Moreover, his behavior may differ from normal subject when a protrusion force was applied. The alignment of prosthesis components may be the other reason for better stability of the subject.
The alignment of prosthesis component keeps the leg in an extended posture which is quite stable during standing [ 7 ]. Although there are few studies on the gait analysis of subject with hip disarticulation amputation, there is no study on hemipelvectomy amputation.
The result of this research showed that there was a significant asymmetry between the kinetic and kinematic performance of the sound and prosthesis sides which may be due to lack of muscular power and alignment of prosthesis component. It has been recommended to use the data of this study to design prosthesis components. The authors declare that there is no conflict of interests regarding the publication of this paper. National Center for Biotechnology Information , U.
Journal List Case Rep Orthop v. Case Rep Orthop. Published online Apr Kamali , 1 H. Omar , 2 and Javid Mostmand 3. Box , Isfahan, Iran Find articles by M. Author information Article notes Copyright and License information Disclaimer. Karimi: moc. Received Aug 25; Accepted Oct Karimi et al.
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background. Introduction Lower limb amputations have been done as a result of trauma, vascular disease, cancer, and so forth. Case Description and Methods A subject with hemipelvectomy amputation at right side was involved in this study Figure 1 a.
Open in a separate window. Figure 1. Figure 2. Parameter The spatiotemporal gait parameter walking speed, cadence, stride length, and percentage of stance phase , the moments applied on the lower limb joints, the three planar motions of the lower limb joints and trunk, and the force applied on the legs during walking were the parameters collected in this study. Procedure Kinetic and kinematic assessments were performed in the gait lab using seven cameras of a three-dimensional 3D gait analysis system Qualisys Motion Analysis System and a force plate Kistler.
Findings and Outcomes The range of motion of the ankle, knee and hip joints in three planes is shown in Table 1. Table 1 The range of motion of the ankle, knee, and hip joints in three planes. Table 2 The kinematic parameters of pelvic and thorax in normal and amputed sides. Table 3 The mean values of the moment applied on the ankle and knee joints and the force transmitted through both sides. Discussion Hemipelvectomy amputation is a surgical procedure in which the lower limb and a portion of pelvic are removed.
Table 4 The mean value of stability parameters of the participant under eyes opened and closed condition. Parameter Mean value Open eye Closed eye Path length x Conclusion Although there are few studies on the gait analysis of subject with hip disarticulation amputation, there is no study on hemipelvectomy amputation.
Conflict of Interests The authors declare that there is no conflict of interests regarding the publication of this paper. References 1. Dillingham T, Mackenzie E. Limb amputation and limb deficiency: epidemiology and recenttrends in the United States. Southern Medical Journal. The British Journal of Surgery. Rehabilitation of patients after hip disarticulation. Archives of Orthopaedic and Trauma Surgery. Total hip disarticulation prosthesis with suction socket: report of two cases. Energy consumption during prosthetic walking and physical fitness in older hip disarticulation amputees.
Journal of Rehabilitation Research and Development. If the operation is performed to remove a cancerous tumor, then the tumor will most likely be sent to a lab for assessment. Depending on the results of the analysis, then more bone and tissue samples might be removed and examined until the samples finally come back clean. Surgical reconstruction is standard following any lower extremity amputation. This will usually involve a skin-transplantation graft or flap procedure to recreate the pelvic area and protect the remaining structures — while also protecting any attached metal screws, plates, or other sensitive materials.
Immediately following the procedure, postoperative care will be provided for varying lengths of time within the hospital or intensive care unit. A thorough surgical assessment will also be implemented to reduce or treat any possible wound infections or necrosis and further ensure your health and safety before you can leave the hospital grounds and continue recovery at home. With that said, finding the right physical and occupational therapists, continuing your follow-up care at an outpatient clinic, and staying up to date with routine blood work and tests will all work wonders when it comes to coping with these emotions in a healthy and productive way.
There is also an abundance of support groups and resources , both online and in your community, that can provide opportunities for open dialogue and education as you transition back into daily life. Some of these groups and resources include:. When it comes to prosthetic options for pelvic amputations — or any lower extremity amputations, for that matter — the highly trained team at MCOP can help steer you down the right path.
In our clinical experience, hemipelvectomy amputees can be great candidates for powered prosthetic devices. It also reduces the risk of falling and improves posture while sitting. With a wholly unique joint design, this high-tech hip replacement replicates the natural gait cycle by allowing for three-dimensional and safe movement.
We find this product to be much better than conventional hip joint systems, which typically only allow for restrictive, one-dimensional forward-and-backward movements.
For external hemipelvectomy clients, we find that some of the more technologically advanced devices do indeed offer the best mobility options by replicating the movements of the knee, another complex joint. The built-in PowerLogic Workbench software enables our prosthetists and physical therapists to monitor clients and give real-time visual feedback in regards to how they are using the device and optimize the device aspects that will improve stability and mobility for each individual.
Clients can also easily report on their performance and progress, allowing for convenient documentation and tracking over time.
It allows users to keep their long-term healthcare costs low and prevents the need for future surgeries or amputations by reducing the hard load on your remaining joints over time.
The Pro-Flex XC also uses innovative pivot technology to reduce south-side steps, allowing uses to experience a comfortable form of mobility that closely emulates natural foot movement.
For amputees who want to enjoy activities from regular day-to-day to intensive jogging and hiking, the Pro-Flex XC makes for an ideal lower-limb prosthetic. With each step, it provides a powered push-off to propel the wearer forward. J Trauma ; Imler C, Quigley M: A technique for thermoforming hip disarticulation prosthetic sockets. Pinzur MS, et al: An easy-to-fabricate modified hip disarticulation temporary prosthesis technical note. Ann R Coll Surg Engl ; Those who remain dependent on dual canes or crutches for balance eventually realize that mobility with crutches and the remaining leg, without a prosthesis, is much faster and requires no more energy expenditure than using a prosthesis does.
Prosthetic fitting is typically limited to motivated and physiologically vigorous individuals; still, a significant number do not become long-term wearers. To investigate this further, the senior author T. W studied a group of 20 male and female hip disarticulation and transpelvic amputees who were representative of the age and diagnoses typically encountered. After a 3-year follow-up during which these patients were fitted with a totally new prosthesis that included a novel silicone rubber socket Fig 21B Ninety percent of those polled reported that increased comfort was the main reason for using the prosthesis more often.
Other significant reasons were less effort when walking and improved appearance of the prosthesis. Interestingly, the actual weight of the prosthesis had increased in several cases due to incorporation of more sophisticated componentry such as units to absorb torque while walking.
Reference The traditional device prior to consisted of a molded leather socket with a laterally placed locking hip joint called a tilting-table prosthesis. Often shoulder straps were required for suspension. Gross pelvic thrust was required to propel the prosthesis, and a vaulting gait was common. A radical departure, later termed the "Canadian" design, was introduced by McLaurin in Fig 21B This unique approach demonstrated the feasibility of using unlocked hip, knee, and ankle joints that relied on biomechanics to achieve stance-phase stability while permitting flexion at the hip and knee during swing phase.
Marx HW: Some experience in hemipelvectomy prosthetics. This is now the standard for prosthetic fitting worldwide, and locking joints are very rarely necessary. A molded plastic socket encloses the ischial tuberosity for weight bearing, extends over the crest of the ilium to provide suspension during swing phase, and affords excellent mediolateral trunk stability by fully encasing the contralateral pelvis.
The sections dealing with joint and foot mechanisms are reprinted, with minor modifications, from Michael J: Clin Prosthet Orthot ; Fig 21B At toe-off, the heel rises up during knee flexion and pulls the hip joint firmly against its posterior extension stop. The thigh segment remains vertical until the knee has reversed its direction of motion and contacted the knee stop. Only then does the thigh segment rotate anteriorly and cause the hip joint to flex.
In essence, the prosthesis is at its full length during midswing. Since the patient has no voluntary control over any of the passive mechanical joints, the prosthetist is forced to shorten the limb for ground clearance.
In an effort to overcome this limitation, the hip flexion bias system was developed for the young, active amputee who wished to walk rapidly. Hampton F: A Hemipelvectomy Prosthesis. Not only does this provide the amputee with a more normal-appearing gait, it also improves ground clearance.
As a result, the prosthesis can be lengthened to a nearly level configuration in most cases Fig 21B However, two potential problems have been noted with this approach.
One is the development of annoying squeaks in the spring mechanisms after a few months of use, which sometimes tend to recur inexorably. A more significant concern is that as the spring compresses between heel strike and midstance, it creates a strong knee flexion moment.
Unless this is resisted by a stance control knee with a friction brake or a polycentric knee with inherent stability, the patient may fall. Since the friction-brake mechanisms lose their effectiveness as the surface wears, the polycentric knee is the preferred component with this hip mechanism.
Another hip joint option is the Otto Bock four-bar knee disarticulation joint mounted in reverse as proposed by Peter Tuil of The Netherlands Reference Benefits claimed are parallel to those expected from a polycentric knee unit: increased ground clearance during swing phase due to the inherent "shortening" of the linkage in flexion and enhanced stability at heel strike amputees comment favorably on the smooth deceleration and good appearance while sitting that this joint offers.
Other than the exception discussed above, knee mechanisms are selected by the same criteria as for transfemoral above-knee amputees. The single-axis constant-friction knee remains the most widely utilized due to its light weight, low cost, and excellent durability.
Friction resistance is often eliminated to ensure that the knee reaches full extension as quickly as possible. A strong knee extension bias enhances this goal and offers the patient the most stable biomechanics possible with this mechanism. Although the single-axis type was proposed as the knee of choice for the Canadian hip disarticulation design, more sophisticated mechanisms have proved their value and are gradually becoming more common.
The friction-brake stance control safety knee is probably the second most frequently utilized component. Because there is very little increase in cost or weight and reliability has been good, many clinicians feel that the enhanced knee stability justifies this approach, particularly for the novice amputee.
Missteps causing up to 15 degrees of knee flexion will not result in knee buckle, which makes gait training less difficult for the patient and therapist. The major drawback to this knee is that the limb must be non-weight bearing for knee flexion to occur. Although this generally presents no problem during swing phase, some patients have difficulty in mastering the weight shift necessary for sitting.
It should be noted that use of such knee mechanisms bilaterally must be avoided. Since it is impossible for the amputee to simultaneously unload both artificial limbs, sitting with two stance control knees becomes nearly impossible.
A third type that has proved advantageous for this level of amputation is the polycentric four-bar knee. Although slightly heavier than the previous two types, this component offers maximum stance-phase stability. Because the stability is inherent in the multilinkage design, it does not erode as the knee mechanism wears during use.
In addition, all polycentric mechanisms tend to "shorten" during swing phase, thus adding slightly to the toe clearance at that time. Many of the endoskeletal designs feature a readily adjustable knee extension stop. This permits significant changes to the biomechanical stability of the prosthesis, even in the definitive limb. Because of the powerful stability, good durability, and realignment capabilities of the endoskeletal polycentric mechanisms, they are particularly well suited for the bilateral amputee.
Glattly HW: A preliminary report on the amputee census. At first glance, a manual locking knee seems a logical choice. However, experience has shown that this is rarely required and should be reserved as a prescription of last resort. Only additional medical disabilities such as blindness will require this mechanism. Unlocking the knee joint in order to sit requires the use of one hand in the unilateral case; expecting a bilateral amputee to cope with dual locking knees and dual locking hips is unrealistic.
Furthermore, in the event of a fall backwards, fully locked joints may prevent the amputee from bending his trunk to protect his head from impact. For many years, the use of fluid-controlled knee mechanisms for high-level amputees was considered unwarranted since these individuals obviously walked at only one slow cadence. The development of hip flexion bias mechanisms and more propulsive foot designs have challenged this assumption.
Furthermore, a more sophisticated understanding of the details of prosthetic locomotion has revealed an additional advantage of fluid control for the hip-level amputee. It is well accepted that any fluid-control mechanism hydraulic or pneumatic results in a smoother gait.
Gait analysis has demonstrated that utilization of a hydraulic knee in a hip disarticulation prosthesis results in a significantly more normal range of motion at the hip joint during the walking cycle than is possible with conventional knees. In addition, a more rapid cadence was also possible. Van der Waarde T: Ottawa experience with hip disarticulation prostheses. The preferred mechanism has separate knee flexion and extension resistance adjustments. A relatively powerful flexion resistance limits heel rise and initiates forward motion of the shank more quickly.
In essence, the limb steps forward more rapidly.
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