residual limb length responses

residual limb length responses

Ian Gregson

7/15/1999

Fellow OandP'ers:

The following response arrived over the last 12 hours, if there are
more I'll post them tomorrow (Thurs).

I'm in the process of finding out who the surgeon was and if I manage
to do that I'll forward these emails to him/her.


Thanks for the response


---------------------



I am equally appalled as you are that they would not leave that extra
length. I would hope there were other circumstances involved in the
decision.

I am not surprised though that it could happen. There isn't a lot of
communication between prosthetists and doctors. So, neither of us
have our facts straight all the time. You would think on an issue
like this that doctors would pay more attention or ask more questions.

I have encountered a somewhat similar problem. Doctors in my area
sometimes try so hard to save a limb that they actually do the
patient a disservice. I had a patient who had a plantar ulcer. The
doctors suggested amputation but the patient was hesitant. So, they
tried to save as much as possible. First they amputated the big toe,
then they did a transmetatarsal amputation. Eventually, the entire
lower leg had problems so they amputated above the knee!! This
gentleman had been off his feet for FOURTEEN MONTHS and was very week.

I think he would have been much better off had they a transtibial
amputation early on. This gentleman would have been able to get on
with his life.

Well, hope that's food for thought. I just needed to vent.

Thanks,

Matt Bailey, CPO


-----------------


My DAKs were the result of the same type of decision by an Ortho-Chopper. I
don't regret not have a Knee disartic. but I will always wonder if my stumps
would be better for prosths? I have long stumps of the same length, cut just
above my knees.
I drew a line with a magic marker and told the guys: do not cut above this
line!. I wear great prostheses and since I am a double what would have been
the big deal to have made me a double knee disartic instead? I don't/didn't
get it. But what is lost is lost. Not a point to argue now. These fuckin
Docs really creep me out--playing God and little understanding, bad listening
skills and zero follow-up. My only thrill will be the efficacy of KARMA.
These butchers will pay!!!!!!

Mike Russell
<Email Address Redacted>

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I don't belive you will find a sound arguement from a prosthetist that a long
AK is prefferable to a KD (particularly on a male where cosmesis is generally
less of a consideration) and especially when you consider that he is a BK on
the opposing side. If you do I would like to hear it.

Eddie V. White,CP

------------------


When my surgeon discussed my amputation with me, the affected part was
really only on my foot up to and including the heel. I asked him why he
could not just take the foot i.e. through the ankle and he told me that
I would be able to walk better and have a better prosthetic limb if I
had a bk amputation. He indicated that in his opinion I would be better
off having it done below the knee

At the point in time I was still extremely weak having just come out of
ITU for three weeks and not knowing any better I took his advice.

I only think his advice was valid now in retrospect, having ended up
with an ak amp.

I would be really interested to hear other people's comments on this.

JO

----------------


  I've found in my practice the benefits of a distal 1/3 transfemoral
amputation vs. a knee disarticulation are as follows.
Knee disarticulation benefits:
1. All of the musculature of the thigh is in tact and attached so
there is more control over the prosthesis and not any migration of
the femur.
2. There is some end bearing of weight so theoretically the socket
does not need an ischeal seat so it can be trimmed lower ( I've never
been so lucky though)
Distal 1/3 transfemoral amputation benefits:
1. Suction suspension ( the prosthesis seems lighter). This includes
3S system with room for the shuttle lock and even a knee unit.
2.A wider variety of knees available since the length of the distal
end of the residual limb is farther from the anatomical knee center.
This also will allow more room for better feet also.
3. Better cosmesis with the knee centers being even. The knee unit
will operate the way that it's intended when the shank section is at
the right length.

Surgeons are aware of most of these points and are doing this for the
benefit of our patients not for the Prosthetist benefit at all.

I hope that I've given you the answer you've been looking for.
M. Britt Spears CPO

--------------------


Ian, I think this is an example of old conventional ideas that continue to be
propagated despite new information. Knee disartics have a lot of advantages
over Trans Femorals, but I am not surprised that many surgeons would still
cut off a few inches because they thought they were doing the pt-client? a
favor.
-Mark B

-------------------


Charles Truax, who was an instrument maker wrote a genius book printed in
1899, which states:

The golden rule usually practiced in amputations has been to save
everything possible, and to appreciate how rigidly this has been adhered
to....

Donald G. Shurr


-------------------


Lopping off?? You can do better than that can't you, how bout some
compassion!

<Email Address Redacted>

-------------------


  I don't think it was simply a matter of convenience for the prosthetist, but
a consideration of all the factors involved.
I have been a prosthetist for 30 years and I would not allow a KD amputation
on myself or a family member due to the problems with knee center, serious
limitations of componentry and in my experience, KD amputees never walk as
well as long AKs.
I fully understand the rationale for leverage and end bearing, however, most
of the KDs I have had the pleasure to service have not been able to tolerate
full end bearing and we ended up with some type if ischial support system to
partially unload the distal tissues. It is also often very difficult to
control rotational forces without a secure fit in the inguinal and
subtrochanteric area. The cosmetics of the longer thigh section are almost
always unacceptable to the clients.
I remember working with a young male (16) traumatic through the knee amputee
many years ago who was very bitter because his surgeon had told him that
because he still had his knee, he would walk normally. He in fact had only
his femoral condyles and patella. I was never able to convince him that he
must walk like an AK because he did not have a knee. He finally went
elsewhere in disgust.
My opinions, for what they are worth.
Ron Kidd CPO

------------------


Very common indeed. I would say that it is the norm in most medical
centers. I have long advocated greater use of the knee disarticulation. It
is a VERY functional level of amputation. I've discussed this preference
with both surgeons and other prosthetists. My experience is that my opinion
is clearly in the minority.

Ted Trower

-------------------


You know my opinion on saving all limb length at any level. Fitting a knee
disarticulation is noy all that difficult if the amputee understands the
extra thigh length beyond the natural side, while sitting. Having
distal-end bearing is of tremendous advantage!

Tony van der Waarde

---------------------

Ian, in my opinion, having worked with fitting both knee-disarticulation and
long AK's, there is no argument as to which residuum gives the best results
in terms of function and cosmesis for the amputee. The 'thru-knee' stump
certainly can be walked on, but the necessity to play around with the knee
axis, frequent problems with the end-bearing nature of the stump and
relative thigh length discrepancies (especially while sitting) all point to
a less satisfactory result for the amputee.
The surgeon sounds to me like an enlightened one, unless he could have saved
the knee.
kind regards, Richard Ziegeler



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