Hip Disarticulation and Pregnancy

Hip Disarticulation and Pregnancy

KEVIN SHAW

9/12/2005

Dear Colleagues

thank you to all that responded to my question:


Does anyone have any experience of female hip disarticulation patients wearing their prosthesis through pregnancy? Any suggestions for modified socket designs would be much appreciated.
Kevin Shaw

Prosthetist, Dorset, UK.



Here are the replies.




Hi Kevin



I have made a few with different materials but the essence of the design is to transfer the forces to the lateral areas, hips ect., and to allow enough space for growth, during the pregnancy. A bell shape to the maximum of the expected expansion should be shaped and made of a rigid material allowing the forces to be transferred to the hips, Velcro or leather straps should be used either side so that the pressure can be divided evenly. If you can make the socket out of flexible lamination or silicone then that would be beneficial. Something to bear in mind is how much weight the person might put on as that will influence the whole socket not only the front section, if a large expansion is expected then extra liners should be made over each other so that they can be stripped away as the growth takes place and put back after the birth, especially for the first few months as the weight around the hips will remain, initially anyway. Hope this helps feel free to ask questions if y!
 ou feel
 the need.



Kevin:

I thought I had heard this question before and by checking the archives at oandp.com I found the following replies to a question posted by Shane Glasford -



 I cannot claim to have a great deal of practical experience in this matter,
but as a hemipelvectomy amputee myself, woman and a physician, I do have a
special interest in sharing whatever information I can offer. Please pass
on my congratulations to your client and hope both you and she are aware of
my web site for the hip-disartic and hemipelvectomy
population: www.hphdhelp.org and this section in
particular: <URL Redacted> (helpful
hints/pregnancy).

SG: Does anyone have any experience with this population?
CS: The ones I know with the most experience are Tony Van der Waarde in
Vancouver: www.awardprosthetics.com <Email Address Redacted>
Kevin Carroll at Hangar in the USA: <Email Address Redacted>

SG: Do you use any special materials, trim lines, designs?
CS: No matter what the materials, the goal is to provide adequate
suspension so she can ambulate safely and securely while providing support
for the expanding uterus. Of course it's possible to cut out large
sections of the socket.....however she should be aware and accept the fact
that her body shape will change after delivery and probably will require a
new socket. Depending on the type of socket she currently has, this may
be easy or not. She must consider the cost...not only in money, but the
time and effort to make all these changes while caring for a newborn. How
will her time be best spent? This should be explained to her. Only she
can decide what is her level of comfort, and level of function.

SG: How long is wearing feasible? 6,7,8 months, full term?
CS: The pregnant uterus reaches the level of the umbilicus at 5 months,
and approx 2 finger breaths below the sternum at term. Yes, it's possible
to wear a prosthetic(HD) to term, but just because it's feasible, ask
yourself (Mom and prosthetist)....is it the smart thing to do? You have
nothing to prove to anyone, it's a matter of personal choice and how she
can best function at this time, what is her comfort level?

SG: Any other advice of information would be appreciated.
CS: The things I would consider are:
1. Are you potentially compromising the safety and welfare of the baby
and mother? Are you risking a fall or injury, is she more safe, secure and
functional in or out of her leg at this time? Only she can answer this.
2. Energy expenditure will increase throughout her pregnancy...oxygen
consumption will increase, more demands will be placed on her pulmonary
and cardiac function. What shape is she in?, was the amputation due to
cancer.....some chemo Rx can cause heart and kidney problems long
term. With the cumulative demands of both pregnancy and amputation, she
should expect the fatigue factor to kick in big time.
3. If she is considering breast feeding, she should expect to maintain a
higher weight than normal in order to consume sufficient calories for her
and baby for X months after delivery. This will impact on the time
frame for fitting a prosthetic post delivery.
4. If she has a normal vaginal delivery, she should expect her pelvis to
change shape afterwards and will probably require an new socket.



I have fit two hip disarticulation and 2 hemipelvectomy amputees. 2 had
prostheses already that I modified to accommodate the pregnancy and the
other two we started from scratch with 2 new prostheses, trying to
incorporate the new body contours to be anticipated. I have a video of one
of them, who gained 60lbs and actually wore the prosthesis right up till the
delivery and immediately afterwards. She continued to wear her prosthesis
without any adjustments necessary afterwards,as the was constructed of
flexible acrylic resin and a silicone inner liner.
All 4 of them wore the prosthesis at least up to the 7th month.



I just got back from the ACA meeting in Aneheim, Ca. where I gave a
presentation on hips and hemis and this topic was discussed at length. We
believe for the babies well being that one should not wear a prosthesis after
the first trimester. Most did wear some sort of sling to help support but
felt that the prosthesis puts too much pressure on the fetus. Hope this
helps. You might check out the website HPHDHELP.ORG


One of the clients we worked with at Gillette Children's Hospital was fit
with
an appropriate pregnancy LSO corset front that we fit into her prosthesis.
she used this for work only and at home used crutches without her
prosthesis.
her job was doing filing and office work at a private dental office so she
needed some hands free mobility. the corset accommodated her body changes,
but this system was in a socket just for the time she was pregnant. we
asked
around about the kind of intrabdominal pressures, and were told not to worry
about it. this was many years ago, at least 15 or 18, so it might be useful
to again consult with a obstetrician about this. she was a transverse
deficiency client, so she was very used to ambulating without the prosthesis
and with crutches at home.

Never had to deal with this one.... but I wonder if you could integrate a maternity support into your HD socket to provide the anterior closure?


Hello there,

                 just a one patient experience on 2 occasions.The existing socket was trimmed away at the front and a leather wrap round section produced to the back midline fitting her shape.... this was added to in sections when adjustability of the overlap had run out...result was a bouncing baby and a mobile mother........the apron was reduced progressively until a new socket could be made....regret we did not keep the first extended socket as the wheel had to be re invented 2nd time around..

 Patient patience is required if this is to be successful to give time to do the leather work...but if explained and planned it is a very successful result.



Dear Mr. Shaw, Just adjust the socket little posteriorly to bring the weight line closer to the knee axis. Slower pace and enhanced stability while walking are the reasons you would do this.



Kevin, I had two female HD patients years ago that both went on crutches when the baby grew to much and made the prosthesis uncomfortable. Sorry if this is not what you wanted.



Kevin,

Depending how the patient is carrying and how much weight is gained

dictates

how the socket can be modified to accommodate the pregnancy. If your

socket

has a flexible front and the patient is carrying with all of her weight

anterior the socket wall on the side of the hip disarticulation may

need to

be modified and lowered so as not to apply pressure to the womb.

Another

option would be to fabricate a surlyn or similar socket that could be

modified as you go by using a bivalve setup which allows anterior

expansion

by adjusting the closure. This can be done with either elastic straps

and

buckles or elastic Velcro or plain leather and buckles. The most

difficult

time will be at the end of the second trimester going into the third as

the

weight gain and position of the baby changes in the womb. In some cases

we've needed to add a cloth front instead of the plastic.




.


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