Summary of Limb Salvage Inquiry, Part 2

Summary of Limb Salvage Inquiry, Part 2

Custom Prosthetic Services Ltd.

8/9/2006

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Hi Geoffrey,

Would a rotationplasty be an option for your patient? If not, you may end up
fitting your patient as a hip disarticulation, given the short femur. Since
he is young, he might well be a candidate for the rotationplasty. Not
exactly esthetically pleasing, but very functional...
Give me a call if you want to discuss...

Warren R Mays, CPO
503.885.9448
Artisan Orthotic-Prosthetic Technologies, Inc.
Tualatin, OR
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At two inches femoral length his ischial tuberosity probably be lower that his femur. If femur is that short he may be fitted with hipdisarticulation prosthesis. So far in my career I have faced this situation 3 times. Trying to fit them AK was the worst thing I tried. I have done about 103 hip disarticulation and hemi put togather.

If amputation will be performe that short my advise will be to fit him with hip disarticulation. If properly done he will do very well. I have fitted patients who can carry plates loaded with hot beverages, do gardening and you name it.

I am going to attach couple citations for you to look at.

If you need any help with siliconized hip disarticulation socket I will be glad to help you.

vks, CP(C) BOCPO LPO(TX) RPOA(ABC)
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Hi Geoff,

I've dealt with similar cases and probable need a whole lot more
information about this man before I can honestly give my best advice.
His age, job status, marital status, family support and psychological
issues are equally as important to end up with a good long-term outcome
that just the length and design of the residual limb. Just recently
I've given up on 3 long-term very short (2 to 4 inch femurs) TF amputees
who at one point were almost full-time prosthesis users with socket
designs varying from roll-on Seal In liner ski-suction fits in quad and
ischeal containment sockets. All 3 of them are now using hip-disartic
style custom silicone sockets and have greatly improved stability and
comfort. The added bulk around the waist is not pleasant. esp. on hot
and humid days, but well worth the change according to them...

Experimenting with bone salvage, allografts and various other surgical
heroics has resulted in recurrence elsewhere and in 3 cases became
dead sentence. But.....................I'm not a surgeon, so who knows.
I can suggest you contact Dr. Doug Smith in Seattle who has many years
of experience in such extreme cases:
<Email Address Redacted>


Tony van der Waarde CP(C)
Certified Prosthetist

604-298-0236

www.awardprosthetics.com
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Why not a Van Ness rotationplasty?

John Rheinstein

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Geoffrey-
Try looking up turn-up plasty on pubmed for the abstracts on papers about
the turn-up plasty where the tibia is inverted and replaces the femur.
Tibial plataeau is distal. One article mentioned that the procedure has
been done several times in the Seattle area and it was a review of progress
of seven of those cases. I was just exposed to my first one from San
Francisco and it was the first time that they have done one in four years.
Good luck.
Tom Cutler, CPO
Sequoia Prosthetics
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I read once about a doctor performing a Total Hip replacement to
lengthen the femur to provide a workable residual limb length,
unfortunately it was not published yet and I do not know if it has been
since to cite as a reference. I'll go look for it and see. It would be
pretty radical, but potentially functional.

Sincerely,
Sam

Sam L. Phillips, Dean
College of Orthotics and Prosthetics
St. Petersburg College
727-341-4150 Phone
727-341-4152 Fax
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Geoffrey,
This may have already been done but I would suggest to the patient to
definitely get a second or third opinion on this before proceeding with the
amputation. He may have an excellent team of physicians following his case
and all options may be exhausted but if he is interested there are other
limb salvage programs he could explore. Here at the UCLA Medical Center,
there is an excellent limb salvage team headed by Dr. Jeffrey Eckardt
( <Email Address Redacted> ) who may be able to offer an alternative treatment
to save his limb. I don't know if he would be willing or would have the
resources to pursue this but Dr. Eckardt is the person I would see before
deciding on the amputation.

-Maurice

Maurice Wada, CO
Director, Prosthetics and Orthotics
UCLA Medical Center
<Email Address Redacted>
(310) 794-1334
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