Surgical recommendation: TF vs TT with a fused knee

Surgical recommendation: TF vs TT with a fused knee

j hartman

6/26/2010

Pt is 50 y/o who has had a fused knee (b/c of trauma & failed TKR) for the past 10 years. Over this time activity has been very limited and pt wants to get back to hiking/snowboarding/other sport activities. Even with limited activity pt is now in a w/c secondary to his ankle being worn out/painful and is also having significant pain mid tibial area without any clear dx. We are trying to decide the better amputation level TF vs TT. My concerns are with the TT with flexion moment at heel strike to the distal anterior tib without any knee flexion, the unclear pain present here already, limited motion in most prosthetic feet, and the continued substitution with a fused knee to perform ADLs. Of course the normal factors deciding between a TF vs TT would favor the TT; and I realize we could go back and do the TF later but really who would wants to go through all this twice. I was wondering 1. if anyone has worked with a TT with a fused knee and the outcomes
 2. if you prefer TT in this situation why and what components(motion control vs proprio foot?) 3. if you suggest TF why? Thank you for your opinions.

Jay Hartman, CPO