Responses - BKA pending TKA surgery
Ralph W. Nobbe, CPO
Description
Collection
Title:
Responses - BKA pending TKA surgery
Creator:
Ralph W. Nobbe, CPO
Date:
2/28/2011
Text:
Original post at end.
In brief: I received 13 responses, 7 of which all suggested thigh corset
and lacer, 1 suggested rigid, composite, thigh component to maximize
offloading and control varum. 3 described transtibial amputees that had
undergone TKA.
All three iterated the same concerns: initial need for ROM using CPM
machine, limited ability to participate with therapy. One suggestion
included conversion to KD if any complications, ie infection, etc would
delay or compromise outcome and return to ambulation.
The most practical recommendation included use of IPOP type fitting to
facilitate CPM, ROM and physical therapy with limited WB initially.
Our plan now incorporates: use of an early fitting temp prosthesis for
initial 3-6 weeks postop, likely synthetic casting tape over all
dressings, etc. to allow early WB as directed by MD and use of CPM.
We will then progress as MD, incision and tolerance permit with interim
design likely as a socket change/extended use test socket.
Apologize for my delay in posting, went skiing during all the recent
west coast storms.......
Thanks for suggestions and patience!
Original follows:
Hello all, need some assistance on this one.
Patient is an established, well adjusted, 63yo male with traumatic BKA
approximately 30 yrs ago. Has been a very successful, highly active
prosthetic user to date. Initial injury also resulted in multiple
fractures of both LE including amputation side and ligamentous
disruption of ACL and LCL with varum instability on BK side.
This has been managed using a custom OA type unloader orthosis fitted
over prosthesis with some additional alignment compensation (foot
outset)to reduce the varum moments.
This varum instability and associated pain have increased significantly
in past three-six months. He has had some other unrelated health issues
over the past year resulting in hospitalization and generalized health
deterioration.
His orthopedist has suggested a Total joint replacement.
We have successfully fit several patients that had prior TKA then went
on to BKA without issue. Over the years I have had BK amputees that went
on to total hip replacement as well, just never encountered this one.
Functionally and prosthetically our concerns include: location of scar
tissue anteriorly, dressing bulk, weight bearing capability in early
post op phase, CPM use for first three weeks post op and then the ROM
stretching protocols typically required following TKA, in addition to
the standard infection risk, etc.
I would anticipate a significant risk of range of motion loss,
particularly flexion as a result of a reduced ability to comply with
PTher regimen - due to other heatlh issues and BKA. I also anticipate a
lot of volume issues and scar tissue management challenges anteriorly.
We have already suggested he get a second opinion.
What else should be considered? Anyone else work with a BKA that had a
TKA on the amputated side? What was the functional outcome?
As a final note, would he be better off as a Knee disartic? this would
seem to have the immediate advantage of reduced recovery time, reduced
therapy, etc, but imposes additional prosthetic issues.
Will compile and post responses. Thanks in advance.
--
Ralph W. Nobbe, CPO
Nobbe Orthopedics, Inc.
3010 State Street
Santa Barbara, CA 93105
(805) 687-7508 tel
(805) 687-6251 fax
<Email Address Redacted>
www.nobbeorthopedics.com
CONFIDENTIALITY NOTICE: This electronic message is intended to be
viewed only by the individual or entity to whom it is addressed. It
may contain information that is privileged, confidential and exempt
from disclosure under applicable law. Any dissemination, distribution
or copying of this communication is strictly prohibited without our
prior permission. If the reader of this message is not the intended
recipient, or the employee or agent responsible for delivering the
message to the intended recipient, or if you have received this
communication in error, please notify us immediately by return e-mail
and delete the original message and any copies of it from your computer
system.
In brief: I received 13 responses, 7 of which all suggested thigh corset
and lacer, 1 suggested rigid, composite, thigh component to maximize
offloading and control varum. 3 described transtibial amputees that had
undergone TKA.
All three iterated the same concerns: initial need for ROM using CPM
machine, limited ability to participate with therapy. One suggestion
included conversion to KD if any complications, ie infection, etc would
delay or compromise outcome and return to ambulation.
The most practical recommendation included use of IPOP type fitting to
facilitate CPM, ROM and physical therapy with limited WB initially.
Our plan now incorporates: use of an early fitting temp prosthesis for
initial 3-6 weeks postop, likely synthetic casting tape over all
dressings, etc. to allow early WB as directed by MD and use of CPM.
We will then progress as MD, incision and tolerance permit with interim
design likely as a socket change/extended use test socket.
Apologize for my delay in posting, went skiing during all the recent
west coast storms.......
Thanks for suggestions and patience!
Original follows:
Hello all, need some assistance on this one.
Patient is an established, well adjusted, 63yo male with traumatic BKA
approximately 30 yrs ago. Has been a very successful, highly active
prosthetic user to date. Initial injury also resulted in multiple
fractures of both LE including amputation side and ligamentous
disruption of ACL and LCL with varum instability on BK side.
This has been managed using a custom OA type unloader orthosis fitted
over prosthesis with some additional alignment compensation (foot
outset)to reduce the varum moments.
This varum instability and associated pain have increased significantly
in past three-six months. He has had some other unrelated health issues
over the past year resulting in hospitalization and generalized health
deterioration.
His orthopedist has suggested a Total joint replacement.
We have successfully fit several patients that had prior TKA then went
on to BKA without issue. Over the years I have had BK amputees that went
on to total hip replacement as well, just never encountered this one.
Functionally and prosthetically our concerns include: location of scar
tissue anteriorly, dressing bulk, weight bearing capability in early
post op phase, CPM use for first three weeks post op and then the ROM
stretching protocols typically required following TKA, in addition to
the standard infection risk, etc.
I would anticipate a significant risk of range of motion loss,
particularly flexion as a result of a reduced ability to comply with
PTher regimen - due to other heatlh issues and BKA. I also anticipate a
lot of volume issues and scar tissue management challenges anteriorly.
We have already suggested he get a second opinion.
What else should be considered? Anyone else work with a BKA that had a
TKA on the amputated side? What was the functional outcome?
As a final note, would he be better off as a Knee disartic? this would
seem to have the immediate advantage of reduced recovery time, reduced
therapy, etc, but imposes additional prosthetic issues.
Will compile and post responses. Thanks in advance.
--
Ralph W. Nobbe, CPO
Nobbe Orthopedics, Inc.
3010 State Street
Santa Barbara, CA 93105
(805) 687-7508 tel
(805) 687-6251 fax
<Email Address Redacted>
www.nobbeorthopedics.com
CONFIDENTIALITY NOTICE: This electronic message is intended to be
viewed only by the individual or entity to whom it is addressed. It
may contain information that is privileged, confidential and exempt
from disclosure under applicable law. Any dissemination, distribution
or copying of this communication is strictly prohibited without our
prior permission. If the reader of this message is not the intended
recipient, or the employee or agent responsible for delivering the
message to the intended recipient, or if you have received this
communication in error, please notify us immediately by return e-mail
and delete the original message and any copies of it from your computer
system.
Citation
Ralph W. Nobbe, CPO, “Responses - BKA pending TKA surgery,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 17, 2024, https://library.drfop.org/items/show/232337.
