Hemipelvectomy Considerations: RESPONSES
Spencer Doty
Description
Collection
Title:
Hemipelvectomy Considerations: RESPONSES
Creator:
Spencer Doty
Date:
11/28/2012
Text:
Hello again,
Thanks to everyone for their valued feedback and suggestions. As requested, here are responses to my previous post. As a side note, after several discussions with various sources I've opted to go with the Otto Bock Helix/Cleg combination. Best Wishes. - Spencer
We recently moved a client from a Bock 7E7/3R60/1E56 (which he liked a lot) combo over to a 7E7/C-Leg/1E56 (Which he liked even more) to a Helix/C-leg/1E56 Combo which now that he's used to it, likes the best. We did have to play around with torque adapters in the C-leg pylons - He plays golf, works out, skis, varies his cadence, etc. but the transverse plane movement of the Helix + the torque adapter from pylon ended up being too much force going through the prosthesis and causing a bit of instability (or at least the sensation of instability). Socket-wise he has a standard flexible insert with laminated hard socket. The trimlines are fairly proximal, although this client is used to the support - just proximal to the sound side Iliac crest level throughout. His abdomen is loaded a fair amount during gait thanks to the Helix, so we had to make sure our volume was dead on, and that there was enough preloading going on. Client is in his 40s now, but he's been a hemi since he was about 20.
Use the pediatric littig hip, the adult strut is too rigid for a 200lb man.
the vacuum design with a puck is the way to go. stan patterson at poacfl is the one to talk to. go to www.poacfl.com< <URL Redacted>> for contact info.
Don't know about you but take a good look at the helix hip. I have had 2
young bilateral HP/TF amps sucessfully use this hip. In combination with the
C-leg, it is like comparing a horse and cart to a car. In combination to a flexible silicone and carbon framed skt, open front and
ratch rear you can make a fantastic comfortable socket.
During my P residency, I saw a young man with a hemipelvectomy, I
provided him a sitting socket. My residency was up by the time he
would have advanced to a full prosthesis, however, the sitting socket
that we made utilized ski boot clips (if you know what I mean) to
secure the unaffected-side waist groove pad. The clips allowed the
patient to tightly secure the prosthesis with ease. Also, if 2 of the
receiving clips are on the socket, the tension on the waist groove pad
can be somewhat directed anteriorly or posteriorly by the patient,
depending on how it is ratcheted down. I really liked this part of
the design. Also, we were discussing the idea of fabricating the socket out of
polytol with an internal rigid frame, as polytol has an inherent
tackiness to it which may help with suspension (Otto Bock C-Fab). I
don't have an outcome for you with the polytol, just something to
think about.
The Total Knee is a little difficult to unlock late in stance so often those patients do not unlock the knee. The smaller Ottobock hydraulic High activity knee is nice though. If your patient can manage the silicon shorts that Stan Patterson makes it can help with suspension, other wise I would suggest a side opening diagonal design that would be lower profile. I don't know if you need to go single axis on the foot, the C-stance or other type of rolling heel works well for these patients. Here is a picture of a Hemipelectomy I saw. Look at the opening on the involved side.
Tough case. One of the most important factors aside from the socket design
is the knee. I would not use a Total knee for this type of amputee. You
will need a knee that will flex easily. When you do your alignment you
will want to set the knee posterior to the center of gravity as much as
possible. This will make it extremely stable and if you use a Total Knee
in place of a free knee, she will never be able to flex it to sit down.
Other than that I think you should be fine. Good luck,
Sincerely,
Spencer Doty, CPO, MBA
President - Active Life, Inc.
2222 Santa Monica Blvd #405
Santa Monica, CA 90404
Office: (310) 315-2780
Private/Direct Fax: (818) 478-3457
IMPORTANT WARNING: This email (and any attachments) is only intended for the use of the person or entity to which it is addressed, and may contain information that is privileged and confidential. You, the recipient, are obligated to maintain it in a safe, secure and confidential manner. Unauthorized redisclosure or failure to maintain confidentiality may subject you to federal and state penalties. If you are not the recipient, please immediately notify us by return email, and delete this message from your computer.
Thanks to everyone for their valued feedback and suggestions. As requested, here are responses to my previous post. As a side note, after several discussions with various sources I've opted to go with the Otto Bock Helix/Cleg combination. Best Wishes. - Spencer
We recently moved a client from a Bock 7E7/3R60/1E56 (which he liked a lot) combo over to a 7E7/C-Leg/1E56 (Which he liked even more) to a Helix/C-leg/1E56 Combo which now that he's used to it, likes the best. We did have to play around with torque adapters in the C-leg pylons - He plays golf, works out, skis, varies his cadence, etc. but the transverse plane movement of the Helix + the torque adapter from pylon ended up being too much force going through the prosthesis and causing a bit of instability (or at least the sensation of instability). Socket-wise he has a standard flexible insert with laminated hard socket. The trimlines are fairly proximal, although this client is used to the support - just proximal to the sound side Iliac crest level throughout. His abdomen is loaded a fair amount during gait thanks to the Helix, so we had to make sure our volume was dead on, and that there was enough preloading going on. Client is in his 40s now, but he's been a hemi since he was about 20.
Use the pediatric littig hip, the adult strut is too rigid for a 200lb man.
the vacuum design with a puck is the way to go. stan patterson at poacfl is the one to talk to. go to www.poacfl.com< <URL Redacted>> for contact info.
Don't know about you but take a good look at the helix hip. I have had 2
young bilateral HP/TF amps sucessfully use this hip. In combination with the
C-leg, it is like comparing a horse and cart to a car. In combination to a flexible silicone and carbon framed skt, open front and
ratch rear you can make a fantastic comfortable socket.
During my P residency, I saw a young man with a hemipelvectomy, I
provided him a sitting socket. My residency was up by the time he
would have advanced to a full prosthesis, however, the sitting socket
that we made utilized ski boot clips (if you know what I mean) to
secure the unaffected-side waist groove pad. The clips allowed the
patient to tightly secure the prosthesis with ease. Also, if 2 of the
receiving clips are on the socket, the tension on the waist groove pad
can be somewhat directed anteriorly or posteriorly by the patient,
depending on how it is ratcheted down. I really liked this part of
the design. Also, we were discussing the idea of fabricating the socket out of
polytol with an internal rigid frame, as polytol has an inherent
tackiness to it which may help with suspension (Otto Bock C-Fab). I
don't have an outcome for you with the polytol, just something to
think about.
The Total Knee is a little difficult to unlock late in stance so often those patients do not unlock the knee. The smaller Ottobock hydraulic High activity knee is nice though. If your patient can manage the silicon shorts that Stan Patterson makes it can help with suspension, other wise I would suggest a side opening diagonal design that would be lower profile. I don't know if you need to go single axis on the foot, the C-stance or other type of rolling heel works well for these patients. Here is a picture of a Hemipelectomy I saw. Look at the opening on the involved side.
Tough case. One of the most important factors aside from the socket design
is the knee. I would not use a Total knee for this type of amputee. You
will need a knee that will flex easily. When you do your alignment you
will want to set the knee posterior to the center of gravity as much as
possible. This will make it extremely stable and if you use a Total Knee
in place of a free knee, she will never be able to flex it to sit down.
Other than that I think you should be fine. Good luck,
Sincerely,
Spencer Doty, CPO, MBA
President - Active Life, Inc.
2222 Santa Monica Blvd #405
Santa Monica, CA 90404
Office: (310) 315-2780
Private/Direct Fax: (818) 478-3457
IMPORTANT WARNING: This email (and any attachments) is only intended for the use of the person or entity to which it is addressed, and may contain information that is privileged and confidential. You, the recipient, are obligated to maintain it in a safe, secure and confidential manner. Unauthorized redisclosure or failure to maintain confidentiality may subject you to federal and state penalties. If you are not the recipient, please immediately notify us by return email, and delete this message from your computer.
Citation
Spencer Doty, “Hemipelvectomy Considerations: RESPONSES,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/234129.
