A case of an elderly hip disarticulation amputee with rheumatoid arthritis who regained the ability to walk using a hip prosthesis

Abstract

[Purpose] We report a case of an elderly patient with rheumatoid arthritis who underwent hip disarticulation because of necrotizing fasciitis and regained the ability to walk independently with a prosthetic limb. [Participant and Methods] A 61-year-old female patient underwent right hip disarticulation due to severe necrotizing fasciitis of the right lower limb. Her chief complaint was that she was not able to walk inside her house or outdoors to perform instrumental activities of daily living. We applied a Canadian-type hip disarticulation prosthesis to the stump. The patient received in-hospital physical therapy, occupational therapy, and clinical psychology counselling for 145 days. As her hands and fingers were weakened by rheumatism, we made several modifications to the prosthesis to enable the patient to attach and detach it independently. [Results] The patient was able to use the prosthesis to walk continuously for 45 m, perform various housework duties, drive a car, and go out, thus accomplishing the desired daily activities. [Conclusion] Our patient, an elderly hip disarticulation amputee with rheumatoid arthritis, was able to walk independently using a prosthetic limb. The application of prosthetic limbs may be appropriate even for hip disarticulation amputees with comorbidities that make it difficult to acquire a prosthetic gait.

Multiple Sessions of One-Legged Recumbent Cycle Ergometer Exercise Improved Pedaling Rate and Knee Range of Motion in a Middle-Aged Man after Hip Disarticulation: A Clinical Case

“…In addition, gait with a prosthetic limb leads to a higher energy consumption compared with gait with crutches [25][26][27][28], and energy expenditure for such a gait increases by 82%, which may potentially lead to patients being confined to a wheelchair or bedridden [29,30]. In previous case reports there are some significant successes with regaining gait with a fixed walker using a hip prosthesis during the early postoperative period [8,9]. Moreover, it might be considered that there are only small group of HD amputees with few comorbidities or high physical fitness/ activity who can walk with a hip prosthesis [31,32].…”

“…Limb exercise therapies such as walking using a crutch and/or upper arm/shoulder physical training including an arm cranking ergometer are well accepted for HD amputees [8,9]. Additionally, single leg ergometer activity may also provide an optimal exercise model for repeat leg cranking with working of the major thigh muscle mass, trunk, and buttocks for reduced muscle mass activity [10][11][12][13][14].…”

“…Over whole days, at the beginning of exercise lower PR was seen due to taking more time for the 1st to approximately 4th pedal rotation from the onset of exercise. St, start of exercise; rpm, revolutions per min.Volume 4(4):[5][6][7][8][9][10][11][12][13]…”