Gait rehabilitation for a patient with an osseointegrated prosthesis following transfemoral amputation

Abstract

Background: In patients with a transfemoral amputation socket-related problems are associated with reduced prosthetic use, activity, and quality of life. Furthermore, gait asymmetries are present that may explain secondary complaints. Bone-anchored prostheses (BAPs) may help these patients. Two types of BAP are available, screw and press-fit implants. Rehabilitation following surgery for a press-fit BAP is poorly described. Purpose: To describe a rehabilitation program designed to minimize compensation strategies and increase activity using a case-report of an active, 70-year-old man with a traumatic transfemoral amputation who had used a socket prosthesis for 52 years and received a press-fit BAP [Endo-Exo Femoral Prosthesis -EEFP]. Intervention: A 13-week physiotherapy program. Outcomes: Outcomes were assessed before surgery, at the end of rehabilitation, and six-month and one-year follow-ups. After rehabilitation gait had improved, the patient had more arm movement, more pelvic shift, less hip rotation during swing phase on the prosthetic side, and absence of vaulting on the sound side. Isometric hip abductor strength was 15% higher on the sound side and 16% higher on the prosthetic side, and walking distance increased from 200 m to 1500 m. At the six-month follow-up, the patient had lower back complications and reduced hip abductor strength and walking distance. At oneyear follow-up, walking distance had recovered to 1000 m and gait pattern had improved again, with yielding and absence of terminal impact on the prosthetic side. Conclusion: The described rehabilitation program may be an effective method of improving gait in patients with an EEFP even after long-term socket usage.

Clinimetric properties of hip abduction strength measurements obtained using a handheld dynamometer in individuals with a lower extremity amputation

“…In scientific research various instruments are used to evaluate lower extremity muscle strength in individuals with a lower extremity amputation, such as isokinetic dynamometers [4,7,8,14], an Optical Testing of Isometric Moments (OpTIMo) device [13], 10-repetition maximum tests on resistance machines [1] and handheld dynamometers (HHD) [3,15]. For daily clinical practice a measurement has to be low in cost, non-time-consuming, portable and easy to use, which is only the case for HHD measurements [16].…”

Functional performance and safety of bone-anchored prostheses in persons with a transfemoral or transtibial amputation: a prospective one-year follow-up cohort study

“…The mean change-over time of the continuous outcomes Questionnaire for persons with a transfemoral amputation Global Score f (0-100 points) 10 Single question C 10,17 : 'How would you summarize your overall situation as an amputee? ', with five response alternatives; 'extremely poor', 'poor', 'average', 'good' or 'extremely good' Level of satisfaction Prosthetic comfort Prosthetic Comfort Score g (0-10 points) 5…”

“…Rehabilitation focussed on improving hip abductor strength, core stability, symmetry of gait parameters, and level of activity. 5 The duration of the predefined twice weekly rehabilitation programme depended on amputation level and ranged from four weeks (transtibial amputation) to 11 weeks (transfemoral amputation). 4 An interlude was initiated if pain or limited muscle strength was an obstacle to reduce walking aid use.…”

“…This prospective study focussed on patients with a lower extremity amputation who had problems with using a socket-suspended prosthesis, and therefore, were scheduled for implantation of a press-fit osseointegration and a predefined rehabilitation programme. 4,5 The primary aim was to describe the change in the body functions or structures (hereafter referred to as level of function), level of activity, level of health-related quality of life (HRQoL), and level of satisfaction at 6 and 12 months after surgery compared to preoperative while using a socket-suspended prosthesis. We hypothesized that hip abductor strength, prosthetic use, back pain, mobility level, walking ability, HRQoL, and prosthetic comfort would improve over time.…”

Safety, prosthesis wearing time and health-related quality of life of lower extremity bone-anchored prostheses using a press-fit titanium osseointegration implant: A prospective one-year follow-up cohort study

“…Rehabilitation started one week after the second OI surgery, or 3 weeks after single stage OI surgery, with loading the full-length prosthesis based on pain (numeric grading score 0-10: aim score <5) building up to full bodyweight. [5,22]The rehabilitation was given in group sessions twice per week with sessions of two hours each and a total duration of 4 weeks or 11 weeks for tibial and femoral BAP, respectively. Follow-up visits including radiologic examination and performance tests were scheduled prior to stage 1 surgery and one year after stage 2 surgery.…”