Hip Disarticulation & Hemipelvectomy Prosthetic Fitting TechniquesTony Van der Waarde, C.P.(c),
John W. Michael, M.Ed., C.P.O. We have divided this article up into sections for faster load times as follows: Part One | Part Two | Part Three | Part Four | Part Five | Part Six | References
Although the anatomic differences between hip disarticulation and transpelvic
(hemipelvectomy) amputations are considerable, prosthetic component selection
and alignment for both levels are quite similar. The major differences
are in socket design and will therefore be discussed in some detail. A full surgical report
identifying muscle reattachments along with postoperative radiographs can
be extremely valuable during the initial examination of the amputation
site, particularly if any portions of the pelvis have been excised.
This information, combined with a thorough physical examination and a precise plaster impression, will influence the ultimate fit and function of the prosthesis. Many authors have noted that the rejection rates for lowerlimb prostheses are the highest at these proximal levels.25,59,66 The energy requirements to use such prostheses has been reported to be as much as 200% of normal ambulation. At the same time, the lack of muscle power at the hip, knee, and ankle/foot results in a fixed, slow cadence. As a practical matter, only those who develop sufficient balance to ambulate with a single cane (or without any external aids at all) are likely to wear such a prosthesis longterm. Those who remain dependent on dual canes or crutches for balance eventually realize that mobility with crutches and the remaining leg, without a prosthesis, is much faster and requires no more energy expenditure than using a prosthesis does. Prosthetic fitting is typically limited to motivated and physiologically vigorous individuals; still, a significant number do not become longterm wearers. To investigate this further, the senior author (T.v.d.W) studied a group of 20 male and female hip disarticulation and transpelvic amputees who were representative of the age and diagnoses typically encountered. Only 15% had been fulltime users of their initial prostheses; many complained of how cumbersome or uncomfortable their rigid sockets seemed. After a 3-year followup during which these patients were fitted with a totally new prosthesis that included a novel silicone rubber socket (Fig21B-1), a significant improvement in prosthesis utilization was noted. The majority increased their wearing time; in fact, the fulltime users group increased from 15% to 65%. Ninety percent of those polled reported that increased comfort was the main reason for using the prosthesis more often. Other significant reasons were less effort when walking and improved appearance of the prosthesis. Interestingly, the actual weight of the prosthesis had increased in several cases due to incorporation of more sophisticated componentry such as units to absorb torque while walking.64 Hip Disarticulation: Prosthetic Management *References 2, 4, 26-28, 30, 43, 49, 51, 53, 69, 70. †References 1, 5, 6, 8-13, 24, 29, 34, 35, 37, 38, 42, 54, 58, 60, 62, 64. We have divided this article up into sections for faster load times as follows: Part One | Part Two | Part Three | Part Four | Part Five | Part Six | References |