AMPUTEE INTERVENTIONS, TRAINING, OI Flashcards
What is osteointegration?
Bone anchored prosthesis
“The anchoring of a surgical implant by the growth of bone around it without fibrous tissue formation at the interface”
Where did OI first have its start?
dentistry
ex: dental implant - first one 1965
What is the most difficult part of OI surgery?
soft tissue closure
Screw fit vs press fit system OI
SCREW FIT
-FDA approved
PRESS FIT
-usually transfemoral amputees
-also for ease, functionality
-great for those who don’t tolerate a socket
-NOT FDA approved; done under exemption
-pressure holds the prosthetic in place
-very quick to don and doff with less skin problems
OI rehab vs Socket rehab
Not much different
-myodesis: muscle to bone
-myoplasty: muscle to muscle
*both used to foster distal muscle stabilization after amputation
-rehabilitation to prevent contractures
-improved biomechanics after OI rehab compared to socket rehab
–> glut med function
–> closed chain
–> better proprioceptive feedback
Rehab screw fit vs press fit
SCREW FIT
-2 stage surgery: 1st: implant, close 4-6 months rest, then 2nd surgery with more ST attention
-REHAB: 6 MONTHS
* 3 wks progressive exercise
* 3 wks progressive WB on short prosthesis
* 3 wks progressive WB on long prosthesis
* 4 wks progressive WB gait in II bars/crutches
* 4 wks full WB gait 2 crutches
* 6 wks single crutch/cane short distance 2 canes/crutches longer distance, uphill, downhill, speed
* 3 wks single A device community level, unlimited distance
PRESS FIT
-2 stage surgery; single stage for TTA
-stage 1- 6 wks rest
-stage 2- 2 days rest
REHAB:
-3 wks: full WB progressing from standing–> 2 crutches community level
-3-6 wks: progress through 2 crutches –> canes–> walking sticks–> no A device
-SHORTER PROCESS
-keep pain level <4/10
-keep biomechanical symmetry
Position of femur with OI compared to standard amputation with socket
-femur is not aligned properly with the socket as opposed to OI
-with the socket, the femur is pushed to the left –> makes you trunk lean
–> glutes and stabilizers are on stretch
-alters the biomechanics of gait
-with OI–> since the femur is aligned properly–> the glut med can actually work to stabilize the hip
BIOMECHANICAL ADVANTAGE OF OI:
-OI: closed chain
-can maintain level pelvis
-proximal stability from gluteus medius
Outcomes and data of OI
-100% of patients would do it again (even those with complications)
-Patient-reported outcomes (comparing OI to standard transfemoral amputation socket prosthesis)
-improved PROMs overall
Biomechanics changes one-year following OI in individuals with transfemoral lower limb amputation
-glut med activation increased
-glut max activation inc.
-increased knee extension moment
-increased trunk lateral flexion moment
Adverse events after OI
pain
infection
-20% rate of infection over 15 year follow up
-superficial most common
loosening or hardware failure
-may need revision
poor healing
fracture (test sensation)
HO
granulation tissue
WATCH FOR
-pain
-infection
-loosening hardware
-poor healing
-poor sensation
-TTA:
–longer lever arm
–rotation
–knee OA
Conservative pain management
pendulums
decreased WB
bike with no resistance
rest
pain killers
modalities
wrapping/compression
manual therapy
stoma considerations
Activities to avoid with OI
plyometric and high level activities:
running
football
powerlifting
snowboarding
soccer
wakeboarding
skydiving
How long does post-amputation/pre-prosthetic mobility training take?
3- 6 months to fully walk and use their prosthetic independently
Supine strengthening
hip adduction/abduction
quad and glute sets
hamstring stretches
ab crunches
Prone strengthening
lying prone propped on elbows
isometric glute sets–> hip extension
