Hip Disarticulation & Hemipelvectomy

Question 1

HD/HP Rejection Variables

Answer 1

• age
• sex
• etiology
• level of amputation
• general health

Question 2

Wearing a prosthesis pros and cons

Answer 2

• weight
• speed: 51%-61% of AB
• increase energy cost by 80%-250%
• toileting

Question 3

Compare to Crutches pros and cons

Answer 3

• 43% faster than HD px
• increase energy cost by 45%
• no problem with toileting

Question 4

Compared to wheelchair pros and cons

Answer 4

• 2x faster than with prosthesis
• 25% as much energy

Question 5

Reasons to use prosthesis

Answer 5

• maintain muscle strength and tone
• cardiovascular health
• functional mobility
• less upper limb overuse

Question 6

What must a pt have before considering prosthetic treatment

Answer 6

• excellent balance
• great core strength
• good pelvic/lumbar ROM
• thin

Question 7

Reasonable expectations for prosthetic wear

Answer 7

• walk more slowly
• have noticeable gait deviation
• remove for some toileting
• only wear 6+ hours/day except congential limb deficiencies

Question 8

Hip Disarticulation

Answer 8

• weight bearing through IT and tissue compression
• socket can be ischial containment
• suspension over both crests or elevated vacuum
• some pistoning

Question 9

Hemipelvectomy

Answer 9

• weight through compression of the tissue/musculature of the amputated side
• suspension is over contralateral iliac crest or elevated vacuum
• need to support the viscera
• significant pistoning

Question 10

Challenges with HP

Answer 10

• huge energy consumption
• lower frequency of fittings leads to lack of consistant fitting protocol
• added complexity in: suspension, control of hip and knee, unprotected organs. colostomy bags

Question 11

Alignment: Sagittal

*

Answer 11

• requires angled tube clamp adapter at knee
• Hip anterior to wt line
• knee posterior to wt line

Question 12

Suspension

Answer 12

• compression superior to iliac crests
• trimlines just superior to iliac crest
• custom silicone and active vacuum

Question 13

Control of prosthesis

Answer 13

• gained through active lordosis
• shorter prosthetic side for swing clearance
• vaulting is common
• ischial containment
• low contralateral trim line
• socket must fit well

Question 14

Most important factors for feet

Answer 14

• dynamic response: light weight
• softer heel: knee extension early stance
• Softer keel: not pushing too hard, not walking fast enough for energy return

Question 15

Most important factors for feet

Answer 15

• dynamic response: light weight
• softer heel: knee extension early stance
• Softer keel: not pushing too hard, not walking fast enough for energy return

Question 16

Torque absorber

Answer 16

• compensates for loss of limb’s natural rotation during ambulation

Question 17

Shock absorbers

Answer 17

• reduce GRF on torso
• extension assists or knee and hip