MT: Transfemoral Surgery & Post Op Care Flashcards
Causes for TF amputations
- older
- more corborbidities
- majority vascular
* diabetes (10x more likely to have TF amp)
When is mortality rate 100% higher in TF than TT
within the first 30 days
Considerations and complications for TF amp
- Tf expend more energy
- longer limb = better suspension
- muscle atrophy
- more time sitting than TT
- femur can protrude
Muscle atrophy in TF
- inversely proportional to limb length (shorter limb = more atrophy)
- hip extensors
- hip adductors
Traditional TF Amputation
- No consideration of muscular imbalance
- no beveling of the femur
- shorter surgery decreases risks of complications
Knee Disarticulation Pros
- longer lever arm
- more musculature preserved (adductor magnus)
- less energy expenditure
- some distal weight bearing
- self suspending
- no need for IC
Knee Disarticulation Cons
- cosmesis
- bulbous
- knee centers do not match
- limited componentry
Candidates for KD
- peds
- active individuals
Peds KD
- disartics dont have issues with bony overgrowth
- preserves length/growth plates
- growth plates can be fused to allow TF length, with KD functionally
Once the amputation is proximal to the femoral condyles:
- still no knee extensors
- still weakened hip extensors
- further weakened hip adductors
- lack of stabilization of femur in all planes
What muscles are rarely impacted by TF amp
- hip flexors
- hip abductors
What is always transected in TF amputation
Quads
What anterior musculature is never transected
- Iliopsoas
- hip flexor strength unimpacted
What medial musculature will always be transected
- adductor musculature
- amputation of distal 1/3 femure results in 70% loss of adductor strength
How will loss of adductor strength impact the patients gait/control?
inability to stabilize femur in coronal plane
What lateral musculature are not transected?
gluteus medius
When a TF amputee fires their unimpacted abductors, what happens?
Shift of the center of mass to closer to the femoral head to decrease the moment
Trendelenburg Gait
- femur of amputee is no longer attached to ground
- abductor musculature is comromised
- not musculoskeletal support for ML stability in the hip (no collateral ligaments)
I THINK I HAD THIS WRONG ORIGINALLY
what is impacted with TF surgery
loss of hip extensor strength
Where do hip extensors insert
- hamstrings: posterior tibia
- **glutes **: 1/4 gluteal tuberosity of femur; 3/4 in iliotibial tract
transfemoral amputations lose MOST of these important muscles
Osseointegration
- eliminates the socket
- componetry is attached directly to bone
- persistant socket and /or skin issues
Van Nes Rotationplasty
- usually done for osteosarcoma
- foot/ankle are rotated 180 deg
- ankle acts the knee
- foot acts like transtibial residual limb
Staged amputation
- primarily when medical condition of patient is extremely poor
- surgeon performs guillotine amputation initially
- evaluates if it will heal
- performs closure later
Pediatrics
- preserve as much length as possible
- preserve growth plates if possible
- perform disarticulations if possible
Post Surgical Care Goals TF
- **Prevent **contractures
- Decrease pain, edema, bulbous distal end
- Promote strength, balance, control
- preparefor prosthetic care
Issues with Shrinkers
- thighs are conical
- lots of soft tissue
- going proximal to the next joint is an issue
Issues with RRDs and IPOPs for TF
- same as shrinker
- must used belt or shoulder harness
- suspension is a huge issue
