TransPelvic/Hip Disarticulation_Clinical Decision Making [Ch. 11}

Question 1

Many transpelvic/hip disarticulation aputations are performed due to:

Answer 1

• Malignant LE bone tumors

Question 2

Most common causes of amputation at hip disarticulation level (descending order): [5]

Answer 2

• Tumor
• Infection
• Vascular Disease
• Trauma
• Congenital abnormalities
• [2:1 male to female ratio}

Question 3

Common complication of hip disarticulation surgery:

Answer 3

• Infection

Question 4

Patients with hip disarticulation/transpelvic amputation need to maximize:

Answer 4

• upper extremity strength
• abdominal strength
• LE strength

Question 5

Patients with a hip disarticulation need to initiate a _________ ______ ____ to initiate swing phase.

Answer 5

• Posterior pelvic tilt

Question 6

With a hip disarticulation, balance training is important to enable the patient to:

Answer 6

• transfer independently
• apply and remove the prosthesis
• ambulate safely

Question 7

The transpelvic socket:

Answer 7

• encases the abdominal cavity
• provides hard wall to enclose and compress the abdominal viscera so that they can accept weight bearing pressures
• Extends superior to the 10th rib to allow vertical loading

Question 8

Weight transfer in the transpelvic socket is to the:

Answer 8

• Ischial tuberosity and buttock of the remaining leg

Question 9

The hip disarticulation socket:

Answer 9

• Encloses the ischial tuberosity and gluteal muscles for weight bearing
• Extends over the ilium to provide suspension
• Encloses the opposite pelvis
  
  • to assist in mediolateral trunk stability
• Contains reliefs over anterior and posterior iliac spine

Question 10

Little to no bandaging is needed with a transpelvic or hip disarticulation amputation. [True/False]

Answer 10

• True
  
  • Very little edema associated with these amputations

Question 11

Primary hip disarticulation sockets in use [3]:

Answer 11

• Canadian
• Diagonal
  
  • suitable for short transfemoral amputations at the level of the greater trochanter
• Total Contact Suction Socket
  
  • most common
  • allows better stabilization of the prosthesis

Question 12

Endoskeletal prostheses are preferred due to:

Answer 12

• Lighter weight
• interchangeable and adjustable features
• improved cosmesis

Question 13

Where is the hip joint attached in the Canadian and Total Contact Suction Socket, and why is it attached there?

Answer 13

• The hip joint is attached to socket anteriorly
  
  • this causes the weight line to fall behind the hip and in front of the knee to assist with extension

Question 14

A spring loaded hip joint that shortens the effective length of the limb which allows the wearer to swing the limb forward without having to vault.

Answer 14

• Hip flexion bias system

Question 15

A component which is an elastic strap that passes behind the hip and in front of the knee which functions to limit hip flexion and assist with knee extension:

Answer 15

• Stride Length Control Strap

Question 16

Type of knees commonly used in transpelvic/hip disarticulation:

Answer 16

• Stance control knee
  
  • resists knee flexion in excess of 15 degrees
  • Disadvantage: must be non-weight bearing for more than 15 degree knee flexion to occur
    
    • This makes it difficult to weight shift for sitting
• Polycentric axis (four bar) knee
  
  • center of rotation that changes or adapts to the degree of knee flexion
  • Advantage:
    
    • shortens during swing phase to aid in toe clearance
    • If this component has pneumatic control it also helps control excessive heel rise and terminal swing impact

Question 17

A component which enables the prosthetic leg to be crossed over the sound leg:

Answer 17

• Rotator adapter
  
  • assists with getting in and out of an automobile

Question 18

Lateral trunk bending toward the prosthetic side may be normal [true/false].

Answer 18

• True
  
  • transpelvic/hip disarticulations are often made 1.25 cm shorter for easier foot clearance.

Question 19

The individual with the hip disarticulation weight bears:

Answer 19

• On the ischium of the amputated side

Question 20

The individual with the transpelvic amputation weight bears:

Answer 20

• On the ischium and buttock of the sound side

Question 21

Prosthesis length may be determined by:

Answer 21

• For a hip disarticulation:
  
  • Checking the bilateral iliac crest heights
• For a transpelvic amputation
  
  • Checking the lower rib height