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PubMed1995

Prosthetic usage in major upper extremity amputations.

Patterns of use of contemporary prostheses by 135 patients with major upper extremity amputations were evaluated by questionnaire. Eighty-four percent of the patients were male and 16% were female. Amputation levels represented were below elbow, 44%; above elbow, 40%; and shoulder disarticulations or forequarter amputations, 16%. The follow-up interval averaged 12 years (range, 1-67 years). One hundred and thirteen patients were fitted with either a myoelectric or body-powered prosthesis. The overall rejection rate was 38%. Thirty-nine of 42 in the below-elbow amputation group used the prosthesis and appeared to benefit the most. Eight of 141 in the wrist disarticulation group used the prosthesis: as did 9 of 21 in the above-elbow amputation group. In contrast, all bilateral amputees used their prostheses. Stiff shoulders and brachial plexus injury were both predictors for poor prosthetic usage.

Amputees↗
PubMed2000

Unna and elastic postoperative dressings: comparison of their effects on function of adults with amputation and vascular disease.

OBJECTIVES: To compare the functional outcome associated with the use of Unna semirigid dressings (SRD) and elastic bandage soft dressings (ED) for adults with lower limb amputation. DESIGN: Experimental design. SETTING: Inpatient rehabilitation unit of an urban academic medical center. PARTICIPANTS: A successive series of adults with vascular disease who had lower limb amputation surgery. Subjects were randomly assigned to the SRD (12 patients with 12 recent amputations) or the ED (9 patients with 10 recent amputations) group. Subjects in each group were not significantly different except for age; those in the SRD group were somewhat older. INTERVENTION: Subjects in the SRD group had Unna dressings applied to the amputation limb by physical therapists trained in the technique. Those in the ED group had elastic bandaging by therapists, nurses, family, and themselves, all of whom were trained in the technique. RESULTS: Sixty-seven percent of the SRD group and 20% of those in the ED group were discharged from the rehabilitation unit ambulating with prostheses. Of those who received prostheses, time from admission to the rehabilitation unit to readiness for fitting averaged 20.8 days for the SRD group and 28.7 days for the ED group. Comparison of survival curves shows that the time from surgery to fitting in the SRD group was almost half that of the ED group; 30% of the SRD group was fitted within 34 days, whereas it took 64 days for the same percentage of the ED group to be fitted. CONCLUSIONS: Unna semirigid dressings are more effective in fostering amputation limb wound healing and preparing the amputation limb for prosthetic fitting. Subjects treated with SRDs were more likely to be fitted with prostheses and to return home walking with a prosthesis.

Aged↗
PubMed1999

[Experimental study on three-dimensional adjustable condyle prosthesis for reconstruction of temporomandibular joint].

OBJECTIVE: To study the possibility of reconstructing TMJ with a modified three-dimensional adjustable condylar prosthesis (TDACP). METHODS: The modified TDACP was placed immediately after resection of the mandibular ramus and condyle in 3 adult rhesus monkeys. The results were evaluated by radiography, histological and anatomical examinations, as well as chewing function at 3, 6, and 14 months after surgery. RESULTS: Through adjustment the condyle prosthesis could fit exactly, the functions were good, every part of the prosthesis was firm, the screws were osteointegrated, there was no adverse soft tissue reactions and no pathological changes in the TMJ of non-operated opposite condyle. Problems were: the distribution of fixation stress of screws was somewhat unreasonable, the downward sliding of the condyle was limited, there was erosion of the posterior slope of the glenoid fossa, and the articular disc could not keep its in situ place and function. CONCLUSION: The results suggests that the prosthesis needs further improvement.

Animals↗
PubMed1996

Early motion after arthroplasty.

Early controlled motion after arthroplasty in the MP and PIP joints allows for collagen remodeling during the encapsulation process that creates a stable joint. Motion generally is begun within the first few days after surgery and must be supervised carefully. Dynamic splinting is an important component in achieving early motion in the MP joints and often is a useful adjunct in the PIP joints. Early motion after total wrist arthroplasty depends on surgical fit of the prosthesis. Only a tight fit allows early motion. The potential for complications resulting from early motion in the wrist is greater than in the MP or PIP joints and may involve increased wear, fracture, or component loosening. The benefits of early motion after arthroplasty, therefore, must be weighed against potential risks. Although generally necessary in the MP and PIP joints to achieve satisfactory results, early motion after total wrist arthroplasty has limited applications and significant risks.

Arthritis↗
PubMed2006

The effects of prosthetic foot design on physiologic measurements, self-selected walking velocity, and physical activity in people with transtibial amputation.

OBJECTIVE: To investigate the physiologic differences during multispeed treadmill walking and physical activity profiles for the Otto Bock C-Walk foot (C-Walk), Flex-Foot, and solid ankle cushion heel (SACH) foot in people with transtibial amputation. DESIGN: A repeated-measures design with 3 prostheses. SETTING: Research laboratory. PARTICIPANTS: Eight men with unilateral transtibial amputation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Physiologic responses (energy expenditure, gait efficiency, exercise intensity, rating of perceived exertion [RPE]) during multispeed treadmill walking (53.64, 67.05, 80.46, 93.87, 107.28 m/min) test were analyzed with 2-way repeated-measures analysis of variance (ANOVA). One-way ANOVA was employed to analyze foot-type differences for self-selected walking velocity (SSWV), and steps per day (daily activity). Analysis of covariance was used to analyze foot-type differences with SSWV as the covariable for the physiologic measurements. RESULTS: The C-Walk had a trend of improved physiologic responses compared with the SACH; however, no foot-type differences were statistically significant. Compared with the C-Walk and SACH, the Flex-Foot showed no significant differences in energy expenditure and gait efficiency, but significantly lower percentage of age-predicted maximum heart rate and RPE values. CONCLUSIONS: The energy storing-releasing feet appeared to have certain trends of improved gait performance compared with the SACH; however, not many objective foot-type differences were significantly noted. Further studies with a larger sample size are suggested.

Activities of Daily Living↗
PubMed1999

New techniques in spark erosion: the solution to an accurately fitting screw-retained implant restoration.

How accurate is today's method of casting in the dental laboratory? Normally it is good enough, but what happens if the dental technician is confronted with an extensive restoration or has to deal with the precision of prefabricated implant abutments? In either case, he or she is headed for trouble. So what is to be done, especially if both of these components come together? The force transferred to the osseointegrated endosseous implants is naturally undesirable and the main reason for premature loss of the implants. The present article describes the production of an implant-related restoration for a 50-year-old patient. The plans were to make a partially removable, implant abutment-- connected, base metal framework and to administer spark-erosion machining to achieve a passive fit.

Dental Casting Technique↗
PubMed1994

Use of the hydroxyapatite ocular implant in the pediatric population.

OBJECTIVES: There is always a hesitancy to use an ocular implant after enucleation in children, especially in cases of eyes enucleated for retinoblastoma. DESIGN AND SETTING: In this prospective study, we report our experience of 60 consecutive cases in which we used the hydroxyapatite ocular implant after enucleation in children younger than age 10 years. RESULTS: The mean age at the time of enucleation and hydroxyapatite placement was 27 months (range, 1 to 108 months). The histopathologic diagnoses after enucleation included retinoblastoma in 51 patients, endophthalmitis in two patients, persistent hyperplastic primary vitreous in two patients, neovascular glaucoma resulting from Coats' disease in one patient, uveal melanoma in two patients, undifferentiated intraocular neoplasm in one patient, and blind painful traumatized eye in one patient. After a mean follow-up of 19 months (range, 6 to 36 months), two cases of conjunctival erosion and five cases of conjunctival thinning were recorded. These problems were associated with a flat posterior prosthesis vault in all seven cases. There were no cases of orbital cellulitis, implant extrusion, or implant migration. All children showed good small-degree prosthesis motility despite the lack of peg placement. Only one older child underwent drilling and peg placement and she had excellent small- and large-degree prosthesis motility. We generally postpone the drilling and peg placement stage and tedious prosthesis revision in children until they are able to fully cooperate with the ocularist. CONCLUSIONS: The hydroxyapatite ocular implant is well tolerated and provides good prosthesis motility in children with few complications. It is critical for the ocularist to fit the prosthesis comfortably with a high posterior vault.

Child↗
PubMed1986

A fixed prosthodontic technique for mandibular osseointegrated titanium implants.

A detailed technique has been presented for the fabrication of a fixed prosthesis supported by osseointegrated titanium implants. The fixed prosthodontic technique is based on the original Swedish procedure. Several new dental products have been added, and some refinements in technique have been made in an effort to consistently produce a fixed prosthesis that fits, functions, and satisfies today's esthetically conscious patient. Branemark's tissue-integrated prosthesis (TIP, Bofors Nobelpharma, Inc.) is the only dental implant system with two decades of high-quality longitudinal clinical experience. A fixed prosthesis supported by osseointegrated implants offers a treatment modality that is predictably successful (Fig. 21).

Dental Articulators↗
PubMedDate not supplied

Patient education for women being fitted for breast prostheses.

Women who undergo mastectomy or other types of breast surgery often will be fitted for breast prostheses for therapeutic weight replacement as well as cosmetic purposes. Nurses are instrumental in educating women about issues related to breast surgery and in helping to promote psychosocial adjustment to the diagnosis and subsequent treatment. Nurses often are involved in the referral process for breast prostheses. Prostheses and bras that fit properly can be very important in the recovery process and ultimately improve quality of life for cancer survivors. Unlike in the past, many choices are available today for women who opt to use breast prostheses. Prostheses come in different colors, shapes, and weights, and some adhere to the chest wall. Many options also are available for bras, camisoles, and swimsuits, which are helpful adjuncts to the fit of the prosthesis. The purpose of this article is to describe the fitting process and options currently available for breast prostheses. Nurses can use this information to inform women of available breast prostheses options and help prepare them for a fitting.

Breast↗
PubMedDate not supplied

[Oscillometry on various stape protheses. Experimental examination of human temporal bone preparations].

In human temporal bone specimens the vibrations of the labyrinthine fluid were measured by a piezoelectric system after application of various techniques of otosclerosis surgery. Compared with the amplitude in the case of a normal stapes, the surgical techniques according to Zangemeister, Shea and Schuknect resulted in considerable transmission losses in the high frequency range, while transmission of low frequencies to the inner ear was almost equivalent to normal transmission via the stapes. For frequencies of more than 3,000 Hertz the damping influence of the fibrous tissue implanted into the oval window was verified. The results of surgery according to Zangemeister, Shea and Schuknechtdid not differ significantly in the low and medium frequency range. Only a Robinson prosthesis implanted like a Teflon piston caused an impairment of transmission, while the method of fitting this prosthesis onto fibrous tissue was equilvalent to the other techniques.

Ear, Middle↗
PubMed1992

A Swedish knee-cage for stabilizing short below-knee stumps.

Stump length is an important factor in attaining successful prosthetic rehabilitation in below-knee (BK) amputees. Stability of the stump-prosthesis complex is impaired in the case of a stump shorter than 10 cm. Thus, fitting a prosthesis to a BK amputee with a stump which is very short often requires the use of different prosthetic techniques. In this work, the authors suggest the use of a Swedish knee-cage attached to a conventional patellar-tendon-bearing prosthesis as an alternative solution in the case of a short BK stump. Objective evaluation was performed by an analysis of gait and the foot-ground reaction forces. The results obtained indicate an improvement in all the measured parameters resulting from the modified stump-prosthesis complex.

Adult↗
PubMed2005

Biologic response of immediately versus delayed loaded implants supporting ill-fitting prostheses: an animal study.

BACKGROUND: Computer-assisted preoperative implant planning and transfer toward the patient allow the production of a prosthesis prior to surgery. This implies that the prosthesis can be installed immediately following implant insertion. An inherent disadvantage of this is a cumulated error, which can lead to prosthesis misfit owing to topographic deviations of the planned versus the installed implants. PURPOSE: The aim of this study was to determine whether prosthesis misfit is compromising the osseointegration of immediately versus delayed loaded implants and whether freshly installed implants adapt to the prosthesis. MATERIALS AND METHODS: In each of five New Zealand White rabbits, two experimental conditions were compared. One tibia harbored the so-called test implant, which originally showed a vertical misfit of about 500 microm with the prosthesis to which it was tightened immediately after implant installation. The control implant was installed in the other tibia and was allowed to heal during 9 weeks before the prosthesis with the vertical misfit of about 500 microm was connected to it. The prostheses were left in place for 12 weeks, after which the animals were sacrificed. RESULTS: All implants healed uneventfully. There were no statistically significant differences between the biologic responses of test and control implants. With a three-dimensional laser scanner, significantly more displacement of the test implants toward the prostheses was observed compared with the control implants. This led to a significant decrease in prosthesis misfit for the test implants compared with the control implants. CONCLUSIONS: This study indicates that prosthesis misfit does not per se lead to biologic failure of immediately loaded or of already osseointegrated implants. In addition, immediately loaded implants seem to topographically adapt to the prosthesis, thereby minimizing the existing misfit.

Alveolar Bone Loss↗