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PubMed1993

[An original method of disarticulation in the hip in paraplegic patients].

The surgical technique of disarticulation in the hip in paraplegic patients with deep decubitus around the trochanter area is presented. The presence of penetrating decubitus calls for early decision of disarticulation, before deteriorating of patients general condition, as it is the only measure to control infection, save patients life and make further rehabilitation possible. Disarticulation and concurrent excision of the decubitus is illustrated by a case of a patient who underwent bilateral procedure.

Adult↗
PubMed1991

Acute and chronic hemodynamic impact of total right ventricular disarticulation.

Right ventricular disarticulation is a radical operation to control ventricular arrhythmias in patients with arrhythmogenic right ventricular dysplasia. This report describes the acute and chronic hemodynamic impact of the procedure based on our experience of five patients with life-threatening arrhythmias unresponsive to medical therapy who have undergone total disarticulation of the right ventricle. Although all patients suffered acute postoperative hemodynamic problems, all survived and returned to an excellent functional class. Right ventricular disarticulation should be considered in patients with drug refractory ventricular tachycardias due to arrhythmogenic right ventricular dysplasia when the arrhythmia either poses a life threat or results in chronic morbidity.

Adult↗
PubMed1997

Right ventricular disarticulation procedures: the role of late potentials in the genesis of postoperative ventricular arrhythmias.

Arrhythmogenic right ventricular disease may be associated with life-threatening and drug refractory ventricular arrhythmias. Right ventricular disarticulation procedures are effective antiarrhythmic surgical approaches in selected patients. This study examined the role of late potentials in the postoperative development of new ventricular arrhythmias, and showed that right ventricular isolation is effective, probably because it destroys the tissue giving rise to late potentials. Total disarticulation is associated with fewer postoperative arrhythmias than partial isolation procedures. Total disarticulation may be the surgical approach of choice in such patients.

Adult↗
PubMed2001

Healing of partial flap necrosis in ankle disarticulation amputation by débridement and continued weight-bearing.

Five patients with partial tissue loss of the weight-bearing surface of the heel pad following ankle disarticulation were treated with residual-limb debridement and continued end-weight-bearing using a total-contact cast. The patients, ranging in age from 53 to 76 years, had insulin-requiring diabetes and insensate heel pads and were low-demand, limited-activity, community walkers before amputation surgery. Each underwent amputation surgery as a consequence of peripheral vascular disease. All patients progressed to complete wound healing over 3 to 6 months and were able to return to their previous ambulatory level using a prosthesis. At a minimum 2-year follow-up, no patient experienced further residual-limb complications. Partial loss of the weight-bearing heel pad in ankle disarticulation amputation does not preclude successful return to independent ambulation using a standard ankle disarticulation prosthesis. Weight-bearing ambulation need not be avoided during healing.

Aged↗
PubMed2000

Why knee disarticulation (through-knee-amputation) is appropriate for non ambulatory patients.

PURPOSE: To determine the reason why 79% of knee disarticulation amputees had not received a prosthesis. METHOD: A 10 year survey was carried out of all patients who had undergone a knee disarticulation at our medical centre. RESULTS: Seventeen of the 37 patients that had not received a prosthesis were recognized to be non-ambulators prior to the surgery. Four patients died after the surgery and in 16 of the patients their general condition limited functional ambulation. An effort had been made to ambulate the patients but had failed. CONCLUSIONS: From a biomechanical point of view many advantages are to be gained for sedentary and bedridden amputees when the level of amputation is through-the-knee.

Adult↗
PubMed2001

Reciprocating gait prosthesis for the bilateral hip disarticulation amputee.

This paper describes the design, manufacture and use of a new prosthesis which produced reciprocating gait for a bilateral hip disarticulation amputee. A special mechanism used the hip extension moment during weight bearing to drive the contralateral limb through the swing phase. The user rapidly attained efficient and safe reciprocating gait, together with simple donning and doffing. The success of this project has major implications for hip disarticulation amputees in terms of profound improvements of their independence and self-esteem.

Adult↗
PubMed1979

Knee disarticulation versus above-knee amputation.

If below-knee amputation is impossible, knee disarticulation should be considered before above-knee amputation, regardless of age and etiology. Knee disarticulation which leaves the femur and patella untoched offers many advantages. The surgical technique is simple and non-traumatic since no bone or muscle tissue is to be dissected. The thigh muscles are completely preserved and thus there is no muscular imbalance. The stump permits total end bearing and its bulbous shape permits easy and firm attachment of the prosthesis. A specially designed double-wall socket and various types of knee joints are presented. Modern prostheses are superior to above-knee prostheses with regard to function, comfort and cosmesis. Results of 72 patients of all age groups are presented and discussed.

Adolescent↗
PubMed1997

Effect on knee disarticulation on bone growth in immature rabbits.

This study was designed by the University of Ankara Experimental and Research Laboratory for animals in 1997. In the study an anteroposterior skin flap technique was used for 20 knee disarticulation amputations and also in 20 trans-femoral amputations on immature rabbits, in order to investigate their effects on the femoral epiphyseal growth plate. The femurs of the rabbits were observed radiographically for 8 weeks. It was observed that the femurs tended to grow at a slower rate compared to the normal contralateral femur. These studies showed that the disarticulated limb femurs grew 0.68 cm shorter on average compared to the contralateral femurs and the femurs in the trans-femoral amputated limbs 3.58 cm shorter on average compared to the contralateral ones. These results were found to be statistically significant.

Animals↗
PubMed2005

Energy expenditure during walking in amputees after disarticulation of the hip. A microprocessor-controlled swing-phase control knee versus a mechanical-controlled stance-phase control knee.

We have compared the energy expenditure during walking in three patients, aged between 51 and 55 years, with unilateral disarticulation of the hip when using the mechanical-controlled stance-phase control knee (Otto Bock 3R15) and the microprocessor-controlled pneumatic swing-phase control knee (Intelligent Prosthesis, IP). All had an endoskeletal hip disarticulation prosthesis with an Otto Bock 7E7 hip and a single-axis foot. The energy expenditure was measured when walking at speeds of 30, 50, and 70 m/min. Two patients showed a decreased uptake of oxygen (energy expenditure per unit time, ml/kg/min) of between 10.3% and 39.6% when using the IP compared with the Otto Bock 3R15 at the same speeds. One did not show any significant difference in the uptake of oxygen at 30 m/min, but at 50 and 70 m/min, a decrease in uptake of between 10.5% and 11.6% was found when using the IP. The use of the IP decreased the energy expenditure of walking in these patients.

Artificial Limbs↗
PubMed1989

Double disability of hemiplegia and hip disarticulation: rehabilitation outcome.

Double disability of hemiplegia and hip disarticulation is uncommon. To our knowledge, there are no reports of such patients and their rehabilitation outcomes. We report on a patient with hemiplegia and hip disarticulation who became independent in prosthetic ambulation and activities of daily living. Motivation, age, good neuromuscular status, and past successful prosthetic use favored the excellent rehabilitation outcome in this patient.

Adolescent↗
PubMedDate not supplied

Knee-disarticulation.

The disarticulation of the knee joint is--in contrary to the above-knee level--a fast and tender method for amputation, resulting in a vigorous, complete weightbearing stump. Without problems the bulky stump is fitted in an exactly moulded plastic or resin socket--eventually combined with a soft socket--, which can be easily put on and off also by older patients suffering from general dysvascular disorders. Nowadays special joints are used for functionally as well as cosmetically satisfying knee-disarticulation-prostheses. The surgical technique with alternative incisions, the peculiarities in dysvascular patients, the postoperative care including immediate or early fitting, the management after wound-healing with a temporary exercise-prosthesis and finally the various possibilities of the definitive prosthetic fitting are stressed in detail.

Artificial Limbs↗
PubMed1997

Wound coverage after modified hip disarticulation using a total adductor myocutaneous flap.

There are several options available for wound coverage after hip disarticulation and hemipelvectomy. Standard flaps for closure are not always available due to the 3-dimensional extent of the tumor and availability of satisfactory tissue for coverage. This article details a new coverage technique after a modified hip disarticulation using a total adductor myocutaneous flap in a patient with radiation induced osteosarcoma of the femur after Ewing's sarcoma. In this case, neither the commonly used posterior flap nor an anterior flap could be used because of the location of the tumor and the presence of radiation induced skin and soft tissue changes. The total adductor myocutaneous flap allowed for wide surgical margins, avoided soft tissue coverage using previously irradiated soft tissue flaps, and provided excellent coverage without requiring the use of free or pedicle based flaps.

Adult↗
PubMed1977

Disarticulation of the knee. A modified technique.

Knee disarticulation provides an excellent level of amputation in the lower extremity, particularly of the younger, active male amputee. Many surgeons, particularly in England, still prefer knee disarticulation when major amputation is required for peripheral vascular disease. Its use has been restricted over the years, largely because of certain prosthetic problems associated with fitting the standard prosthesis. Modification in surgical techniques to allow the incorporation of modern prosthetic design and materials will enlarge the range of usefulness of through-knee amputation. This is particularly true as it relates to the knee control mechanism of the prosthesis. The surgical modifications presented in this report allow modern prosthetic application to the amputation, with maximum functional benefit and retention of the basic functional advantages of amputation at this level.

Amputation, Surgical↗
PubMed1990

Hip disarticulation. An 11-year experience.

Thirty-eight hip disarticulations performed in 34 patients were retrospectively reviewed. The indications were ischemia secondary to atherosclerosis in 17 cases, femoral osteomyelitis in 10, and trauma in 11. Patient ages ranged from 20 to 95 years. The mortality was 60% in patients with ischemia with preoperative infection, 20% in patients with ischemia without preoperative infection, 22% in patients with femoral osteomyelitis, 100% in patients with trauma with preoperative infection, and 33% in patients with trauma without preoperative infection. The overall mortality was 44%. Postoperative wound infections were frequent (63%) and had poor correlation with the presence of a preoperative wound infection. No patient was able to use a prosthesis after hip disarticulation, but most were independent in wheelchairs.

Activities of Daily Living↗
PubMed1992

Initial experience with the disarticulated (one-half) Palmaz-Schatz stent: a technical report.

We developed an alternative method to stent suitable lesions located in anatomical settings considered to be too complex for regular Palmaz-Schatz stent placement. This method consists of using a disarticulated (one-half) Palmaz-Schatz stent. Eight patients underwent stenting utilizing this method. The left anterior descending was stented in five patients, the right coronary artery in one patient, the proximal and mid shaft of a vein graft in one patient, and a protected left main coronary artery in one patient. In all patients the stents were placed in addition to full stents. In four patients, 1 1/2 stents were placed; two patients had 2 1/2 stents; one patient had 3 1/2 stents and the last patient had a total of 5 stents placed (1 full stent and 8 half stents). One patient had 8 disarticulated stents placed. All half stents prepared for delivery were successfully deployed to the pre-designated angiographic site without complication.

Angioplasty, Balloon, Coronary↗
PubMed1986

Computed tomography of the disarticulated incus.

Complete incus disarticulation may be a complication of trauma, chronic otitis, or prosthetic stapedectomy. Purposeful incus disarticulation (with incus interposition) is used as a method of ossicular reconstruction. CT has been a valuable diagnostic tool for preoperative location of the incus in the former disorders and for determination of the status of the ossiculoplasty in the latter.

Ear Ossicles↗
PubMed1997

Rehabilitation of patients after hip disarticulation.

We review rehabilitation of patients after hip disarticulation operated on over the past 5 years. Sixty-two patients underwent 63 hip disarticulations: 24 had malignancies, 23 arteriosclerosis, 11 Buerger's disease, 3 diabetes and 1 uncontrollable infections. The mean age of tumour patients was 39 years (range 6-69 years), that of the vascular patients was 55 years (range 33-78 years). The postoperative mortality rate of the vascular patients was 16/37, and 0/24 of those with malignancies. There was one bilaterally operated patient with bilateral purulent coxitis from decubitus ulcers, who died on the 32nd post-operative day. Complicated wound healing was observed in 5 of the 24 tumour patients, and in 24 of the 37 vascular patients. The strategy of prostheses fitting has a two-stage concept: temporary prostheses in the 1st or 2nd month, permanent prostheses in the 6th month. All 24 tumour patients were fitted and could walk, while only 2 of 37 vascular patients were able to walk with prostheses. In our experience the outcome is significantly dependent upon the primary illness: in vascular cases it is poor, while in malignancies it is fairly good.

Adolescent↗
PubMed1987

Hip disarticulation in peripheral vascular disease.

The authors had to perform hip disarticulation on vascular patients in an increasing number - in spite of the general amputation principles. In the majority of the cases hip disarticulation followed other, more distal amputations of the same lower limb. Results of wound-healing, prosthetic fitting and mortality are poor, nevertheless this operation may lengthen life, relieve pain and lead to a tolerable life, usually bound to wheel-chair.

Adult↗