[Evaluation of prosthesis fitting in the adult: our experience].
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Adolescent↗
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Results for “Prosthesis Fitting”
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Fitting a prosthesis over phthisis bulbi or discolored blind eyes.
An ocular prosthesis fitted over phthisis bulbi or a discolored blind eye of near normal size is a positive approach to improve the cosmetic appearance and psychological well-being of the patient. Unless surgical intervention is essential, fitting a prosthesis over the residual eye is a successful alternative to enucleation or evisceration. In general, for these individuals there is minimal disruption of the periocular tissues, thus, reducing fitting problems associated with enucleation and evisceration. A prosthesis properly fitted over phthisis bulbi or a discolored blind eye will maintain the integrity of the orbital anatomy, enhance cosmesis, and accelerate the rehabilitation of the patient.
Blindness↗
[Partial replantation following proximal limb injury].
PURPOSE OF THE STUDY: Proximal replantation is a technically feasible but life-threatening procedure. Indications must be restricted to patients in good condition with a good functional prognosis. The goal of replantation must be focused not only on reimplanting the amputated limb but also on achieving a good functional outcome. For the lower limb, simple terminalization remains the best choice in many cases. When a proximal amputation is not suitable for replantation, the main aim of the surgical procedure must be to reconstruct a stump long enough to permit fitting a prosthesis preserving the function of the adjacent joint. If the proximal stump beyond the last joint is very short, it may be possible to restore some length by partial replantation of spared tissues from the amputated part. We present here the results we obtained following this policy. MATERIALS AND METHODS: This series included 16 cases of partial replantations, 14 involving the lower limb and 2 the upper limb. All were osteocutaneous microsurgical transfers. For the lower limb, all transfers recovered protective sensitivity following tibial nerve repair. The functional calcaeoplantar unit was used in 13 cases. The transfer of this specialized weight bearing tissue provided a stable distal surface making higher support unnecessary. In one case, we raised a 13-cm vascularized tibial segment covered with foot skin for additional length. For the upper limb, the osteocutaneous transfer, based on the radial artery, was not reinnervated, but this lack of sensitivity did not impair prosthesis fitting. RESULTS: One vascular failure was finally amputated. This was the only unsuccessful result. For all other patients, the surgical procedure facilitated prosthesis fitting and preserved the proximal joint function despite an initially very proximal amputation. DISCUSSION: The advantages of partial replantation are obvious compared with simple terminalization or secondary reconstruction. There is no secondary donor site and, because there is no major muscle mass in the distal fragment, the overall risk is very low compared with the risk of total proximal leg replantation.
Adolescent↗
The frictional-fit periodontal prosthesis: innovative esthetic and functional solutions to an old problem.
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Dental Abutments↗
Prosthetic rehabilitation in traumatic upper limb amputees (an Indian perspective).
INTRODUCTION: Rehabilitation of traumatic upper limb amputees depends on a multitude of factors. This study attempts to evaluate the success of prosthetic rehabilitation in this group of patients, determine the reasons for non-compliance and find ways to increase prosthetic acceptance. MATERIALS AND METHODS: The prosthetic rehabilitation status of 71 traumatic upper-limb amputees was assessed by a questionnaire and clinical review. A Prosthetic Rehabilitation Scoring (PRS) system, based on patient satisfaction, prosthetic usage and activity level, was devised to quantify the success of rehabilitation. RESULTS: The rehabilitation was found to be equally good in above-elbow and below-elbow amputees. The delay in fitting of the prosthesis had no correlation with successful rehabilitation. Chances of successful rehabilitation decreased when the prosthesis fitting was done in older patients. The main reasons for inadequate use of the prosthesis were repeated mechanical failure and the high cost of repair and replacement. CONCLUSION: In order to achieve an optimum benefit for the patient in a developing country, the prosthesis should be durable, inexpensive and have a low cost of maintenance.
Adult↗
Comparison of the stability of press-fit hip prosthesis femoral stems using a synthetic model femur.
The motion of three different press-fit hip prosthesis femoral components was compared with that of a cemented stem and an Austin Moore noncemented hemiarthroplasty. Synthetic composite femurs were used as an experimental model to reduce the variations in shape and quality typical among cadaver femurs. Motion was measured under axial and rotational loading approximating a walking load. On the initial application of load, axial subsidence was as much as several millimeters for the noncemented stems. Considerable tightening occurred during the 5,000 walking cycles, such that the motion of the noncemented stems in some directions eventually was as small as that of the cemented stem, on the order of tens of microns.
Biomechanical Phenomena↗
Results of knee arthroplasty using the cemented press-fit condylar prosthesis. Based on a preliminary report.
Although retention of the posterior cruciate ligament in total knee arthroplasty remains controversial, several prostheses exist for this purpose and have been reported to have varying results. This study examines the short-term follow-up results of 107 total knee arthroplasties using a cemented press-fit condylar prosthesis. The mean follow-up period was 2.5 years, and the mean postoperative knee score was 96 points. Radiolucent lines were infrequently found and were incomplete. At short-term follow-up, no problems were identified with the cemented press-fit condylar prosthesis.
Aged↗
[The custom-fit voice prosthesis, for treatment of periprothetic leakage after tracheoesophageal voice restoration].
BACKGROUND: Leakage around an indwelling voice prosthesis is detected during 13% up to 27% of all replacement procedures of voice prosthesis and causes serious complications in further voice restoration of the laryngectomee. Lots of therapeutic options to stop periprothetic leakage have been described (Injection of Bioplastique, autologous fat or collagen, suture techniques, spacer therapy) without convincing success rates. METHODS: Custom-fit voice prostheses are ordinary indwelling voice prostheses (Blom-Singer low pressure Indwelling 20 fr) with enlarged flanges and reduced shaft length that are individually sized for the shunt of the laryngectomee. Especially enlarging the esophageal flange provides a tight sealing of leakage around the prosthesis. PATIENTS: In a one year lasting clinical trial 692 voice prostheses were changed. In 77 cases periprothetic leakage was detected and fistulas were fitted with individually sized voice prostheses. RESULTS: In 76 cases total control of leakage was achieved without any specific complications taking place. Moreover two types of leaking tracheoesophageal fistulas were distinguished, a dilated-atrophic and an infected-necrotic type. 57% of the fistulas were dilated-atrophic type and 43% of the fistulas were classified infected-necrotic type. Infected-necrotic fistulas needed enlarged flanges tracheal an esophageal for tight sealing in 91% of the cases whereas dilated-atrophic fistulas needed double flanges only in 45%. 70% of infected-necrotic type fistulas needed only one singular history of a custom-fit prosthesis and could be changed back to ordinary indwelling prostheses after healing had taken place. CONCLUSIONS: As the insertion of a modified prosthesis is only slightly more effort than an ordinary voice prosthesis insertion, the success rate is high und complications are rare we recommend the custom-fit voice prosthesis for treatment of periprothetic leakage.
Aged↗
Long-term follow-up evaluation of a prototype press-fit knee prosthesis. A. T. Moore's distal femoral resurfacing arthroplasty.
Austin T. Moore designed a little-known prototype press-fit distal femoral resurfacing knee prosthesis. The implant's history and its long-term follow-up result in one existing patient are reported in the 51st anniversary year of Dr. Moore's first prosthetic procedure.
Aged↗
Problems with the hydroxyapatite orbital implant: experience with 250 consecutive cases.
The coral derived hydroxyapatite sphere is a popular, integrated orbital implant designed to provide improved motility of the ocular prosthesis following enucleation. Although the implant has rapidly become widely used by ophthalmologists, little information is available regarding the problems of this technique in a large series of cases. Experience with 250 consecutive cases of hydroxyapatite orbital implant use was reviewed and the problems of the implants and their management investigated specifically. The reasons for enucleation included uveal melanoma (157 cases), retinoblastoma (70 cases), blind painful eye (22 cases), and intraocular medulloepithelioma (one case). Earlier treatment to the eye was performed before enucleation in 47 cases and included repair of ruptured globe (17 cases), plaque radiotherapy (18 cases), external beam radiotherapy (six cases), and others (six cases). During a mean of 23 months' follow up (range 6-40 months), there have been no recognisable cases of orbital haemorrhage related to the implant, and no cases of implant extrusion or implant migration. There was one case of presumed orbital infection (culture negative) that resolved with intravenous antibiotics and the implant was retained within the orbit. Other problems included conjunctival thinning in eight cases managed by observation and prosthesis adjustment, and conjunctival erosion in four cases managed by combinations of scleral patch graft, conjunctival flap, and prosthesis adjustment. The conjunctival erosion was caused by a poorly fitting prosthesis in three cases and wound dehiscence in one case. The problem rate in eyes receiving prior radiotherapy or surgery was not increased. The hydroxyapatite integrated orbital implant is a well tolerated motility implant without the high rate of extrusion and infection seen with other motility implants. The prosthesis fit may contribute to the tolerance of the implant.
Child↗
The supply and fitting of a temporary breast prosthesis.
The fitting of soft breast prostheses is an essential nursing duty on breast cancer surgery wards, but it appears to be performed on an ad hoc basis, without evidence-based guidelines. A diagnosis of breast cancer carries enormous implications for the patient in terms of physical and psychological health. For this reason, it is vital that nurses respond sensitively to these needs and assist women to cope with the changes in body image. This includes ensuring that knowledge underpins practice when fitting the soft breast prosthesis. This article outlines a 12-point plan devised by the authors, giving guidance on how to fit temporary breast prostheses.
Adaptation, Psychological↗
Successful fitting of a prosthesis for a child amputee suffering from scleroderma.
A few anecdotal cases of limb amputations owing to scleroderma have been described in the literature. This article outlines the salient problematic features of a residual stump and provides the prosthetic considerations and appropriate design that eventually facilitated ambulation.
Activities of Daily Living↗
Compression friction and not proper fitting of the prosthesis.
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Ankle Joint↗
Residual-limb shape change: three-dimensional CT scan measurement and depiction in vivo.
PURPOSE: To perform quantitative evaluation of lower-extremity prosthesis fit by using spiral computed tomography (CT). MATERIALS AND METHODS: Two spiral CT scans were obtained at each of two different sessions in seven adult patients who had undergone amputation below the knee. A rigid-body transformation of the tibia was computed and used to align paired (intra- and intersession) spiral CT data sets for each individual in a common coordinate system. Paired scans in each individual were compared to assess registration and precision of soft-tissue change measurement. Clinical prosthesis fit evaluation was demonstrated in an adult amputee volunteer who underwent CT evaluation while wearing two different prostheses. RESULTS: In the seven patients examined, more than 90% of the measured soft-tissue volume displacements between sessions could be explained as true differences. Precision error of soft-tissue volume change was approximately 13 cm3, or approximately 1% error relative to the mean volume. Volumetric changes due to different prostheses were substantially larger than the random error. CONCLUSION: Registration of CT volumetric data sets to quantify residual-limb soft-tissue envelope change in lower-limb prosthetics is precise and can be used to detect the effect of prosthesis shape alterations.
Adult↗
Use and satisfaction with prosthetic limb devices and related services.
OBJECTIVES: To examine the use and satisfaction with prosthetic limb devices and satisfaction with prosthetist services in a large and diverse sample of persons with limb loss. DESIGN: Retrospective cohort study. SETTING: General community. PARTICIPANTS: Persons aged 18 to 84 years identified from the Amputee Coalition of America registry as having a major upper- or lower-limb loss due to vascular disease, trauma, or malignancy. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Use and satisfaction with prosthetic limb devices and satisfaction with prosthetists' services, assessed via structured telephone interviews. RESULTS: Most persons (94.5%) surveyed had a prosthesis and used it extensively (71h/wk). Most persons with amputations appeared to be satisfied with the overall performance of their prostheses (75.7%). Nearly one third of them, however, expressed dissatisfaction with their prostheses' comfort. Frequency of prosthesis use and satisfaction with the device were significantly higher among those with shorter timing to first prosthesis fitting, even after controlling for a wide array of respondents' sociodemographic and amputation characteristics. Overall, persons with amputations in our sample had positive assessments of their prosthetists' quality. Less favorable ratings concerned items related to the prosthetists' interpersonal skills. Multivariate analyses showed that men and black persons with amputations were less likely than their female or white counterparts to have favorable perceptions about their prosthetists across all dimensions of provider quality. Persons with fewer years of schooling were also less likely to be satisfied with their prosthetist's interpersonal manner. There were no significant differences in prosthesis use, satisfaction, or assessment of prosthetists' quality based on amputation etiology or amputation level. CONCLUSIONS: Efforts should be directed at minimizing the interval from surgery to first prosthesis fitting and at improving communication between patients and prosthetists, to improve the quality of care provided to the growing numbers of persons with limb loss.
Adolescent↗
[Surgical treatment of a femoral agenesis: a case report].
We report a case of severe femoral agenesia in an adult and propose a new surgical approach facilitating prosthesis fitting. The procedure involves insertion of a total hip arthroplasty, arthrodesis of the knee and amputation of the foot. The final prosthesis fits on the crural area with weight bearing on the ischiatic region, the lesser pelvis, and the articulated knee. Outcome was satisfactory at one year in our patient. Other surgical alternatives are presented.
Adult↗
Comparison of the lateral release rates in the press fit condylar prosthesis and the PFC Sigma prosthesis.
There are many different total knee replacements on the market. Most have undergone design changes since they were introduced. The manufacturers claim these changes are necessary to improve outcomes of their products. Johnson and Johnson changed their press fit condylar (PFC) knee to PFC Sigma. One of the reasons for the change was to improve patella tracking by combining the deeply radiused trochlear groove of the PFC cruciate sacrificing knee with the natural asymmetrical valgus angle of the PFC cruciate retaining knee. In 1995 we started a prospective audit of our knee replacements. We analysed our early outcomes to test this theory. Group 1 consisted of 468 patients who underwent 543 PFC replacements. Group 2 consisted of 359 patients who underwent 423 Sigma knee replacements. An audit nurse saw all the patients preoperatively and an American Knee Society Score was done. Operative details were recorded. Patients were followed up by an audit nurse at a dedicated knee clinic. The same surgeons using the same instrumentation carried out the operations. The change in design reduced the lateral release rate by 50% from 32 to 16%. The complications were similar in both groups and there was no difference in the outcomes at 6 months. The change in design from the PFC to the Sigma knee has had an effect in reducing the lateral release rate, without affecting the early outcomes. We plan to continue this audit to see if the change leads to less patellar problems in the future.
Arthroplasty, Replacement, Knee↗
Predictive value of objective esophageal insufflation testing for acquisition of tracheoesophageal speech.
This prospective study was undertaken to assess the predictive value of esophageal insufflation on the acquisition of tracheoesophageal (TE) speech. Fourteen total laryngectomy patients were evaluated prior to tracheoesophageal puncture (TEP) using objective esophageal pressure measurements. These patients then were followed prospectively for 6 to 13 months. Speech was assessed at the time of prosthesis fitting, at 1 month, at less than 6 months, and at greater than 6 months post-TEP. No patient underwent pharyngeal myotomy. Pre-TEP esophageal insufflation pressure was associated (P = .065) with successful TE speech at the time of prosthesis fitting, but was not associated with successful TE speech acquisition after 6 months. This study's results suggest that patients with poor pre-TEP esophageal insufflation test results will usually obtain successful TE speech given adequate time and training, even without pharyngeal myotomy.
Aged↗