Trans-USA Hip Disarticulation/Transpelvic Prostheses Tour: Part Two = Rochester, MN
I recently spent two solid weeks criss-crossing the United States with a colleague from England, Steve Taylor. We started our adventure by heading up to Minnesota to visit Mike Gozola CP and his colleagues at Prosthetic Labs of Rochester. PLOR has long been associated with the Mayo Clinic in Minnesota, and as a result they have long-term experience with a variety of uncommon amputation levels.
They recently moved the lab from a crowded location in the bowels of the Mayo campus to a new and spacious building five minutes up the road. At the time we visited, they were still settling in to their new facility. Steve was very impressed with how spacious and versatile the lab was, but I tried to explain to him that not all US P&O facilities look like this!
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Of all the places we visited, Mike's group had the most highly organized approach to post-operative management of these high level patients. Because Mayo is an internationally known orthopedic and rehabilitation referral center, PLOR routinely sees new amputees within a few days of surgery, and in many cases prior to the amputation. They showed us an excellent patient video for pending HD and TP amputees that explained what to expect, from pre-op to final fitting. This tape was produced by the Mayo Clinic, and is one of the best of its kind that I have ever seen.
Interestingly, Mike reports that the number of hip disarticulation amputations they see has been steadily decreasing in recent years. He believes this is due to the growing success of various surgical limb salvage procedures, better tumor treatment and surgery, and similar medical advancements. The rate of transpelvic amputations seems to have been unchanged, and they typically see one or two new TP amputees each month.
During the immediate post-operative period, the TP amputee has difficulty sitting, due to post-operative pain as well as to the loss of pelvic structure. PLOR routinely provides a simplified "sitting prosthesis" to help the patients through this time. In many ways, it is a larger version of the "shoulder cap" configuration that is often provided to interscapulothoracic amputees.
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They form a Plastazote sheet over a TP cast and build it up with layers of Plastazote to form a sitting base. It is fitted at the patient's bedside by sculpting the outer layers, as necessary, with an electric carving knife. Once it has been trimmed to fit the patient's residual limb, it is covered with another thin sheet of Plastazote and hook Velcro is attached. A single Velcro loop strap running diagonally over the contralateral hip is used to secure the sitting device to the patient's body. According to Mike, this technique not only reduces patient discomfort but also helps shape the residual limb more quickly, facilitating early prosthetic fitting.
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Mike has developed a specialized hand casting method that he uses for TP patients, including a technique to accentuate weight bearing through the soft tissues that he feels results in significantly less stance phase pistoning than with other methods he has tried. Although we were unable to observe a casting procedure during our visit, we did review several patient videos and their apparent stability within the socket Mike had created was quite impressive.
Mike routinely provides a bandolier strap for suspension with the initial socket for TP amputees, so his videos also demonstrated reduced swing phase pistoning compared to most other designs. He feels that minimizing the pistoning results in a more energy efficient gait, and this justifies the use of a suspension strap.
Steve and I were able to meet with one of Mike's HD amputees, a delightful gentleman who was originally from Germany and now works full time as a restaurant chef. He has worn a thermoplastic socket for many decades, and demonstrated a very steady gait pattern without the use of any external aids. The socket was nearly ten years old and very well worn, but the patient reported it was comfortable and secure.
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He had a lateral opening secured by three straps that included a quick-disconnect feature. The overall socket configuration was a modified diagonal trimline, but his was unique because the extension over the ipsilateral iliac crest was anchored by two Velcro straps.