Improved Suspension Method for Transpelvic Sitting Prosthesis

I recently had the opportunity to fit a preparatory prosthesis for a gentleman in his 40s who had undergone revision amputation to the transpelvic level following recurrence of a malignancy. Even though he was only five weeks post-amputation, the residual limb was quite well healed and surprisingly pressure-tolerant, enabling him to start ambulating within parallel bars the morning after we took the plaster impression.

Within 24 hours, he had progressed from taking tentative steps with a stable polycentric knee to walking with a variable cadence using the new Otto Bock 3R92 stance control knee with pneumatic swing phase resistance. He completed one week of outpatient gait training and then returned to work 8 days after receiving the preparatory limb. In my experience, successfully rehabilitation is not always this rapid with adult patients who have undergone such high level amputations.

Certainly, the superb surgical result he presented with was a major factor in achieving this result. His residuum was carefully tailored without any "dog ears" at the corner of the incisions, the entire suture line was completely healed, and he had no gross post-operative edema. And, his positive attitude, good balance, and physical fitness were also important contributors. The fact that he wore a sitting prosthesis as soon as the sutures were removed may also have helped expedite the maturation of his residual limb.

A previous Corner [Trans-USA Hip Disarticulation/Transpelvic Prostheses Tour: Part Two = Rochester, MN] described the method Mike Gozola CP and his colleagues use to create a lightweight post-operative sitting prosthesis and this patient used a very similar design provided by his local prosthetist. But, there was one important difference: there were no hook-and-loop straps. Instead, the custom-sculpted padding was held securely against his hip by a pair of modified sports shorts, enabling him to sit comfortably and to apply controlled pressure to the site of the amputation.

When I commented that I was very impressed with how nicely the shorts suspended the sitting prosthesis, the patient smiled and informed me that it was his wife's idea, to eliminate the hassle of hook-and-loop straps. He also reported that the gentle compression provided by the shorts increased his overall comfort, and the smooth contours made it easy to wear clothes over the device. He found it so convenient and comfortable, that he put on the shorts/prosthesis combination at the start of the day and wore it continuously until bedtime.

This meant that the sitting aid was always in place, even if he was driving or riding in a car, walking with crutches, or doing any other normal activities of daily living. Unlike strap-on or separate "sitting pillow" configurations, he never left it across the room or back home. One consequence was that, every time he was seated, controlled pressure was being applied to his residual limb. This might be analogous to the forces applied by the well-known removable rigid dressing technique for transtibial amputations that has been shown to decrease the time to rehabilitation.

With the patient's permission, photos of this adaptation are being posted here so that other prosthetists can duplicate this very patient-friendly result. Note that the portion of the leg of the shorts that was removed to tailor the shorts to fit his residual limb contours was then stitched to form a pocket for the foam pad. Because the pocket closed with a small piece of hook-and-loop tape, the pad could be easily removed and the shorts laundered whenever necessary.

Reader Comments: Read all user comments Anti-blister balm Hello John! We recently met at the clinic in Houston at Muilenburg P&O. You saw my six-year old, Paul (right, below knee amp., flex-foot, etc.) and I told you about some wonderful anti-chaffing cream from Avon that worked wonders on his c... read more - Mary   7/7/2004 Re: Anti-blister balm Thanks for the correction, Mary. I'm sure this will encourage other folks to give this a try. It was a pleasure to meet your son and to see for myself how well he is doing. --John Michael CPO - John Michael   7/8/2004 ¿Como esta John Michael? Ciudad de Mexico 5 de Julio, 2004. Estimado John Michael, CPO, FAAOP: ¿como esta usted de salud? Extrañamos no haber recibido La Esquina de John Michael Edicion Julio 2004. Le enviamos un afectuoso saludo desde la Ciudad de Mexico. Sincera... read more - Alberto E. Castillo Moreno O. P.   7/5/2004 Re: ¿Como esta John Michael? Ciudad de Mexico 5 de Julio, 2004. Estimado John Michael: sentimos mucho la muerte de su suegra. Esperaremos sus interesantes escritos cuando usted se restablezca de esta perdida irreparable. Reciba usted y su esposa nuestra mas profunda m... read more - Alberto E. Castillo Moreno O. P.   7/5/2004 Re: ¿Como esta John Michael? Sorry for the delay in writing July's Corner. My wife's mom passed away recently, after a long illness, so I'm about 10 days behind in all but critical deadlines. --John Michael CPO - John Michael   7/5/2004 Brandon's good work! Hi John, good to see Brandon's good work getting a mention! Loved his music and probably just as important to show that many of the talented P&Os are "multi" talented also....Keep up the good work....both of you! - Bill Contoyannis   6/29/2004 Search Hi John, I just discovered that your articles are indeed included in the OandP.com O.P.I.E. search engine! Randy McFarland , CPO - Randy McFarland, CPO   6/17/2004 tri-planar orthotic control Hi John, Is there an expedient way to look up past topics you've discussed? I'm interested in your take on the current status of Tri-planar control in othotics. It's my understanding Jean Paul Nielsen, CP founded Oregon Orthotic ... read more - Randy McFarland, CPO   6/17/2004 Re: tri-planar orthotic control I have always used triplanar control concepts in developing lower limb orthosis designs because that was the way we were taught "orthoses 101" at Northwestern. It was only when the OOS movement came along that I realized that this was not ... read more - John Michael   6/18/2004