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JBJS Essential Surgical Techniques 2024Constructing an osseointegrated prosthetic leg is the necessary subsequent phase of care for patients following the surgical implantation of an osseointegrated...
BACKGROUND
Constructing an osseointegrated prosthetic leg is the necessary subsequent phase of care for patients following the surgical implantation of an osseointegrated prosthetic limb anchor. The surgeon implants the bone-anchored transcutaneous implant and the prosthetist constructs the prosthetic leg, which then attaches to the surgically implanted anchor. An osseointegration surgical procedure is usually considered in patients who are unable to use or are dissatisfied with the use of a socket prosthesis.
DESCRIPTION
This present video article describes the techniques and principles involved in constructing a prosthetic leg for transfemoral and transtibial amputees, as well as postoperative patient care. Preoperatively, as part of a multidisciplinary team approach, the prosthetist should assist in patient evaluation to determine suitability for osseointegration surgery. Postoperatively, when approved by the surgeon, the first step is to perform an implant inspection and to take patient measurements. A temporary loading implant is provided to allow the patient to start loading the limb. When the patient is approved for full-length leg to begin full weight-bearing, the implant and prosthetic quality are evaluated, including torque, implant position, bench alignment, static alignment in the standing position, and initial dynamic alignment. This surgical procedure also requires long-term, continued patient care and prosthetic maintenance.
ALTERNATIVES
For patients who are dissatisfied with the use of a socket prosthesis, adjustments can often be made to improve the comfort, fit, and performance of the prosthesis. Non-osseointegration surgical options include bone lengthening and/or soft-tissue contouring.
RATIONALE
Osseointegration can be provided for amputees who are expressing dissatisfaction with their socket prosthesis, and typically provides superior mobility and quality of life compared with nonoperative and other operative options. Specific differences between the appropriate design and construction of osseointegrated prostheses versus socket prostheses include component selection, component fit, patient-prosthesis static and dynamic alignment, tolerances and accommodations, and also the expected long-term changes in patient joint mobility and behavior. Providing an osseointegrated prosthesis according to the principles appropriate for socket prostheses may often leave an osseointegrated patient improperly aligned and provoke maladaptive accommodations, hindering performance and potentially putting patients at unnecessary risk for injury.
EXPECTED OUTCOMES
Review articles describing the clinical outcomes of osseointegration consistently suggest that patients with osseointegrated prostheses have improved prosthesis wear time, mobility, and quality of life compared with patients with socket prostheses. Importantly, studies have shown that osseointegrated prostheses can be utilized in patients with short residual limbs that preclude the use of a socket prosthesis, allowing them to regain or retain function of the joint proximal to the short residuum. Osseoperception improves patient confidence during mobility. Because there is an open skin portal, low-grade soft-tissue infection can occur, which is usually treated with a short course of oral antibiotics. Much less often, soft-tissue debridement or implant removal may be needed to treat infection. Periprosthetic fractures can nearly always be treated with familiar fracture fixation techniques and implant retention.
IMPORTANT TIPS
Falls can lead to periprosthetic fractures.Malalignment can lead to unnecessary pathologic joint forces, soft-tissue contractures, and an accommodative gait.Inadequately sophisticated components can leave patients at a performance deficit.Wearing the prosthetic leg while sleeping may lead to rotational forces exerted on the limb, which may cause prolonged tension on the soft tissue.
ACRONYMS AND ABBREVIATIONS
QTFA = Questionnaire for Persons with a Transfemoral AmputationLD-SRS = Limb Deformity Modified Scoliosis Research SocietyPROMIS = Patient-Reported Outcomes Measurement Information SystemEQ-5D = EuroQol 5 Dimensions.
PubMed: 38406563
DOI: 10.2106/JBJS.ST.22.00064 -
Journal of Ultrasound in Medicine :... Feb 2024A new ultrasound-based device is proposed to non-invasively measure the orientation of the scapula in the standing position to consider this parameter for Total Shoulder...
OBJECTIVES
A new ultrasound-based device is proposed to non-invasively measure the orientation of the scapula in the standing position to consider this parameter for Total Shoulder Arthroplasty. The aim of this study was to assess the accuracy and reliability of this device.
METHODS
Accuracy was assessed by comparing measurements made with the ultrasound device to those acquired with a three-dimensional (3D) optical localization system (Northern Digital, Canada) on a dedicated mechanical phantom. Three users performed 10 measurements on three healthy volunteers with different body mass (BMI) indices to analyze the reliability of the device by measuring the intra and interobserver variabilities.
RESULTS
The mean accuracy of the device was 0.9°± 0.7 (0.01-3.03), 1.3°± 0.8 (0.03-4.55), 1.9°± 1.5 (0.05-5.76), respectively, in the axial, coronal, and sagittal planes. The interobserver and intraobserver variabilities were excellent whatever the BMI and the users experience.
CONCLUSIONS
The device is accurate and reliable enough for the measurement of the scapula orientation in the standing position.
Topics: Humans; Reproducibility of Results; Standing Position; Scapula; Observer Variation; Canada; Shoulder Joint; Range of Motion, Articular; Biomechanical Phenomena
PubMed: 37987527
DOI: 10.1002/jum.16370 -
Seminars in Neurology Feb 2024Historically, the practice of neurology as an independent subspecialty from internal medicine began in Europe and the United States in the 1930s. The American Academy of...
Historically, the practice of neurology as an independent subspecialty from internal medicine began in Europe and the United States in the 1930s. The American Academy of Neurology (AAN) was founded 75 years ago in 1948, solidifying its emergence as a stand-alone discipline of medicine. In 1967, St. Christopher's Hospice, the first free standing hospice home, was opened in London by Dame Cicely Saunders. Dame Saunders is considered a pioneer in the development of the hospice movement, and she embodies the importance of the multi-disciplinary team in the care of the patient, as she began her career as a nurse, then became a social worker and, finally, a physician. A decade later, in 1978, Dr. Balfour Mount, a Canadian urologic cancer surgeon, coined the term "palliative care" ("to improve the quality of life") after having spent time with Dr. Saunders at St. Christopher's some years earlier. The field of palliative care continued to develop as a distinct subspecialty focused on improving quality of life for patients at any age and in any stage of serious illness. In a 1996 position statement, the AAN made clear that the practice of primary palliative care is the responsibility of all neurologists to their patients. Finally, coming full circle, the specialty of neuro-palliative care, a subspecialty not just of neurology but of palliative medicine, became established around 2018. Neuro-palliative care can be seen as a specialty focusing on the holistic approach to symptom management in patients suffering from neurologic disease with the aim of improved symptom control and attention to the psychologic and spiritual aspects of illness.
Topics: Female; Humans; United States; Palliative Care; Quality of Life; Canada; Hospice Care; Internal Medicine
PubMed: 38176423
DOI: 10.1055/s-0043-1777703 -
European Journal of Applied Physiology Nov 2023There is considerable interest in simple and effective methods to reduce sitting time and increase energy expenditure, and standing breaks have emerged as a realisable...
PURPOSE
There is considerable interest in simple and effective methods to reduce sitting time and increase energy expenditure, and standing breaks have emerged as a realisable approach in individuals with obesity. The aim of the present study was to determine the extent to which energy expenditure in standing differs from sitting, and whether this energetic and metabolic-related responses are modified following a weight loss program in adolescents with obesity.
METHODS
After body composition assessment (DXA), cardiorespiratory and metabolic variables were continuously recorded (indirect calorimetry) during 10 min while sitting and then during 5 min standing posture before (n = 21; T1) and at the end of a multidisciplinary intervention (n = 17; T2) in adolescents with obesity.
RESULTS
Before and after the intervention, energy expenditure and fat oxidation rates were significantly increased in standing compared with sitting. Weight loss did not change the relationship between sitting and standing energy expenditure. Sitting energy expenditure represented 1.0 and 1.1 Metabolic Equivalent of Task at T1 and T2, and increased to 1.1 and 1.2 during standing at T1 and T2, respectively. The percentage of change of android fat mass between T1 and T2 was positively associated with the percentage of change in energy expenditure from sitting to standing at T2.
CONCLUSION
The vast majority of the adolescents with obesity significantly increased their energy expenditure between sitting and standing, both before and after a weight loss intervention. However, the standing posture did not allow breaking the sedentary threshold. Abdominal fat mass is associated with energic profile.
Topics: Adolescent; Humans; Pediatric Obesity; Sedentary Behavior; Posture; Standing Position; Energy Metabolism; Weight Loss
PubMed: 37310434
DOI: 10.1007/s00421-023-05247-8 -
Frontiers in Physiology 2023The triceps surae muscle plays important roles in fundamental human movements. However, this muscle is relatively unresponsive to resistance training (difficult to...
The triceps surae muscle plays important roles in fundamental human movements. However, this muscle is relatively unresponsive to resistance training (difficult to hypertrophy) but prone to atrophy with inactivity compared with other muscles. Thus, identifying an effective training modality for the triceps surae is warranted. This study compared triceps surae muscle hypertrophy after standing/knee-extended seated/knee-flexed plantarflexion (calf-raise) training, where the gastrocnemius is lengthened and shortened, respectively. Fourteen untrained adults conducted calf-raise training with one leg in a standing/knee-extended position and the other leg in a seated/knee 90°-flexed position at 70% of one-repetition maximum. Each leg performed 10 repetitions/set, 5 sets/session, 2 sessions/week for 12 weeks. Before and after the intervention, magnetic resonance imaging scans were obtained to assess muscle volume of each and the whole triceps surae. : Muscle volume significantly increased in all three muscles and the whole triceps surae for both legs ( ≤ 0.031), except for the gastrocnemius muscles of the seated condition leg ( = 0.147-0.508). The changes in muscle volume were significantly greater for the standing than seated condition leg in the lateral gastrocnemius (12.4% vs. 1.7%), medial gastrocnemius (9.2% vs. 0.6%), and whole triceps surae (5.6% vs. 2.1%) ( ≤ 0.011), but similar between legs in the soleus (2.1% vs. 2.9%, = 0.410). Standing calf-raise was by far more effective, therefore recommended, than seated calf-raise for inducing muscle hypertrophy of the gastrocnemius and consequently the whole triceps surae. This result and similar between-condition hypertrophy in the soleus collectively suggest that training at long muscle lengths promotes muscle hypertrophy.
PubMed: 38156065
DOI: 10.3389/fphys.2023.1272106 -
Healthcare (Basel, Switzerland) Nov 2023The habit of using smartphones while walking has become widespread among modern individuals, particularly when pedestrians are in a hurry. However, there has been little...
The habit of using smartphones while walking has become widespread among modern individuals, particularly when pedestrians are in a hurry. However, there has been little exploration into the differences between standing and walking at various speeds in terms of smartphone use. In this study, we examined 60 young participants (30 men and 30 women) who engaged in smartphone tasks such as one-handed browsing or two-handed texting while standing, walking slowly, and walking normally. The measured variables included neck flexion (NF), head flexion (HF), gaze angle (GA), and viewing distance (VD). The study findings indicate that using smartphones while walking may cause a more pronounced kyphotic curve in the cervical spine compared to when standing, leading to increased strain in the neck region. The heightened neck load can be attributed to the concurrent dynamic nature of both walking and smartphone usage. Moreover, two-handed texting had a more detrimental impact on NF, HF, and GA when contrasted with one-handed browsing. The interplay among hand operation, posture, and maintaining arm position displayed an uncertain correlation with VD. While women typically exhibited smaller NF, HF, and GA than men, it is important to explore whether their shorter VD might contribute to increased eyestrain.
PubMed: 38063595
DOI: 10.3390/healthcare11233027 -
Military Medicine Jul 2023Transitioning between the ground and standing is a required activity for many professions including skilled trades, law enforcement, and military service. However,...
INTRODUCTION
Transitioning between the ground and standing is a required activity for many professions including skilled trades, law enforcement, and military service. However, available assessments are limited and focus primarily on quality of movement. Thus, we developed two novel assessments of functional mobility specific for ground-to-standing transitions: Stand-Prone-Standx2 (SPS2) and Stand-Kneel-Standx2 (SKS2-L/R) tests. The purpose of this study was to determine the psychometrics of these two new measures in able-bodied (AB) service members and in service members with unilateral lower extremity injury (LEI).
MATERIALS AND METHODS
A total of 57 AB service members and 31 service members with a traumatic unilateral LEI wearing a custom carbon-fiber ankle-foot orthosis participated in this study. In total, 36 AB and 18 LEI participants returned for a second session to assess intersession reliability. Intraclass correlation coefficients were calculated for intersession and inter-rater comparisons (two-way random model for consistency and single measure). Additionally, performance was compared between legs and groups.
RESULTS
The SPS2 and SKS2 assessments demonstrated excellent inter-rater and intersession reliability in both the AB and LEI groups with all intraclass correlation coefficient values greater than 0.8. Further, the tests were responsive to deficits associated with LEI, with the LEI group having significantly longer times on all assessments compared to the AB group.
CONCLUSIONS
The SPS2 and SKS2 performance measures were found to have excellent inter-rater and intersession reliability in both AB participants and participants with LEI. Further, participants with LEI performed significantly slower than the AB participants. Excellent reliability and responsiveness to deficits associated with LEI support the use of the SPS2 and SKS2 to assess mobility in individuals with LEI. Transitions between the ground and standing occur in many occupational and daily tasks. These reliable performance measures that assess ground-to-stand transitions can be applied widely, in many populations beyond highly functioning service members with LEI.
Topics: Humans; Male; Female; Adult; Reproducibility of Results; Psychometrics; Standing Position
PubMed: 35869886
DOI: 10.1093/milmed/usac228 -
Journal of Biomechanics Dec 2023This study investigated the inter- and intramuscular variability of plantar flexors stiffness during prone and standing positions at different muscle lengths in healthy...
This study investigated the inter- and intramuscular variability of plantar flexors stiffness during prone and standing positions at different muscle lengths in healthy and paretic individuals. To access tissue stiffness, shear wave elastography (SWE) measurements were carried out on two groups: control group (CG; n=14; age 43.9±9.6 years; body mass index [BMI]=24.5±2.5 kg/m) and stroke survivor group (SSG; n=14; age 43.9±9.6 years; BMI=24.5±2.5 kg/m). Shear Modulus (μ, kPa) within three plantar flexors (the gastrocnemius medialis [GM], gastrocnemius lateralis [GL], and soleus [SOL]) was obtained during two conditions: prone and standing position, at different angles of dorsiflexion (0°, 10°, and 20°). Measurements were also performed in different proximo-distal regions of each muscle. Muscle activation of the GM, GL, SOL, and tibialis anterior were evaluated during the two conditions. Results showed a high spatial stiffness variability between and within plantar flexors during dorsiflexion. The highest stiffness was observed in the GM, especially in the distal region at 20° in healthy and paretic muscles. In the prone position, the paretic muscle exhibits greater stiffness compared to the healthy muscle (p < 0.05). In contrast, in the standing position, an increase of stiffness in the healthy muscle compared to the paretic muscle was observed (p < 0.05). Thus, mechanical properties are differently affected by stroke depending on active and passive states of ankle muscles during dorsiflexion. In addition, the modification of ankle muscle state change stiffness distribution between and within plantar flexors.
Topics: Humans; Adult; Middle Aged; Standing Position; Muscle, Skeletal; Ankle; Ankle Joint; Elasticity Imaging Techniques; Stroke
PubMed: 37922613
DOI: 10.1016/j.jbiomech.2023.111838 -
Journal of the American Academy of... Feb 2024One of the most important jobs in elementary school can be distilled down to 2 words: line leader. This is the mighty carrot to mobilize ordinarily sluggish children...
One of the most important jobs in elementary school can be distilled down to 2 words: line leader. This is the mighty carrot to mobilize ordinarily sluggish children through their morning routine, as they look forward to standing proudly at the front of their classroom line. I have witnessed this phenomenon myself, as my first-grade son was chosen to be the glorious line leader of room 15. He moved with a sense of urgency in the morning to pack his backpack, fill his water bottle, and put on his shoes and socks, all with zero parental prompting. After I dropped him off, I secretly watched through the chain-link fence as he skipped over to his class with his head held high to claim his hard-earned position as the Tuesday line leader. The look of pride on his face was undeniable. This leadership position truly meant something to him, giving him a sense of purpose. As he marched his class to the same classroom door that they walk through every day, it was clear that the kid walking through the door had a little more shine than he had the day before.
Topics: Male; Child; Humans; Parents; Emotions; Schools
PubMed: 37890664
DOI: 10.1016/j.jaac.2023.10.006 -
Biology Sep 2023The maternal cardiovascular-circulatory system undergoes profound changes almost from the conception of a pregnancy until the postpartum period to support the maternal...
The maternal cardiovascular-circulatory system undergoes profound changes almost from the conception of a pregnancy until the postpartum period to support the maternal adaptions required for pregnancy and lactation. Maintenance of cardiovascular homeostasis requires changes in the cardiovascular autonomic responses. Here, we present a longitudinal study of the maternal cardiovascular autonomic responses to pregnancy and maternal position. Over a normal gestation, in the left lateral position there are significant changes in both time and frequency domain parameters reflecting heart rate variability. We show that cardiovascular autonomic responses to physiological stressors (standing and supine positions in late pregnancy) became significantly different with advancing gestation. In the third trimester, 60% of the subjects had an unstable heart rate response on standing, and these subjects had a significantly reduced sample entropy evident in their heart rate variability data. By 6 weeks, postpartum function returned to near the non-pregnant state, but there were consistent differences in high-frequency power when compared to nulligravid cases. Finally, we review complementary evidence, in particular from magnetic resonance imaging, that provides insights into the maternal and fetal impacts of positioning in pregnancy. This demonstrates a clear relationship between supine position and maternal hemodynamic parameters, which relates to compression of the inferior vena cava ( = 0.05). Together, these studies demonstrate new understanding of the physiology of physiological stressors related to position.
PubMed: 37759669
DOI: 10.3390/biology12091268