Journal of Prosthetics and Orthotics最新文献

{"title":"What a Patient Sees in the Mirror: Validation of the Truncal Anterior Asymmetry Scoliosis Questionnaire","authors":"B. Lonner, C. Toombs, Suken A. Shah, T. Bastrom, Phedra Penn, K. Bright, Carrie Stern, M. Roy-Beaudry, M. Beauséjour, Geraldine I. Neiss, Andrea Castillo, S. Parent","doi":"10.1097/JPO.0000000000000433","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000433","url":null,"abstract":"ABSTRACT Introduction Self-image and body shape are important to adolescent idiopathic scoliosis (AIS) patients. The impact of scoliosis on anterior trunk shape has been incompletely studied. The Truncal Anterior Asymmetry Scoliosis Questionnaire (TAASQ) was developed to assess anterior truncal appearance concerns and mental preoccupation and behavioral modification related to those concerns. The purpose of this study is to validate TAASQ in AIS. Methods A total of 105 female surgical AIS patients (average age, 14.9 years; mean Cobb, 53°) completed the TAASQ, Spinal Appearance Questionnaire (SAQ), and Scoliosis Research Society Questionnaire (SRS-22) questionnaires. TAASQ was developed with breast cancer researchers and piloted in 13 perioperative adolescent and adult idiopathic scoliosis patients. TAASQ contains 14 questions, both response scale and free response. Questions are categorized into three domains: breast, appearance, and clothing. Internal consistency/reliability (Cronbach's α) and concurrent validity were determined. Results Internal consistency was 0.86, 0.77, and 0.84 for clothing, appearance, and breast domains, respectively (good to excellent). Domains and subdomains of the TAASQ correlate well with the image domain of the SRS-22 but not with the SAQ. However, given that the TAASQ was designed to assess concerns with anterior appearance, the correlation with the image domain establishes concurrent validity of the questionnaire. Conclusions TAASQ is a reliable and valid measure of the concerns and behavioral modifications related to anterior truncal appearance in female AIS patients. Further study of TAASQ will help clinicians counsel patients on the impact of surgery on anterior truncal deformity. Clinical Relevance There is a clinical lack of knowledge about the significant self-image and anterior body shape concerns of adolescent females with AIS. The TAASQ has been developed to assess concerns related to anterior truncal appearance and mental preoccupation and behavioral modification.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"172 - 179"},"PeriodicalIF":0.6,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48324117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparison of the Effects of Pin and Vacuum-Assisted Suspension Systems in Individuals With Transtibial Amputation","authors":"Senay Cerezci Duygu, Bahar Anaforoğlu, F. Erbahçeci","doi":"10.1097/JPO.0000000000000432","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000432","url":null,"abstract":"ABSTRACT Introduction Suspension systems are essential components for a lower-limb prosthesis, as they provide sufficient prosthetic fit. Although various adverse and positive effects have been reported for suspension systems, it is important to determine the effects on the prosthesis users in detail. Objective The aim of this study was to compare the pin suspension system (PSS) with the vacuum-assisted suspension system (VASS) in terms of parameters including walking capacity, functional mobility, weight bearing on the operated side, prosthesis satisfaction, and body image perception. Study Design This is an original research report. Methods Nine individuals with transtibial amputation were evaluated. Both suspension systems were applied consecutively. Initially, participants used the PSS for 3 months after fabrication and adjustment of the prosthesis and a prosthetic training period. They then used the VASS for 3 months after a similar training period. After both prosthetic systems had been adjusted, L.A.S.A.R. Posture was used to determine weight bearing on the prosthetic side. The 6-minute walk test was applied for walking capacity, the timed up-and-go test was used to determine functional mobility, the Prosthetic Satisfaction Index was used for prosthetic satisfaction, and the Amputee Body Image Scale was used for body image perception. Results Significant differences were observed between PSS and VASS in terms of prosthetic side weight-bearing ratios, walking capacity, functional mobility, and prosthetic satisfaction (P < 0.05), all in favor of VASS. No significant difference was determined in terms of body image scores (P > 0.05). Conclusion In terms of function and prosthetic satisfaction in individuals with transtibial amputation, VASS was determined to be superior. The available evidence suggests that if there is no contraindication for the use of VASS, it may contribute to the individual with amputation functionally and increase the satisfaction with the prosthesis. Clinical Relevance Vacuum systems can make a positive contribution to reaching the goals for prosthesis users who are targeted to have high physical activity levels. This positive contribution includes increased weight transfer to the prosthetic side, an increase in mobility determinants, and increased prosthesis satisfaction, which has many dimensions.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"25 - 31"},"PeriodicalIF":0.6,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42258041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scoping Review of Mechanical Testing of the Structural and Material Properties of Lower-Limb Prosthetic Sockets","authors":"Gila Baer, S. Fatone","doi":"10.1097/JPO.0000000000000424","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000424","url":null,"abstract":"ABSTRACT Introduction Lower-limb amputations account for most cases seen by certified prosthetists in the United States. Fundamental to the success of a lower-limb prosthesis is the socket, and fundamental to the success of a socket is safety and durability. Currently, there are no standards specific to ensuring the safety and durability of lower-limb prosthetic sockets. The purpose of this scoping review was to describe the mechanical testing procedures used to date to assess the structural and material properties of lower-limb prosthetic sockets, with a view to informing the development of future standards. Methods A systematic search was conducted in PubMed, Cumulative Index to Nursing and Allied Health Literature, and Scopus databases and the Canadian Prosthetics & Orthotics Journal website to identify relevant articles. Articles published in English were included if they used mechanical testing to assess the socket and/or socket material and presented those test results. Results Fourteen articles were included in this review. They described 30 different mechanical test protocols, consisting of 12 different types of mechanical tests. The most common mechanical tests conducted were tensile, static load, and cyclic load testing. Of the 30 test protocols, 20 referenced current standards that do not include sockets within their scope and modified them in various ways to allow testing of sockets. Of the 14 included articles, 8 described using a mock residual limb during testing, all of which were unique in their composition. Conclusion Individual researchers modified existing, nonsocket standards in varying ways to adopt them for use in testing lower-limb prosthetic sockets. This scoping review describes information that may inform the development of socket-specific test protocols. Clinical Relevance Future research is needed to determine which tests are good indicators of clinical safety and durability in order to link quantitative results of mechanical testing to the safety and durability of everyday socket use.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"e37 - e47"},"PeriodicalIF":0.6,"publicationDate":"2022-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48136646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contralateral Limb Pain Is Prevalent, Persistent, and Impacts Quality of Life of Veterans with Unilateral Upper-Limb Amputation","authors":"L. Resnik, Matthew L. Borgia, Melissa A. Clark","doi":"10.1097/JPO.0000000000000434","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000434","url":null,"abstract":"ABSTRACT Introduction Individuals with upper-limb amputation (ULA) have increased risk for contralateral limb pain (CLP), and further study of CLP in ULA is needed. Study objectives were to: (1) describe CLP frequency, intensity, and 1-year change; (2) identify factors associated with CLP; and (3) quantify associations between CLP, health-related quality of life (HRQoL), and disability (QuickDASH). Methods A total of 776 veterans with unilateral ULA were surveyed at baseline, and 562 were surveyed again at 1 year. Participants reported CLP frequency and intensity and nonamputated limb conditions. Multivariable models examined factors associated with CLP, as well as associations between CLP intensity and HRQOL (physical component score and mental component score) and disability (QuickDASH). Results Contralateral limb pain prevalence was 72.7% (baseline) and 71.6% (follow-up); 59.8% had persistent pain. Contralateral limb conditions and neck and residual limb pain were associated with higher odds of CLP. Black race (vs White), back pain (vs without), and age 45 to 65 years (vs 18–45 years) were associated with greater CLP intensity. Female sex (vs male) and use of cosmetic prostheses (vs body-powered) were associated with lower intensity. The mental component scores were 2.7 and 6.6 points lower for moderate and severe CLP, respectively; the physical component scores were 4.2 and 8.4 points lower for moderate and severe CLP; and QuickDASH scores were 9.4 and 20.7 point higher for moderate and severe CLP, compared with none to mild pain. Conclusions Findings suggest that overreliance on the nonamputated limb, leading to CLP, occurs regardless of amputation level or prosthesis use. Further research is needed to understand whether disparities in pain treatment exist by race. Contralateral limb pain is prevalent and persistent in veterans with ULA. Moderate to severe CLP is associated with worse HRQOL and greater disability. Efforts are needed to prevent and treat ULA CLP pain. Clinical Relevance Clinicians caring for persons with unilateral ULA should evaluate the contralateral upper limb and refer patients to appropriate therapies to address painful conditions. Persons with ULA should be educated about the risks of development of CLP and be provided with strategies to minimize overuse when possible.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"3 - 11"},"PeriodicalIF":0.6,"publicationDate":"2022-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44306867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of an Inpatient Physical Rehabilitation Program Designed for Persons with Amputations of Traumatic or Vascular Etiologies","authors":"Daniela Mitiyo Odagiri Utiyama, F. Alfieri, A. C. A. dos Santos, C. Ribeiro, Viviane Caroline Sales, L. Battistella","doi":"10.1097/JPO.0000000000000436","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000436","url":null,"abstract":"ABSTRACT Introduction Rehabilitation after amputation is essential, and descriptions of inpatient rehabilitation programs for individuals with amputation are scarce. Therefore, the objective of this study was to describe the effects of an inpatient physical rehabilitation program on mobility, balance, function, and gait of individuals with unilateral lower-limb amputations. Materials and Methods This was a retrospective before-after study. Data were extracted from medical records of individuals with lower-limb amputation admitted for inpatient intensive rehabilitation programs. Data on etiology, functional mobility (by timed up and go [TUG]), balance and functionality (amputee mobility predictor [AMP]), and gait (2-minute walk test [2MWT]) were collected before and after prosthetic fitting phase of an inpatient rehabilitation program. Patient information was stratified as traumatic and vascular etiologies, and after descriptive analysis, general outcomes and intragroup results were compared with t-test and followed by linear regressions analysis for a better understanding of the demographic and clinical roles on treatment evolution. Results Group comparison evidenced differences of age between traumatic and vascular groups, as traumatic amputations had greater incidence among younger individuals, regardless of the prosthesis phase. Before the prosthesis fitting and regardless of the groups, there were significant improvements on AMP, 2MWT, and TUG, and the differences between both groups were influenced by their baseline conditions. After prosthesis fitting, significant improvements were identified, regardless of the etiology. Conclusions This study provides evidence that individuals with amputation who are admitted to an intensive hospitalized physical rehabilitation program experience benefits in mobility, balance, functionality, and gait capacity irrespective of causality or if the prosthesis was provided. Gains evidenced in the preprosthetic phase were continued in the postprosthetic phase. Clinical Relevance Inpatient rehabilitation programs for individuals with amputation are beneficial for improving the functionality of these individuals. This type of multidisciplinary rehabilitation provides functional improvements to the patient from the preprosthetic to the prosthetic phases, favoring global rehabilitation in a short period, which can reduce treatment time and provide better living conditions for the patient.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"152 - 158"},"PeriodicalIF":0.6,"publicationDate":"2022-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46721251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Cooling Time on the Dimensional Stability of Thermoforming Polypropylene","authors":"David J. Ojeda Sersun, K. Swafford, Heather Orosco, Chelsie Rodgers, Michel Davidson, G. Bains, Ben Becerra","doi":"10.1097/JPO.0000000000000428","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000428","url":null,"abstract":"ABSTRACT Introduction Documented by the International Committee of the Red Cross, consolidation time for polypropylene (PP) plastic must be left on the plaster model for 24 hrs. If not followed, this will result in an incorrect shape and volume of PP plastic. To the best of our knowledge, there are no studies that address the comparison of PP plastic expansion at various time domains of plastic cooling after being thermoformed. The purpose of this research was to compare plastic expansion or shrinkage and heat ratio (dimensional stability [DS]) of PP plastic through cooling periods of 6, 12, 18, and 24 hrs, respectively. Materials and Methods Forty-one identical plaster models were made. Vacuum was applied at times of 6, 12, 18, and 24 hrs, respectively. PP was cut and removed. Measurements were taken and recorded at initial times and after 24 hrs. Results DS was not significantly different across the four time groups of 6, 12, 18, and 24 hrs, respectively (P = 0.10). There was a statistically significant linear relationship between DS with room temperature (P = 0.01) and oven temperature (P = 0.04). Conclusions There is no scientific foundation to perform a 24-hr wait before finishing a device. This translates to an effective time frame for removing the plastic from the model, saving time and resources, quicker delivery to the patient, and improvement in whole patient care. Clinical Relevance This article has important implications for the O&P clinic. Creating more dimensionally stable PP devices faster translates to better fitting braces fabricated in a shorter time, thus benefiting patients and clinics and increasing the success rate when delivering this device.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"180 - 185"},"PeriodicalIF":0.6,"publicationDate":"2022-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41885752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Instrumental Balance Training on Balance in Individuals with Unilateral Transtibial Amputation: A Pilot Study","authors":"E. Kırdı, A. Yalçın, H. Keklicek, S. Topuz, Ozlem Ulger, Gülseren Yazicioğlu","doi":"10.1097/JPO.0000000000000430","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000430","url":null,"abstract":"ABSTRACT Introduction With the loss of a lower limb, an individual with amputation may face impaired gait and balance. Different rehabilitation techniques can be used to deal with those functional disabilities. The purpose of this study was to determine whether computerized balance training could have any possible effects on balance in individuals with unilateral transtibial amputation. Materials and Methods A total of 16 subjects who used a prosthesis in their daily life and were between 18 and 65 years of age were included in the study. Individuals were randomly divided into two groups: control group (CG) (n = 7) trained with traditional prosthetic rehabilitation and the experimental group (EG) (n = 9) trained with computerized balance training for five sessions for 2 weeks. Percentage of prosthetic weight bearing (PWB) timed up and go test (TUG), single-leg stance test (SLST), postural sway score, and limits of stability (LoS) were evaluated at baseline and posttreatment. Results No significant differences were observed in between-group comparisons after treatment. Within-group comparison showed that PWB, SLST, and LoS score increased in EG, whereas only PWB increased in CG. Conclusions Similar results were revealed with both computerized and traditional prosthetic training. Although there were no significant differences in between-group comparisons, computerized balance training improved the amputated side single-leg stance and stability limits, which are highly related to fall risk in individuals with amputation. Clinical Relevance Clinical relevance: Usage of computerized balance training can be helpful to improve single-leg stance and LoS in individuals with transtibial amputation.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"186 - 192"},"PeriodicalIF":0.6,"publicationDate":"2022-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49378917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Residual Limb Volume Loss on Socket Internal Pressures: A Preliminary Study","authors":"Nora Emilia Sirrs Díaz, Carlos Galván-Duque, José Luis Zavaleta, Jorge Letechipia Moreno","doi":"10.1097/JPO.0000000000000422","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000422","url":null,"abstract":"ABSTRACT Introduction Daily volume loss of residual limb is a condition that most prosthetic users face, negatively affecting their life. One of the consequences is the loss of contact between the residual limb and the socket, which modifies internal pressures. Objective The aim of this study was to study how the loss of volume of the residual limb affects socket adjustment through measuring pressures inside the socket. Study design The study design is prospective longitudinal. Materials and Methods Four subjects with unilateral transtibial amputation, with at least 1 year of prosthetic use, and walking with a comfortable prosthesis participated in this study. The pressure between the socket and the subject's residual limb was measured with an FSocket System (Tekscan). Residual limb volume was measured before and after each test with two different methods: optical scanning (Structure Sensor, Occipital) and conical frustum model. Sanders' protocol for volume loss was followed (Sanders et al. J Rehabil Res Dev. 2012;49:1467–1478). Volume changes in the residual limb and socket internal pressures were analyzed. Results/Discussion The pressure graph obtained is consistent with Sanders' volume graphs. The pressure distribution inside the socket is lost after 5 hours of use of the prosthetic device; this can be related to volume loss and alignment. The only area where the pressure increases is in the distal zone, given that once the prosthetic fit is lost, weight bearing is transferred to the socket's distal section (mean volume loss, intrasession −3%; mean pressure loss, intrasession −39%). Conclusions The study suggests that a small change in the volume can cause a change in the distribution of pressures inside the socket, indicating that the prosthetic fit may be compromised. For patient follow-up, measuring pressure inside the socket could be a useful indicator of socket misfit. Clinical Relevance Daily volume changes in the prosthesis can produce pressures that lead to pain, injuries, an inefficient gait, and prosthesis abandonment. Consequently, it is important to understand the behavior of the pressures inside the socket and the influence of the daily changes of volume on the socket adjustment to design better strategies and techniques of daily volume changes management.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"106 - 113"},"PeriodicalIF":0.6,"publicationDate":"2022-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46483047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Length-Actuated Lower Limb Prosthesis: Functional Prototype and Pilot Study","authors":"Therese E Parr, A. R. Hippensteal, J. DesJardins","doi":"10.1097/JPO.0000000000000425","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000425","url":null,"abstract":"ABSTRACT Introduction The functional goal for unilateral transfemoral prosthesis users during ambulation is to restore the proper biomechanics and minimize the compensatory actions caused by limb asymmetries. These goals can often lead to embedded design elements that assume the prosthetic limb to look and move like the intact limb. An unconventional artificial limb design can transfer the focus from mimicking the skeletal structure to producing functional symmetry between limbs. In this pilot study, we introduce a length-actuated prosthesis design with the goal of functional biomimicry and collect qualitative feedback from two prosthesis users. Materials and Methods The length-actuated apparatus is attached to the distal end of a transfemoral prosthetic socket and consists of an external motor and a cam and Bowden cable system for powering and dynamically adjusting the prosthesis' length in synchronization with the gait cycle. Two transfemoral prosthesis users ambulated on a treadmill with the length-actuated prosthesis and gave anecdotal feedback. Results The prosthesis was able to support the patient's full weight and adjust to the lengths needed during the gait cycle, including toe clearance. The overall response to the prosthesis and concept was positive; prosthesis users stated that the prosthesis and the action of the knee seemed “comfortable,” and physicians concluded a sufficient and confident ambulation by the prosthesis users. The next iteration will address specific concerns of the prosthesis users by incorporating a more compact electromechanical system with sensors. This will aid in matching and continuously adjusting the prosthesis' length change timing with the cadence of the user's ambulation. Conclusions Overall, the prototype and study proved that linear motion could replace the leg shortening functions of lower-joint rotations, with anecdotal improvements in kinematics and comfort. Future work will consist of a quantitative evaluation of center of gravity displacement, ground reaction forces, toe clearance distance, and the possibilities of knee buckling. Clinical Relevance There are no commercially available lower-limb prostheses that control leg length with dynamic linear motion rather than user flexion and extension of a knee joint. Possible benefits that may come from a length-actuated prosthesis include improved loading symmetry and balance, as well as decreased muscle activity.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"114 - 121"},"PeriodicalIF":0.6,"publicationDate":"2022-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45851532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enthesopathy, a Cause for Persistent Peristomal Pain after Treatment with an Osseointegrated Bone-Anchor: A Retrospective Case Series","authors":"N. V. Kang, A. Woollard, Sanjay Gupta, Dominika Michno, E. Davison, Beth Langley","doi":"10.1097/JPO.0000000000000423","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000423","url":null,"abstract":"ABSTRACT Introduction After limb loss, many patients undergo treatment with an osseointegrated implant. Unfortunately, some develop persistent peristomal pain after surgery. This can be sufficiently severe to reduce the speed of their rehabilitation or may halt the process altogether. The pain may be due to an enthesopathy of the residual muscles. We describe the phenomenon and outcomes of treatment in a series of patients who underwent treatment with an osseointegrated prosthetic limb, bone-anchor. Materials and Methods Over 36 months, we followed 14 patients with symptoms consistent with enthesopathy. Thirteen had undergone treatment with a transfemoral bone-anchor and one underwent treatment with a transhumeral bone-anchor. One patient had a bilateral transfemoral amputation. Analysis of the patients' ages, heights, weight at the time of surgery, length of residual femur, or preoperative dual-energy x-ray absorptiometry scans showed no correlation with the development of enthesopathy pain. Thirteen patients received steroid injections. Most received at least one injection of Adcortyl™ and bupivacaine. Patients were then encouraged to follow a program of physiotherapy to stretch out their enthesis, after injection. Results All patients experienced relief from their symptoms, but only two were rendered completely pain free. The remaining 11 patients gained sufficient control of their symptoms to allow them to continue daily use of their prosthesis with less difficulty or, where rehabilitation had been delayed or halted completely, to resume this process. Conclusion Enthesopathy seems to be a common phenomenon after bone-anchor surgery in individuals with transfemoral amputation. Steroid injections can help to relieve pain, allowing physiotherapy to be carried out. Patients undergoing treatment with a bone-anchor should be advised of the possibility of enthesopathy pain but can be reassured that there is a solution that works well in most cases. Clinical Relevance This article may be of benefit to clinicians who are struggling to manage patients with persistent peristomal pain after insertion of a bone-anchor. It may also encourage further research into measures for securing the soft tissues around the stoma for patients undergoing bone-anchor surgery.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"156 - 163"},"PeriodicalIF":0.6,"publicationDate":"2022-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41589801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}