F-2-15-01
AMPUTATION ARTHRITIS AND OSTEOPOROSIS: A COHORT STUDY OF BRITISH WORLD WAR VETERANS
Kulkarni, J., Adams J., Sailman A. (Univ. of South Manchester, U.K.)
PURPOSE
To investigate the hypothesis that major unilateral lower limb amputation in male war veterans, results in a higher than expected frequency of hip osteoarthritis and to assess prevalence of hip osteoporosis.
METHOD
75 male war veterans from the Second World War were invited to participate. After exclusions, in 44 veterans the presence of hip OA was determined from a single AP pelvic x-ray using two approaches: minimum joint space and Kellgren and Lawrence Scoring System. Bone mineral density (BMD) was measured by a DXA scan and prosthetic rehabilitation outcome measures were recorded.
RESULT
The prevalence of hip OA and osteoporosis was calculated separately for both the amputated and non-amputated sides and these proportions compared with the expected proportion using published data from population surveys. From published surveys only 4 cases of hip OA would have been expected on both the amputated and non-amputated hips (based on Kellgren and Lawrence grade of more than or equal to 2), by contrast 27 (61%) hips on the amputated side and 10 (23%) hips on the non-amputated side were positive. Using a minimum joint space threshold of 2.5mm, 55% of hips on the amputated side and 18% on the non-amputated side were positive for hip OA. There was a three fold increased risk of OA for those with above knee amputation compared to below knee amputation. The bone mineral density was significantly lower in the femoral head of the amputated side in comparison to the non-amputated side (P<0.0001). The femoral neck BMD was significantly lower in the above knee amputees than in the below knee amputees (P=0.0027).
F-2-15-02
REHABILITATION AND FUNCTIONAL OUTCOME OF THE PATIENTS TREATED WITH HEMIPELVECTOMY
Osamu Shirado, M.D., Naoki Takeda, M.D., Toshikazu Itc, R.P.T., Yukio Mano, M.D., Kiyoshi Kaneda, M.D. (Hokkaido University, Sapporo, Japan)
Purpose: The purpose of this study was to report the rehabilitation process and to determine the factors influencing postoperative ADLs in the patients treated with hemipelvectomy.
Method: Twelve patients (10 males and 2 females: mean age 39.2 years) with malignant bone and soft tissue tumors underwent hemipelvectomy, followed by the routine rehabilitation program from 1983 through 1995, were studied. Chemotherapy was carried out in 8 patients. Five patients were alive and 7 were dead at the follow-up (mean, 3 years and 5 months).
Result: The ADLs at the follow-up were as follows; 4 patients were ambulatory at any time with the Canadian-type hip disarticulation prosthesis. Five were the part-time users of the prosthesis. Three patients were wheelchair users without wearing the prosthesis. Eight out of 12 patients returned to the original job. All patients complained of the bulky prosthesis.
Conclusion: The rehabilitation process and the ADLs after the hemipelvectomy in malignant tumors were influenced by the degree of malignancy, wound infection, chemotherapy, and patients motivation. Cosmesis with the prosthesis was a serious problem for return to society.
