ROLE OF SURGERY IN KNEE DISARTICULATION AMPUTEE REHABILITATION
Dr. Pradip D. Poonekar (Artificial Limb Centre, Pune, India),
Professor John H. Bowker (University of Miami, Florida, USA)
Knee disarticulation is biomechanically and physiologically superior to transfemoral amputation by virtue of being a strong a muscle-balanced and weight bearing stump. However, the distal bulky portion of the stump leads to poor cosmesis and some degree of prosthetic fitting problems. The fitment of knee prosthesis leads to modification of the shank length compared to the other side resulting in pendulum effect when the amputee is sitting. The disadvantages were approached surgically so as to maintain the advantages of a knee disarticulation, by a quantitative study of the effects of reduction osteoplasty of the femoral condyles. The greatest cross sectional area was seen to be at mean distance of 2.4 cms from distal end of femur but it was above the level of femoral cruciate attachment and so not ideal from surgical point of view. At 2 cms level, anterior cruciate was maintained. At 1.5 cms level with medial, lateral and posterior condylar reduction resulted in loss of 40% weight- bearing area but still was almost 600% greater than "end weight bearing intact" condylar area. The combination of osteoplasty with mobile distal coverage by gastrocnemius flaps seems to be an ideal knee disarticulation.
POSTURAL RESTORATION STRATEGY IN BELOW KNEE AMPUTEES
El-Abd MA; MD, M.ed , Barakat M A ; PhD , Sultan HE; MD , Koryem H Kh ; MD.
(Alexandria Univ., Egypt)
Fourty below knee amputees fitted, for at least 6 months, with patellar tendon weight bearing and solid ankle cushion heel foot prosthesis, as well as 10 normal healthy control subjects were tested to determine their postural strategies following antro-posterior horizontal perturbation. Each tested subject stood on a mechanically driven single platform with his bare feet being placed in compliance with his postural preference. The platform was displaced for 10 times. The displacements were sudden and at irregular intervals. The onset of the postural adjusting movements at the ankle, the knee, and the hip joints of the anatomic limb were recorded using electric goniometers connected to electric plotter.
All amputees (100%) and 2 controls (20%) demonstrated hip postural restoration strategies. It is concluded that the below knee amputees restore their erect posture by hip strategies as they lack proprioception from the amputated foot and leg segment as well as the ability to generate torque force around their ankles of the prosthetic limb.