Amputation surgery and prostheses
Rodriguez, R.P.
Orthopedic Clinics of North America 27(3): 525-539
1996
ISSN/ISBN: 0030-5898 PMID: 8649734 Document Number: 3358
The p resent-d ay care of the child or adolescent with a malignant bone tumor includes adjuvant and neoadjuvant chemotherapy. When possible, the child should be treated with a surgical resection that provides a wide margin. This can be accomplished by an amputation or by local excision with either allograft or prosthetic replacement. It also can be accomplished by rotationplasty. Amputation surgery has less morbidity than limb-salvage surgery. The cost of the surgical procedure is less, although the cost of prosthetic care must be included. An above-the-k.nee amputation requires greater energy expenditure than a rotationplasty with prosthesis or a limb-sparing resection in which an endoprosthetic replacement is used. In the young child, amputation surgery offers the additional advantage of easy adjustment in leg length during growth. The functional outcome of limb-sparing resections is superior to amputation. Despite advances in preoperative staging, neoadjuvant chemotherapy, resection techniques, and methods of reconstruction, approximately 24% of patients with a limb-sparing resection require secondary amputation surgery. Prosthetic replacement of the amputated lower extremity requires an artificial limb that is comfortable, stable, and mimics the replaced anatomic limb in appearance and function as closely as possible. The most significant recent advances in lower-extremity prosthetics consist of energy storing feet and socket designs and materials. These sockets are of two types-the above-the-knee narrow medial-lateral diameter socket and the flexible socket. Resection of the patient's knee has an adverse effect on function. A limb amputated below the knee functions in a manner more similar to the normal limb than does a higher-level amputation. In upper-extremity amputations, the amputee should be fitted with a prosthesis that is cosmetically acceptable. The addition of external power with myoelectric controls gives satisfactory cosmesis and improves the functional result.
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