Patients with above knee amputation (AKA) often experience poor socket fit exacerbated by minor weight changes, sweating, and skin problems. A transcutaneous, press-fit distal femoral intra-medullary device was designed in 1999, such that the distal external aspect serves as a hard point for AKA prosthesis attachment. The implant is placed in a retrograde fashion, followed 6-8 weeks later by stomatisation and connected via direct extention to an AKA prosthesis.

Thirty-seven patients with 39 limbs (30 males, 7 females) underwent two-stage prosthesis implantation with the Endo-Exo Femurprosthesis (EEFP) in Germany between 1999 and January 2008. Their indications for surgery were persistent AKA prosthesis socket difficulties with absence of major comorbid physical or mental illnesses. The patients were followed clinically and radiographically for a minimum of 2 years. Assessments included patient satisfaction ratings, functional surveys, pain scores, and oxygen consumption.

Fifty-four percent of patients needed at least one revision (20/37); 80% were minor (16/20) and 20% were major (4/20). Most of the minor revisions were due to soft tissue stomal irritation and occurred prior to a design change in the prosthesis. 2 patients sustained traumatic, peri-trochanteric fractures that were treated operatively proximal to the implant, with retention of the implant. 4 implants were explanted due to infection or prosthesis fracture and 2 of these (50%) were later reimplanted successfully. Overall, 94.9% (37/39) limbs had ultimate EEFP implant success. All functional assessments showed statistically significant improvement over baseline except oxygen consumption, which trended toward improvement.

This procedure demonstrated a high degree of functional improvement for the majority of AKA patients treated. Despite an initially high revision rate, the EEFP prosthesis achieves an extremely high rate of successful reconstruction for trans-femoral amputees when more traditional options have failed and therefore warrants further scientific study.

Introduction

In cases of unilateral clubfoot, the leg and foot is visually smaller than the opposite, uninvolved side. Parents want to know how much smaller the leg and foot will be. The purpose of this study was to answer this question and compare the results of children treated with a posterior medial release (PMR) with those treated with the Ponseti method (PM).

Aims: A main condition in succesfull rearthroplasty of acetabular component is the way of stabilizing this component in physiological site, with a full support on bone. Segmental and cavitary acetabular defect are often caused by aseptic loosening of the implants. The use of bulky corticocancellous grafts, which would be loaded is recommended. Methods: Acetabular roof reconstruction technique for revision cemented THA, according to Zuk is presented in a series 42 patients (19 male and 23 female aged 56– 68 yr). No screws and bone pins were used for cortico-cancellous graft þxation. Results: In 22 patients autogenic graft was sufþciently remodeled within 12 months, in 16 cases with frozen allogenic graft it lasted 20 months on average. Longer remodeling time depended on the size of acetabular defect, coexisting conditions and postoperative complication. In 2 cases an autolysis of the graft occurred; one patient underwent prolonged corticosteroid therapy before; the other one was exposed extensively to chemical substances prior to surgery. Aseptic loosening of the acetabular roof in this cases followed. Conclusions: Reconstruction of acetabular roof defect in this method is relatively simple and can diminish complication rate bounded with potential electrolysis harmfull effect. A mean remodeling time of reconstructed acetabular bone roof with this method was equal as with stabilized graft (pins and screws).