This study describes the Osseointegration Group of Australia’s
Accelerated Protocol two-stage strategy (OGAAP-1) for the osseointegrated
reconstruction of amputated limbs. We report clinical outcomes in 50 unilateral trans-femoral amputees
with a mean age of 49.4 years (24 to 73), with a minimum one-year
follow-up. Outcome measures included the Questionnaire for persons
with a Trans-Femoral Amputation, the health assessment questionnaire
Short-Form-36 Health Survey, the Amputation Mobility Predictor scores
presented as K-levels, 6 Minute Walk Test and timed up and go tests.
Adverse events included soft-tissue problems, infection, fractures
and failure of the implant.Aims
Patients and Methods
We hypothesised that adjuvant intermittent pneumatic
compression (IPC) beneath a plaster cast would reduce the risk of
deep-vein thrombosis (DVT) during post-operative immobilisation
of the lower limb. Of 87 patients with acute tendo Achillis (TA)
rupture, 26 were prospectively randomised post-operatively after
open TA repair. The treatment group (n = 14) received two weeks of
IPC of the foot for at least six hours daily under a plaster cast.
The control group (n = 12) had no additional treatment. At two weeks
post-operatively all patients received an orthosis until follow-up
at six weeks. At two and six weeks the incidence of DVT was assessed
using colour duplex sonography by two ultrasonographers blinded
to the treatment. Two patients withdrew from the study due to inability
to tolerate IPC treatment. An interim analysis demonstrated a high incidence of DVT in both
the IPC group (9 of 12, 75%) and the controls (6 of 12, 50%) (p
= 0.18). No significant differences in incidence were detected at
two (p = 0.33) or six weeks (p = 0.08) post-operatively. Malfunction
of the IPC leading to a second plaster cast was found to correlate
with an increased DVT risk at two weeks (φ = 0.71; p = 0.019), leading
to a premature abandonment of the study. We cannot recommend adjuvant treatment with foot IPC under a
plaster cast for outpatient DVT prevention during post-operative
immobilisation, owing to a high incidence of DVT related to malfunctioning
of this type of IPC application. Cite this article:
Incomplete avulsion of the proximal hamstrings
can be a severely debilitating injury that causes weakness, pain
while
