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Long-term outcomes following lower extremity press-fit bone-anchored prosthesis surgery: a 5-year longitudinal study protocol

View Article: PubMed Central - PubMed

ABSTRACT

Background: Patients with lower extremity amputation frequently suffer from socket-related problems. This seriously limits prosthesis use, level of activity and health-related quality of life (HRQoL). An additional problem in patients with lower extremity amputation are asymmetries in gait kinematics possibly accounting for back pain. Bone-anchored prostheses (BAPs) are a possible solution for socket-related problems. Knowledge concerning the level of function, activity and HRQoL after surgery is limited.

Background: The aims of this ongoing study are to: a) describe changes in the level of function, activity, HRQoL and satisfaction over time compared to baseline before surgery; b) examine potential predictors for changes in kinematics, prosthetic use, walking ability, HRQoL, prosthesis comfort over time and level of stump pain at follow-up; c) examine potential mechanisms for change of back pain over time by identifying determinants, moderators and mediators.

Methods/design: A prospective 5-year longitudinal study with multiple follow-ups. All adults, between May 2014 and May 2018, with lower extremity amputation receiving a press-fit BAP are enrolled consecutively. Patients with socket-related problems and trauma, tumour resection or stable vascular disease as cause of primary amputation will be included. Exclusion criteria are severe cognitive or psychiatric disorders. Follow-ups are planned at six-months, one-, two- and five-years after BAP surgery. The main study outcomes follow, in part, the ICF classification: a) level of function defined as kinematics in coronal plane, hip abductor strength, prosthetic use, back pain and stump pain; b) level of activity defined as mobility level and walking ability; c) HRQoL; d) satisfaction defined as prosthesis comfort and global perceived effect. Changes over time for the continuous outcomes and the dichotomized outcome (back pain) will be analysed using generalised estimating equations (GEE). Multivariate GEE will be used to identify potential predictors for change of coronal plane kinematics, prosthetic use, walking ability, HRQoL, prosthesis comfort and for the level of post-operative stump pain. Finally, potential mechanisms for change in back pain frequency will be explored using coronal plane kinematics as a potential determinant, stump pain as moderator and hip abductor strength as mediator.

Discussion: This study may identify predictors for clinically relevant outcome measures.

Trial registration: NTR5776. Registered 11 March 2016, retrospectively registered.

Electronic supplementary material: The online version of this article (doi:10.1186/s12891-016-1341-z) contains supplementary material, which is available to authorized users.

No MeSH data available.


Position of the tapes
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Fig3: Position of the tapes

Mentions: In unaided walkers, kinematics in the coronal plane are recorded using a video camera (Panasonic HC-X920) during two activities. First, while a patient walks three times up and down a path of 15 m. Secondly, while a patient performs a step exercise with the sound side. The step exercise is performed, two times consecutively using a 11 cm high aerobic power step (Tunturi® New Fitness, Almere, The Netherlands). The kinematics (continuous scale) in coronal plane (in degrees) are assessed using two methods: a) an overall angle between trunk and residual limb during the mid-stance is calculated out of two angle measurements, namely the angle between pelvis and residual limb and the angle between pelvis and trunk. To be able to assess these angles using Dartfish® software (Dartfish, Fribourg, Switzerland), a piece of tape (approximately 1.0 by 1.0 cm) is placed on 1) the anterior superior iliac spine (ASIS) on both sides, 2) the proximal part of the manubrium and 3) 30 cm distal of the ASIS on the ventral side of the residual limb (Fig. 3). The reference points for the position of the tape on the residual limb varies. In patients with a transtibial amputation the middle of the patella is used as a reference for all assessments. At baseline, the middle of the socket is used in patients with transfemoral amputation or knee disarticulation, because the position of the bone in soft tissue is not visible. At follow-up the transcutaneous connector is used in patients with a transfemoral amputation; b) peak pelvis and trunk segment angles during stance phase are measured relative to the laboratory axis using two wireless gyroscopes (Valedo®Motion, Hocoma, Volketswil, Switzerland) on the first vertebrae of the sacrum and 17.5 cm cranial of the distal gyroscope respectively, (Fig. 4) using an applicator. A reproducibility study is now ongoing to assess both angle measurements and will determine which instrument will be used to evaluate the kinematics.Fig. 3


Long-term outcomes following lower extremity press-fit bone-anchored prosthesis surgery: a 5-year longitudinal study protocol
Position of the tapes
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5120460&req=5

Fig3: Position of the tapes
Mentions: In unaided walkers, kinematics in the coronal plane are recorded using a video camera (Panasonic HC-X920) during two activities. First, while a patient walks three times up and down a path of 15 m. Secondly, while a patient performs a step exercise with the sound side. The step exercise is performed, two times consecutively using a 11 cm high aerobic power step (Tunturi® New Fitness, Almere, The Netherlands). The kinematics (continuous scale) in coronal plane (in degrees) are assessed using two methods: a) an overall angle between trunk and residual limb during the mid-stance is calculated out of two angle measurements, namely the angle between pelvis and residual limb and the angle between pelvis and trunk. To be able to assess these angles using Dartfish® software (Dartfish, Fribourg, Switzerland), a piece of tape (approximately 1.0 by 1.0 cm) is placed on 1) the anterior superior iliac spine (ASIS) on both sides, 2) the proximal part of the manubrium and 3) 30 cm distal of the ASIS on the ventral side of the residual limb (Fig. 3). The reference points for the position of the tape on the residual limb varies. In patients with a transtibial amputation the middle of the patella is used as a reference for all assessments. At baseline, the middle of the socket is used in patients with transfemoral amputation or knee disarticulation, because the position of the bone in soft tissue is not visible. At follow-up the transcutaneous connector is used in patients with a transfemoral amputation; b) peak pelvis and trunk segment angles during stance phase are measured relative to the laboratory axis using two wireless gyroscopes (Valedo®Motion, Hocoma, Volketswil, Switzerland) on the first vertebrae of the sacrum and 17.5 cm cranial of the distal gyroscope respectively, (Fig. 4) using an applicator. A reproducibility study is now ongoing to assess both angle measurements and will determine which instrument will be used to evaluate the kinematics.Fig. 3

View Article: PubMed Central - PubMed

ABSTRACT

Background: Patients with lower extremity amputation frequently suffer from socket-related problems. This seriously limits prosthesis use, level of activity and health-related quality of life (HRQoL). An additional problem in patients with lower extremity amputation are asymmetries in gait kinematics possibly accounting for back pain. Bone-anchored prostheses (BAPs) are a possible solution for socket-related problems. Knowledge concerning the level of function, activity and HRQoL after surgery is limited.

Background: The aims of this ongoing study are to: a) describe changes in the level of function, activity, HRQoL and satisfaction over time compared to baseline before surgery; b) examine potential predictors for changes in kinematics, prosthetic use, walking ability, HRQoL, prosthesis comfort over time and level of stump pain at follow-up; c) examine potential mechanisms for change of back pain over time by identifying determinants, moderators and mediators.

Methods/design: A prospective 5-year longitudinal study with multiple follow-ups. All adults, between May 2014 and May 2018, with lower extremity amputation receiving a press-fit BAP are enrolled consecutively. Patients with socket-related problems and trauma, tumour resection or stable vascular disease as cause of primary amputation will be included. Exclusion criteria are severe cognitive or psychiatric disorders. Follow-ups are planned at six-months, one-, two- and five-years after BAP surgery. The main study outcomes follow, in part, the ICF classification: a) level of function defined as kinematics in coronal plane, hip abductor strength, prosthetic use, back pain and stump pain; b) level of activity defined as mobility level and walking ability; c) HRQoL; d) satisfaction defined as prosthesis comfort and global perceived effect. Changes over time for the continuous outcomes and the dichotomized outcome (back pain) will be analysed using generalised estimating equations (GEE). Multivariate GEE will be used to identify potential predictors for change of coronal plane kinematics, prosthetic use, walking ability, HRQoL, prosthesis comfort and for the level of post-operative stump pain. Finally, potential mechanisms for change in back pain frequency will be explored using coronal plane kinematics as a potential determinant, stump pain as moderator and hip abductor strength as mediator.

Discussion: This study may identify predictors for clinically relevant outcome measures.

Trial registration: NTR5776. Registered 11 March 2016, retrospectively registered.

Electronic supplementary material: The online version of this article (doi:10.1186/s12891-016-1341-z) contains supplementary material, which is available to authorized users.

No MeSH data available.