Use of the Postsurgical Immediate-Fit Prosthesis
W. MEYER, MD, I. FLEMING, MD, H. SPEARS, MD,B. RAO, MD, D. B. CROM, PNP, M. JACOBSEN, PNP,T. SNELL, CPO, AND P. BUSH, PT*Memphis, Tennessee
We reviewed the use of the immediate-fit prosthesis in 76 consecutive patients undergoing transosseous above-knee amputations for osteosarcoma from 1968 to the present. The amputation is performed in the routine manner, and a plaster cast is applied in the operating room. A unit consisting of pylon and foot is attached to assist ambulation. Gait training begins in the immediate postoperative period. The primary cast is removed in 1014 days, and sutures or staples are removed. Gait training continues in successive plaster casts. Complications were seen in 15 percent of our patients. Blistering along the incision was the most common complication and occurred in six patients. Postoperative complications causing delays in beginning chemotherapy occurred in two patients. In this series the median interval from biopsy to amputation to initiation of chemotherapy was 7 days with 86 percent beginning by the 14th postoperative day; in 83 percent of patients sutures were removed by the 14th postoperative day. Two-thirds of our patients began physical therapy by the third postoperative day. In patients undergoing amputation for osteosarcoma, the immediate-fit prosthesis is safe and does not interfere with wound healing or administration of chemotherapy. Gait training should begin in the immediate postoperative period.
*St. Jude Children's Research Hospital, 332 North Lauderdale, P.O. Box 318, Memphis, TN 38101