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Rehabilitation
Lower Extremity
Amputations
General Principles
| 1. | How does self-selected walking velocity vary with level of lower extremity amputation? | 1. | The more proximal the amputation, the slower the walking velocity |
| 2. | How much additional energy is required for ambulation after traumatic below-knee amputation (BKA)? | 2. | 25% |
| 3. | How much additional energy is required for ambulation after traumatic above-knee amputation (AKA)? | 3. | 65% |
| 4. | How much additional energy is required for ambulation after BKA for vascular disease? | 4. | 40% |
| 5. | How much additional energy is required for ambulation after AKA for vascular disease? | 5. | 100% |
| 6. | Is complex regional pain syndrome an indication for amputation? | 6. | No |
| 7. | What are myodesis and myoplasty? | 7. | Myodesis: muscle attachment to bone Myoplasty: attachment of muscle to its antagonist |
| 8. | Which is preferred in association with amputation? | 8. | Myodesis |
| 9. | What are two factors most predictive of health-related quality of life (HRQOL) after amputation? | 9. | Pain Ambulation distance |
| 10. | What is the prevalence of phantom sensation/pain after amputation? | 10. | 60 to 75% |
| 11. | Musculoskeletal pain at what site is very common after successful amputation? | 11. | Back pain |
| 12. | What skin complication may result from chronic limb swelling after amputation? | 12. | Verrucous hyperplasia |
| 13. | What is the preferred treatment for this condition? | 13. | Total contact casting |
| 14. | Terminal bony overgrowth classically occurs with what two amputations? | 14. | Diaphyseal amputations Pediatric humerus amputations |
| 15. | What is the preferred means of preventing terminal overgrowth? | 15. | Stump capping |
| 16. | If overgrowth does occur, what is the treatment of choice? | 16. | Revise limb |
Above-Knee Amputation and Knee Disarticulation
| 17. | How do AKA functional outcomes compare with those of through-knee amputations? | 17. | AKA patients generally have better functional outcomes |
| 18. | After an AKA, what hip position optimizes prosthetic fit? | 18. | 10 degrees hip flexion 10 degrees hip adduction |
| 19. | What is the ideal limb length for an AKA? | 19. | 12 cm above knee |
| 20. | When performing a knee disarticulation, what should one do with the patellar tendon? | 20. | Suture patellar tendon to anterior cruciate ligament/posterior cruciate ligament (ACL/PCL) |
Below-Knee Amputation
| 21. | After a BKA, what position of the knee optimizes fit of the prosthesis? | 21. | 7 to 10 degrees of knee flexion |
| 22. | What is the ideal limb length for BKA? | 22. | 12 to 15 cm below knee |
| 23. | A cut at this level corresponds to what region of the gastrocnemius? | 23. | Musculotendinous junction |
| 24. | Where should the fibula be cut? | 24. | 1 cm shorter than the tibia |
| 25. | How large a posterior flap is required? | 25. | 1 cm greater than the diameter of the leg |
| 26. | After a BKA, what percentage of elderly patients regain their preoperative functional status? | 26. | 30 to 50% |
Amputations at the Ankle and Foot
| 27. | Where should a great toe amputation ideally be made? | 27. | Distal to the flexor hallucis brevis (FHB) |
| 28. | What is the prosthesis of choice after great toe amputation? | 28. | Steel shank and rocker bottom shoe |
| 29. | Where should a second toe amputation ideally be performed? Why? | 29. | Distal to the proximal phalanx metaphyseal flare To minimize the risk of postoperative hallux valgus |
| 30. | During ray amputations of the foot, what structure should one endeavor to preserve? | 30. | Plantar plate |
| 31. | If more than two rays must be resected, what amputation should be considered? | 31. | Transmetatarsal |
| 32. | What two procedures should be performed in conjunction with a transmetatarsal or Lisfranc amputation? | 32. | Achilles tendon lengthening Transfer of tibialis anterior to the talar neck |
| 33. | What are the two key things required for a successful Syme’s amputation? | 33. | Patent posterior tibial artery Intact heel pad |
Prosthesis Design and Selection
Foot Considerations
| 34. | For what patients is the single action cushioned heel (SACH) foot best suited? | 34. | Low demand |
| 35. | What is the biggest disadvantage of the SACH foot? | 35. | Overload of the contralateral limb |
| 36. | What are the two main advantages of an articulated dynamic response foot? | 36. | Improved performance on uneven surfaces Decreased shear forces |
| 37. | What is the function of the keel? | 37. | Spring-like posterior component |
| 38. | What is the advantage of a split keel? | 38. | Allows inversion and eversion |
Socket and Suspension Options
| 39. | What are the two basic requirements for use of suction-type suspension systems? |
