Frank Braatz

Background: Energy storing and return (ESAR) prosthetic feet often provide high energy return at the cost of increased foot height, compromised appearance, and reduced flexibility. An ESAR foot, Ottobock Evanto, with a novel compact design has been introduced (novel foot). Objective: To characterize user preference and benefits of a novel foot compared with the subject's previously worn (everyday foot) and comparator foot, Össur Pro-Flex XC. Study Design: Multicenter, randomized, nonblinded, cross-over trial (ClinicalTrials.gov, NCT05628064). Methods: Transtibial amputees using ESAR feet were eligible. Outcome measures included perceived mobility, the extent of meeting amputees' needs, pain intensity, EuroQol 5-Dimension 5-Level, Activities-specific Balance Confidence, pain interference, foot preference, and walking experience. The first 3 measures with the novel foot vs. the everyday and comparator feet were used for primary objectives. Results: Data from 20 participants were analyzed. For all primary outcomes, improved scores while wearing the novel foot were obtained. The change in perceived mobility vs. the everyday foot score was highly significant ( P = 0.0007). The novel foot was the most preferred foot overall (55% participants) and for many activities, e.g., walking on inclines (85%) and over uneven terrain (70%). Participants confirmed that the novel foot made walking up slopes easier (95%), standing more flexible (85%), and heel strike more comfortable (85%) vs. their everyday feet. Conclusions: The novel foot offers advantages compared with the tested feet, including making walking on uneven terrain and slopes easier and more comfortable heel strike. Activities in which the novel foot would perform worse than the other feet have not been reported.

Background: Satisfaction with prosthesis plays a key role in regaining mobility and is important for optimizing prosthetic usage, mobility, and increasing compliance with medical regimen. Despite unchangeable factors like age and comorbidities, other factors, like pain, received rehabilitation, satisfaction with assistive devices, service, and information, can be changed and might contribute to a better usage and acceptance of the prosthesis and amputees’ mobility. Objectives: The aim of the study was to analyze mobility, pain, supply of assistive devices, and additional therapies received after major limb amputations. Furthermore, a correlation of those parameters was evaluated. Methods: Retrospective identification of patients with major limb amputation (operation and procedures classification system (OPS)) and relevant related demographics within the clinical documentation system during a four-year observation time. In addition, we undertook prospective assessment of mobility (K-level), pain qualities, additional therapies, self-rated overall quality of life (QoL) and degree of adaptation to the life after amputation, dependency from caregivers, and satisfaction with the provided assistive devices (QUEST). Results: A total of 164 patients (mean age 68, age range: 19 to 97 years) underwent major limb amputation. A total of 27 questionnaires were returned and analyzed. All those traumatic and nontraumatic amputees received assistive devices. Although mobility and QoL decreased significantly after amputation, a high satisfaction with provided prosthetic and assistive devices and care was found. Conclusions: Amputation registries are becoming elementary to allow for nationwide comparisons of clinics, to identify the requirements of amputees, and to design an interdisciplinary care model for a successful comprehensive approach.

Neurogenic hip dislocation is quite common in children with cerebral palsy (CP). The purpose of this study was to evaluate the long-term outcome of single-event multilevel surgery (SEMLS) in combination with hip reconstruction by using a periacetabular osteotomy as described by Dega concerning post-operative remodeling and plasticity of the femoral head post-operatively. A total of 72 patients with CP as the primary disease and in whom a complex surgical hip reconstruction was performed during SEMLS between 1998 and 2004 were included in the study. There were 45 men and 27 women, with a median age of 7.6 (4.7–16.3) years at the time SEMLS was performed. The mean follow-up time was 7.7 years (4.9–11.8). X-rays were taken before and after surgery, and Rippstein 1 and 2 were used for follow-up. As the most reliable value for decentration, migration percentage (MP) as described by Reimers was used. To measure hip-joint cover at follow-up, the centre-edge angle was used. The hip was divided into four different categories according to sphericity and congruity. Using this approach, we could evaluate joint remodeling. Pre-operatively, the mean MP measured by X-ray was 68 %. Directly after surgery, this value decreased on average by 12 % and at the long-term follow-up was 16.0 % on average. A high rate of incongruence was observed on X-rays taken directly after surgery: 66 hip joints were classified as incongruent. The number of aspherical and incongruent joints decreased to 54 at the follow-up examination. Data of our study with high plasticity of the hip joint suggest that even if the femoral head is deformed and a persistent incongruency after surgery is expected, hip reconstruction can be recommended.

Neurogenic hip dislocation is frequently observed in patients with cerebral palsy (CP). If the hip is not centred but not dislocated, the hip joint can be recentered with minor operative effort. Reconstructive procedures are indicated if the femoral head is subluxated or dislocated. There are no data as to when destruction of the femoral head requires a salvage procedure or whether hip reconstruction surgery is successful in restoring joint congruity in patients with CP. Our aim was to investigate femoral head plasticity after hip reconstruction surgery in a long-term outcome study. We studied a large cohort of patients with CP and high hip dislocation (Tönnis grade IV) before surgery. Sixty-eight patients were assessed, of whom 23 presented with bilateral high hip dislocation, and 91 complex hip reconstructions were conducted. Standardised radiographic examination was performed before and directly after surgery and at the long-term follow-up examination. Pain was the most frequent reason for complex hip-joint reconstruction (49 patients, 72 %). An impressive improvement in pain was demonstrated postoperatively. Forty-five hip joints presented aspheric incongruity postoperatively, which improved on average 7.7 years after surgery and 59 hip joints showed congruency. Only 15 % of patients experienced pain at the time of final follow-up, and that was of low intensity. Early conservative treatment for hip dislocation is helpful, and operative reconstruction should also be scheduled early. Continued surveillance is necessary, and Reimers index is useful for monitoring the development of hip centering. In case of hip pain and femoral head deformity, our long-term study indicates that hip reconstruction surgery as a part of multilevel surgery improves pain and function in patients with CP and Tönnis IV hip dislocation, even if the hip joint is incongruent after operation. This incongruity improves over the long-term. If possible, a reconstruction procedure should be performed before the femoral head becomes deformed. High plasticity of the hip joint suggest that even if the femoral head is deformed, hip reconstruction can be recommended.