Amaan Sheikh, DO
Resident Physician
Johns Hopkins School of Medicine
Baltimore, Maryland, United States
Marlis Gonzalez Fernandez, MD
Interim Director Department of Physical Medicine and Rehabilitation
Johns Hopkins School of Medicine
Baltimore, Maryland, United States
Patient was evaluated for rehabilitation after a rare vascular disease led to left transtibial amputation (TTA). Due to continued residual limb pain and poor wound healing, the patient was unable to tolerate standard prostheses and pursued alternative options. After failed amputation revision surgery, the patient was treated with TFA with osseointegration (OI) two years after initial TTA. Months after this procedure, the patient continued to have right lower limb vascular complications eventually requiring right TFA with OI. She was admitted to acute inpatient rehabilitation and progressed to outpatient rehabilitation completing a modified “half-speed” weight bearing protocol (as indicated for OI patients) using the pre-established physical therapy protocol after each TFA.
Discussions:
Due to the complexity of the patient’s condition and procedure, rehabilitation had to be modified to support successful rehabilitation thus lasting approximately twice as long for each limb. The patient had better pain control and tolerance of therapy with the OI interface when compared to previous attempts. This case indicates that patients who have complex vascular issues (even in the absence of a typical diagnosis) limiting their ability to participate in traditional rehabilitation with a usual prosthesis may benefit from OI.
Conclusions: OI is an FDA approved alternative to traditional prostheses that may offer better quality of life and improved function/mobility in well-selected patients. In this case it improved prosthesis daily wear, proximal joint range of motion, K-level, energy conservation, and satisfaction with the overall limb loss rehabilitation process.
