Immediate Post-Op Prostheses

Immediate Post-Op Prostheses

– by John Rheinstein, CP

Postoperative prosthetic limbs can help speed recovery time, protect the wound from trauma, and reduce pain and swelling after amputation surgery. These types of prostheses are known as Immediate Post-Op Prostheses (IPOPs). They are applied in the operating room or in the early days following surgery. Without an IPOP, patients usually wait until the surgical wound heals before getting their first prosthesis. During the healing period, which can vary from three to 12 weeks, patients generally move about in a wheelchair or with crutches or a walker. The longer the waiting period, the greater the risk that patients may experience limb weakness, body deconditioning, joint stiffness, or injury to the residual limb from falling while trying to move about on one leg. By getting an IPOP, many patients can begin their rehabilitation sooner, more safely, and have less uncertainty about their future.

There are two basic types of IPOPs: hand-molded and prefabricated. With the first type, a prosthetic socket is hand-molded from plaster bandages. A foot and pylon may be attached, allowing for controlled partial weight bearing. These plaster sockets are nonadjustable and nonremovable. If the doctor needs to look at the residual limb, the plaster socket must be cut off and reapplied. In addition, the cast needs to be reconstructed at regular intervals as the patient’s limb changes.

A Removable Rigid Dressing (RRD) is another type of hand-molded socket made from plaster. It can be removed and adjusted by adding socks – but like the IPOP, it must be reconstructed as the patient’s limb changes. The RRD is, however, nonweight bearing.

Prefabricated IPOPs are made from plastic in standard sizes. They are adjustable as a patient’s limb changes and are easily removable. This allows the doctor and the rehab team to assess a patient’s progress on a daily basis and to temporarily discontinue the IPOP if complications develop. They are more expensive than the hand-molded IPOPs and patients with very long or irregularly shaped limbs will not fit into them.

As with all medical treatments, there are both benefits and risks of possible side effects with the use of IPOPs. Patients will have different results and experiences depending on their own personal and medical circumstances and the protocols of the medical center where they are treated. Research on outcomes with plastic IPOPs is now underway.

The benefits and risks discussed below are based on clinical experience, input from patients, and past research on handmade plaster IPOPs.

Benefits of IPOPs

In general, an IPOP can:

Control swelling – By applying gentle pressure to a patient’s residual limb, an IPOP can minimize swelling. This helps the healing process and shapes the limb, making the eventual custom-made prosthesis easier to fit.

Reduce pain – By controlling swelling, pain is often reduced. Initial research also indicates that early prosthetic use may reduce the occurrence and severity of phantom sensations.

Improve balance and safety during transfers – Current research shows a dramatic reduction in the number of falls with the use of an IPOP. This is especially important for people who are weak or have other medical complications.

Protect the wound site from trauma – The IPOP forms a protective shell around the limb. If a patient falls or rolls around in bed, the IPOP can help prevent additional injury to the wound.

Prevent joint contractures and loss of muscle strength – By allowing amputees to stand and to gradually begin using their legs, an IPOP can prevent or reduce stiffness and weakness.

Speed up the training and adjustment period – Earlier use of a prosthesis often results in a faster transition to a temporary or definitive prosthesis as patients develop earlier tolerance to weight bearing.

Reduce the length of hospital stay – By enabling patients to be more functional, an IPOP can help them return to their homes or workplaces sooner, especially if wheelchair accessibility is a problem.

Provide psychological benefits – Patients learn early what it feels like to wear a prosthesis and can, thus, focus more on their rehabilitation than on their missing limb. This can be very positive as long as it does not delay the process of accepting the loss of their limb.

Risks and side effects of IPOPs

Not all patients are good candidates for IPOPs. It is up to the physician and the rehab team to decide if the benefits outweigh the risks. Side effects can be avoided or minimized with attentive care by a well-trained rehab team. Damage to the wound can occur from excessive weight bearing too soon after amputation. To use an IPOP correctly, the patient must be able to limit the amount of weight he or she applies to it. Complications can also occur whether or not an IPOP is used because of underlying disease. For example, some patients may develop infected or nonhealing surgical wounds. In these patients, IPOP use is discontinued while the problem is being resolved.

Summary

IPOPs can be of significant benefit to new amputees if they are used correctly under the supervision of a trained rehabilitation team. A doctor and prosthetist should assess which type of prosthesis is best for each individual patient.

What you can do

Patients should be aware that an IPOP is an option so that they can discuss it with their doctor and rehabilitation team before amputation. Most insurance plans will cover the cost of these devices if prescribed by a physician. Further information can be obtained from your doctor or prosthetist.

About the Author:

John Rheinstein, an ABC-certified prosthetist, is the lower-extremity prosthetic specialist for Hanger Prosthetics & Orthotics in New York City, where he is engaged in clinical practice, research, and teaching. He is a co-inventor of the Aircast Air-limb™ IPOP. He is also a member of the American Academy of Orthotists and Prosthetists, and a professional member of the Amputee Coalition. John can be reached by e-mail at jrheinstein@nyc.rr.com