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A CASE STUDYWHAT A DIFFERENCE A WEEK MAKES
The Patient - Wendy
• 55 year old transfemoral amputee July 2018.
• Previously working (housekeeper) and walking up to 12
miles with dog. Large garden.
• Surgical negligence admitted.
• Interim payment support.
• NHS supplied Rheo knee.
• Trialled Genium knee and preferred, so purchased.
3What a Difference a Week Makes, Mary Tebb, June 2019 © Dorset Orthopaedic
Other Pertinent History
• Had a gastric bypass reducing bodyweight
from 24 stone to 9 stone but leaving excess
skin.
• Lives alone.
• A lot of emotional baggage!
4What a Difference a Week Makes, Mary Tebb, June 2019 © Dorset Orthopaedic
Day 1
• Physiotherapy and prosthetic review: outcome measures taken, minor adjustments to liner.
• Circuit programmed 3 x 1 min stations.
• Garden centre visit.• Stair practise.
5What a Difference a Week Makes, Mary Tebb, June 2019 © Dorset Orthopaedic
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Day 2Accessible Cycling in the New Forest
What a Difference a Week Makes, Mary Tebb, June 2019 © Dorset Orthopaedic
We used a Local
company with a
variety of bikes, and
settled on the
recumbent.
7What a Difference a Week Makes, Mary Tebb, June 2019 © Dorset Orthopaedic
Boscombe Beach
Day 2
8
Boscombe Beach
Walking on sand and up and down zig zag slopes
What a Difference a Week Makes, Mary Tebb, June 2019 © Dorset Orthopaedic
Day 2
9
Our route – 1.23 miles
What a Difference a Week Makes, Mary Tebb, June 2019 © Dorset Orthopaedic
Day 2
10
Day 3
• New Forest long walk (2 miles) at Linford Bottom with
inclines, stream and mud.
• Worked on personal entrance to consultant due next
week.
• Swimming lanes at local pool – logistics of managing
locker, leg and crutches. Need an X3 waterproof leg.
What a Difference a Week Makes, Mary Tebb, June 2019 © Dorset Orthopaedic
New Forest Walk
11
Day 3settled on the recumbent.
What a Difference a Week Makes, Mary Tebb, June 2019 © Dorset Orthopaedic
Our Route
12
settled on the recumbent.
What a Difference a Week Makes, Mary Tebb, June 2019 © Dorset Orthopaedic
Day 3
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Day 4
• Gait re-ed / balance training and challenges.
Kerbs unaided.
• Local walk with no walking aid.
• Relaxation techniques.
• West Quay shopping centre visit,
escalators, crowds, slopes.
What a Difference a Week Makes, Mary Tebb, June 2019 © Dorset Orthopaedic
West Quay Shopping Centre
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settled on the recumbent.
What the top of an escalator feels liketo an amputee!
What a Difference a Week Makes, Mary Tebb, June 2019 © Dorset Orthopaedic
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settled on the recumbent.
Day 5
• Gym ball exercises.
• Individual home exercise plan
(strength, balance, CV).
• Repeat outcome measures.
• Prosthetic review.
• Discharge report to referrer.
What a Difference a Week Makes, Mary Tebb, June 2019 © Dorset Orthopaedic
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settled on the recumbent.
Can a week make a difference?
TEST 14/1/19 18/1/196 Minute walk test 186m 247m
Video analysis Leaning to the right.Requiring a stick.Not using stance yield.
Improved symmetry.Can walk without stick, transitioning off stick with use of pole as interim.Using stance yield on slopes
Strength testing(prosthesis on)
Right hip flexion 4/5Right hip extension 2/5Right hip abduction 3/5Right hip adduction 3/5Left hip flexion 4/5Left hip extension 3/5Left hip abduction 3+/5Left hip adduction 4/5Left knee flexion 5/5Left knee extension 4/5
4/53/53/53+/55/54/53+/54/55/54/5
What a Difference a Week Makes, Mary Tebb, June 2019 © Dorset Orthopaedic
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settled on the recumbent.
Can a week make a difference?
Pain – stump 30/100 20/100
Pain – back 40/100 50/100
Satisfaction rating 81/100 86/100
Socket comfort 60/100 90/100
EQ5D 75 85
PLUS M 46 69
ABC-UK 38 71
What a Difference a Week Makes, Mary Tebb, June 2019 © Dorset Orthopaedic
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settled on the recumbent.
Recommendations
• Genium X3 – water activity leg with all the
features of a Genium MPK knee.
• Recumbent bike with pedal-assist.
• Explore osseointegration.
What a Difference a Week Makes, Mary Tebb, June 2019 © Dorset Orthopaedic
