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Total Surface Bearing Below-Knee Prosthesis: Advantages- Disadvantages- and Clinical Implications Essay (Critical Writing)

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Brief Summary of the Article

The article under consideration is called Total Surface Bearing Below-Knee Prosthesis: Advantages, Disadvantages, and Clinical Implications and dedicated to the analysis of total surface bearing prosthesis for patients with below-knee amputations (Hachisuka et al., 1998 p. 783). The research is also aimed at determining clinical results and importance. This problem is also highlighted in the research conducted by Datta et al. (1996) who investigate the suitability of ICEROSS trans-tibial prosthesis. Both articles investigate the problem in a contradictive manner. The participants of the research are patients from the Welfare Center for the Disabled who utilize TBS prosthesis and experience using patellar-tendon bearing socket. The main material used in the research is TBS prosthesis. During the research, it is necessary to evaluate the TBS bearing composed of total rating and that of 13 separate items. The results are analyzed with the help of Fisher’s exact test. According to the results, 75 % of the patients are satisfied with TBS devices, including such items as ease, pain, comfort, knee flexion, perspiration, etc. However, such items as perspiration, odor, and donning have been recognized as poor and unreliable by 20 % of patients.

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Article Quality

Referring to the analysis of comfort/pain characteristics, the article discloses numerous issues for discussion. First of all, the article addresses the problem of extreme pressure on patellar tendon area when wearing prosthesis. The second problem related to the topic is the limitation of knee-flexion. Both problems are connected with the socket design that cannot guarantee an absolute comfort. The reason is that most sockets do not have additional suspensions that cause sliding on the skin. There are sockets that too high enough thus provoking other difficulties. The application of the modified prosthesis decides some problems but partially.

In overall estimation of the new device, it should be stressed that the characteristics influencing the extent of pain and comfort are not fully approved. In particular, positive results consist in elimination of pressure and pain, excellent improvement of walking characteristics, and knee flexion. However, the applied TBS sockets have not met the comfort requirements like perspiration, donning, and staining.

Considering the outcome measures in more detail, the researcher state that amputee patients have experienced discomfort at popliteal fossa (Hachisuka, 1998, p. 786). The modification – the inner silicone socket for 30 degrees knee position – has considerably reduced discomfort in this area. Therefore, this introduction proves that utilization of the silicon socket is rather effective for elimination of walking disadvantages. Besides the modifications suspending the socket have increased the elastic characteristics and have reduced discomfort.

Another problem occurred with socket application with silicon have also reduced the pressure on patellar tendon, since it has bettered the knee flexion and less traumatization. Besides, the knee flexion has also improved among the residual limb when the bone has an arrow-like tale that provokes more problems during wearing of prosthesis.

Another serious problem revealed in the article also relates to the necessity of application silicon liner for reducing or eliminating pain and discomfort. In particular, the researcher have found out that the new silicon produces difficulties in doffing and donning the TBS socket among patients suffering from hemi-paresis. Arising from this, it is more reasonable to apply another type of sockets that are easily donned and doffed (Hachisuka, 1998, p. 786)

The comfort characteristic of TBS prosthesis are subjected to negative critics when talking about such problems as perspiration and itching causing to skin irritation and discomfort in this part of the limb. However, the perspiration problems also exist with other than silicon sockets due to the lack of space for evaporation and there are not any improvements or regression. Hence, silicon inner socket can still compete with other types of sockets, as there is not evidence for superiority of PTB socket over TSB one so that there is the necessity to conduct the research in this particular field.

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Considering the pain characteristic, the article reveals that silicon inner socket is not applicable for the patient with bony spur. With regard to this problem, the modified device should be provided for limited kind of patients. In whole, the article clearly addresses the issues under consideration and provides a consistent explanation of the outcomes of the research.

List of score tables
1. 0 14 0
2 1 15 0
3 1 16 0
4 1 17 1
5 1 18 1
6 1 19 1
7 1 20 1
8 1 21 0
9 0 22 1
10 1 23 0
11 1 24 0
12 0 25 0
13 1 26 0

Total amount: 14

Viewing the results of the study, it is worth saying that all procedures of the research have been accurately followed since the results and the statistics do not contradict the initial goals of the study. Besides the statistical outcomes have also been analyzed according to the principles of Fisher’s test.

Article Results

The investigation of results shows that more than half of the amputee patients have been satisfied with the result of the modifications. The TBS socket has been accepted according to mostly all items under consideration. However, minor part of the participants (6 %) has not been satisfied with all previously mentioned. Judging upon the results from the article, the central tendency of the article shows that the silicon inner socket is appropriate for a limited type of patients (those with bony spur). The research has been carried out with the help of Fisher’s test, which means that one object is evaluated from 13 different items. Arising from this, p-value is, therefore calculated as if the margins of the list are fixed thus leading to hyper-geometric distribution of the numbers in the table.

Clinical and Practical Importance of the Article for the Research

A thorough investigation of the article have revealed that specific important evidence and approval in terms of application of silicon inner socket. In particular, the article indicates that this prosthesis with silicon liner have some advantages in comparison with other types of apparatuses. The modifications to TBS bearing have improved such items as knee flexion, donning pressure, and walking have been approved by the participants of the research. Concerning this, the reliability of the research is rather high since the amputee patients are assessing the results after they used other types of sockets and TBS in particular. The comparative analysis shows that this device overcomes the indicators of other sockets. The main shortcoming of TBS bearing lies in their low comfort level in terms of perspiration and scarring. However, in comparison with other prosthesis modifications this problem remains unsolved for all types of sockets. Therefore, referring to our clinical research and practice we believe that this type of silicon inner sockets can definitely be purchased for people with trans-tibial type of amputation. The article presents the evidence that disapproves the claims expressed in the article by Datta et al. (1996).

Reference List

Datta, D., Vaidya, SK., Howitt, J., and Gopalan, L. (1996) Outcome of fitting an ICEROSS prosthesis: views of trans-tibial amputees. Prosthetics and Orthotics International. 20(2), pp. 111-115.

Hachisuka, K., Dozono, K., Ogata, H., Ohtime, S., Shitama, H., and Shinkoda, K. (1998). Total Surface Bearing Below-Knee Prosthesis: Advantages, Disadvantages, and Clinical Implications. Arch Phys Med Rehabil. 79, pp. 783-9.

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