TEETH-IN-AN-HOUR™ is a revolutionary concept providing patients with fully functioning teeth on dental implants in one single procedure that lasts about an hour. This technology was recently developed by Nobel Biocare and allows for collaboration between both the restorative doctor and the surgeon. This merging of knowledge and experience achieves not only increased safety, but also a more precise implant placement. In addition, the fabrication of a final prosthesis is completed prior to the surgery. The computer-guided implant surgery is done in an arthroscopic fashion without requiring any flap reflection. This benefits the patient in that there is less postoperative discomfort, less swelling and less bruising. Patients can often resume their normal activities the next day.
The weight-bearing prosthetic pegs (from hock to ankle) are known asintraosseous transcutaneous amputation prosthetics (ITAPs) and weredeveloped by a team from University College London led by ProfessorGordon Blunn, head of UCL's Centre for Biomedical Engineering. Itinvolves implanting a piece of titanium metal and a flange into whichbone and skin grows. The titanium implant attaches to the bone at thepoint of amputation and sticks out through the skin which moulds aroundit, mimicking the way a deer's skin and fur moulds around antlers. Theresult resembles a lower leg bone in the way it moves. Once these hadhealed fully, rubber paws were attached. These were later replaced byrubber and metal paws (thoughtfully covered in black tape to matchOscar's colour!) and Oscar was up and moving as soon as the sedativewore off. Oscar was soon walking, running and jumping like a normal catand will return to Jersey when vets are satisfied with hisrehabilitation and his treatment is complete. His access to outdoorswill have to be supervised in future because the prosthetic paws lacksensation or claws. Four pairs of longer lasting prosthetic paws hadhad to be made as active Oscar wore through the first set in weeks!
In 2009 he became the first veterinary surgeon in the world to successfully apply a cutting edge amputation prosthesis (PerFiTS) to a cat named Oscar who had lost two feet in an accident. Noel has gone on to perform many more of these lifesaving procedures in dogs and cats from his practice, Fitzpatrick Referrals.
He has won many awards including the Mark S Bloomberg and Simon Awards for teaching and for contribution to veterinary surgery. He has sponsored and inspired more than forty fellowships, internships, residencies and PhDs in Europe and the USA, leading to landmark publications and embracing the marriage of high-volume high-quality clinical veterinary practice with evidence-based medicine and compassionate care, with the aim of giving all animal guardians access to all options for their animal friends. His most recent hub of co-operation is with The Ohio State University where two residents, a fellow and a PhD student, all sponsored by Fitzpatrick Referrals, are contributing to research on joint disease, limb prostheses and spinal implants.
Buba faced a number of practical problems following the amputation. Jumping onto favourite furniture was difficult and he was inclined to give up. To aid him, furniture was rearranged enabling Buba to move from one piece to another, and gain easy access to favoured places. As his confidence and ability increased, so the furniture was moved apart until eventually it was returned to its normal location and Buba was able to go wherever he wanted.
The front legs can be considered severely crippled, often with toes going in all different directions. To help a cat with radial hypoplasia in getting around the house, you need carpet or rugs because they may have a hard time slithering across slippery floors on almost useless front legs. Because the cats are walking on a crooked part of the leg rather than on the paw, you need to watch out for sores developing on the leg over time, the skin becomes callused and hardened, but when an affected kitten is learning to walk and trying to play, the skin can become abraded. If calluses do not form, you may be able to fashion a padded leather bootee to protect the cat's skin. Favourite resting places need to be at low level and should be well padded to give the forelegs a well-earned rest.
Although wearing a transpelvic or hip disarticulation prosthesis may be cumbersome, when fitted within a few weeks of amputation, the initial acceptance rate appears to be similar to that for transfemoral amputation. Immediate postoperative fitting is technically feasible but rarely performed today. Long-term wearing rates increase significantly when sockets are comfortable, flexible, and carefully aligned. In view of the magnitude of loss at this level, application of newer, sophisticated joint and foot mechanisms is often helpful. Every case requires review on its own merits; careful attention to socket design, components, and alignment ultimately determines the effectiveness of the prosthesis.
The recent advent of laminating silicone rubbers allows even more flexibility than do available thermoplastics. As was noted earlier, the resulting comfort and range of motion has been associated with significantly higher rates of prosthetic usage. Although the fabrication is complex and difficult and the finished result slightly heavier than thermoplastic designs, favorable patient response and good durability recommend further development and more widespread application of this technique. The senior author (T.v.d.W.) has fitted 35 silicone rubber sockets over the past 2 years. Amputees who have previously worn more rigid designs typically describe the rubberized sockets as feeling "more natural" or "more like a part of me" (Fig 21B-15.).
Some people who see a cat with Radial Hypoplasia (RH) for the first time either think it has both front legs broken or notice that it sits up like a rabbit. They walk in a shuffling or scrabbling motion. There are varying degrees of the condition, these tips take a worst case scenario. Mildly affected cats may get along just fine, but have a peculiar bobbing gait. Some affected cats are found among feral cat colonies, but unless the colony is being fed by someone, RH cats are unlikely to survive outdoors - they cannot hunt, cannot run from predators, traffic or malicious humans and cannot defend themselves if molested. In addition they are likely to be singled out for abuse because they are different and therefore "easy targets".
Many materials are suitable for socket fabrication. As is the case with other levels of lower-limb amputation, the most commonly utilized socket material is a rigid thermosetting resin: polyester or acrylic. An increasing trend toward more flexible thermoplastic materials is evident, as in other aspects of prosthetic practice. One of the authors (J.W.M.) has fitted more than two dozen polypropylene/polyethylene copolymer sockets for hip-level amputation over the past decade with good long-term results in durability, comfort, and patient acceptance (Fig 21B-14.).
We prefer to have the amputee simulate weight bearing during the plaster impression technique to create as precise a mold as possible. However, in contrast to the technique advocated by Otto Bock, we believe that careful attention to shaping the medial wall in the ischial region is important to improve control of the prosthesis for both walking and sitting.
Torque-absorbing devices are often added to hip dis-articulation/transpelvic prostheses to reduce the shear forces transmitted to the patient and components. Ideally, they are located just beneath the knee mechanism (Fig 21B-9.). This increases durability by placing the torque unit away from the sagittal stresses of the ankle while avoiding the risk of introducing swing-phase whips (which can occur if it is placed proximal to the knee axis). The major justification for such a component is that the high-level amputee has lost all physiologic joints and, hence, has no way to compensate for the normal rotation of ambulation.