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Transcutaneous, Distal Femoral, Intramedullary Attachment for Above-the-Knee Prostheses: An Endo-Exo Device
Horst Heinrich Aschoff, Dr Med1; Robert E. Kennon, MD2; John M. Keggi, MD2; Lee E. Rubin, MD2
1 Klinik fur Plastische, Hand und Rekonstruktive Chirurgie, Lubeck, Germany
2 Orthopaedics New England, 1579 Straits Turnpike, Middlebury, CT 06762.
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Copyright © 2010 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Dec 01;92(Supplement 2):180-186. doi: 10.2106/JBJS.J.00806
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Patients with an above-the-knee amputation often experience poor socket fit, which may become more problematic with minor weight changes, sweating, and skin problems. In 1999, the first author began using a transcutaneous, press-fit distal femoral intramedullary device with the distal, external portion serving as a hard point for attachment of an above-the-knee prosthesis (Fig. 1). The implant is placed in a retrograde fashion as a first stage, and approximately six to eight weeks later this is followed by stomatization, in which the distal aspect of the implant is exposed and an extension is added for fixation of the above-the-knee prosthesis. Thirty-seven patients underwent the procedure between 1999 and December 2009. The indications for surgery were persistent difficulties with the socket of an above-the-knee prosthesis after an above-the-knee amputation; the amputations had typically followed trauma but in some cases were for surgical treatment of a malignant tumor.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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