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Have we missed something?  In this episode we go back to the basics.  Actually we go before the basics and that is surgery.  Does the quality of surgery affect outcomes?  What makes a good amputation? What makes a good outcome?  Are prosthetists asked to do miracles? What is the role of the IT band in normal gait?

We cover this and more with Tom Cutler.  If you listen to this episode and have not been challenged to think and consider what we have learned well....I did not do my job. 

This episode is brought to you by Advanced 3D.

Resources:

Here's the video clip of femur vs IT band hip action: Link. 

Here's the animation showing how large the horizontal force is at the hip vs at the ground: Link. 

Here's the theory about the IT band being 30% of hip power:  Link.

Here's the article about TF amputees missing 30% of hip power. Link. 

This has amputees at up to 40% deficient. Link. 

Here's Gottschalk's article about amputation surgery:  Link. Page 19 shows the sharp edge, open bone marrow, and the text about moving the tensor fasciae latae. 

Here's Gottschalk's article (Link) about TFL being the most important hip muscle in gait (page 184) and the gluteus medius being inactive during stance while TFL shows intense activity (pg 182). 

Here's Pohl 2015 about a gluteus medius nerve block followed by... NOTHING! Link. There's no trendelenburg gait... no changes...  

What about increased cardiovascular morbidity after amputation? 

Here's an article about a 10 year old dying of fat embolism syndrome after TF amputation. Link. 

Here's a spike in cardiovascular mortality in traumatic amputees (amazing data, very sound). Link.

What about the validity of the "adductor myodesis" technique? Link. According to this article surveying surgeons, "it is not possible to stitch the muscles to the bone due to the lack of fasciae structures." and a very telling statement "I have been a surgeon for 40 years and have learned by bitter experience. The information provided in the literature is miserable and I often
disagree with the arguments." 

To all of the above, consider this:  there's no skeletal support. End of discussion, right? Until we provide amputees with skeletal support, everything else is moot.

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