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Prosthetic Care for Proximal Femoral Focal Deficiency (PFFD)

What is Proximal Femoral Focal Deficiency or PFFD?

Proximal Femoral Focal Deficiency (PFFD) is a rare congenital condition of the proximal femur that presents in many unique ways. PFFD is characterized by the underdeveloped, or completely absent proximal femur of the upper leg, which can cause challenges in mobility and function for the patient. Roux & Pieters describe that “PFFD is often associated with hip instability, malrotation of the hip, insufficient proximal musculature, unequal limb length and contractures or instability of the knee” (2007). PFFD is a complex congenital anomaly that affects the development of the hip and proximal femur during fetal growth and can take on many different forms. The spectrum of PFFD ranges from mild limb length discrepancy to severe femoral shortening and hip joint abnormalities. These anatomical variations pose unique challenges in mobility, stability, and functional alignment, necessitating a comprehensive approach to care.

Fitting a PFFD Prosthesis  

Prosthetic care of individuals with PFFD is very individualized, and entirely customized to the liking of the prosthetic wearer and their needs. The prosthetic fitting process is often a challenge due to the customization needed, but when it is done properly, and sometimes atypically, it can lead to improved mobility and increased autonomy for the individual. Tillges is here to help guide you through these trials of prosthetic care, ensuring that your prosthesis is fitting and functioning properly. 

Figure 1

Prosthetic Intervention and Care for PFFD Patients

Prosthetic intervention for a patient with PFFD can be an enlivening experience at Tillges Orthotics & Prosthetics. There are generally several steps involved when fitting and fabricating a PFFD prosthesis. These steps include: an initial evaluation, casting of the residual limb, diagnostic test socket fitting, alignment changes and adjustments to the test socket, a two-week trial period of wearing the test socket at home, a follow-up clinic visit prior to the final socket fitting, and finally, the definitive light-weight carbon socket fitting. Oftentimes, a prosthesis can be made for both pediatric and adult cases under non-surgical circumstances. The prosthesis will support and fit the patient’s residual limb in a completely unique way. A prosthetic practitioner may need to adopt unconventional techniques to allow the patient’s limb to sit and function in its most natural position during standing, walking, and running activities. If needed, the prosthesis may be customized for higher levels of physical activity such as sports and high impact activities. Some circumstances require that the prosthesis functions properly along with atypical muscle movements of the lower limb that can be present during gait. If such circumstances require atypical customization, those must be addressed within the fitting process of the prosthetic device. The image below (Fig. 2) depicts just a few of the many different medical presentations of proximal femoral focal deficiency, and their corresponding prosthetic interventions.

Figure 2

Rotationplasty Procedure: a Mobility-Saving Option

PFFD patients can be challenging to fit prosthetically. If a patient is present with a functional ankle joint, and they also have room to utilize this joint on the residual limb, there is a creative surgical procedure that may be indicated for you. “Rotationplasty has been described as a reconstructive procedure in the management of PFFD” (Roux & Pieters, 2007). Rotationplasty can be a mobility-saving surgical procedure that repositions the ankle joint in place of the missing, or ill-placed knee joint of the patient’s lower limb. The loss or malalignment of a knee joint can be detrimental to an amputee. Regaining that joint allows the patient to become symmetrical to the contralateral (unaffected) side. This enhances mobility and ease of donning and doffing a prosthesis. Roux & Pieters explains that “the purpose of the rotationplasty is to provide a full-weight bearing leg with preservation of the ankle joint to function as a knee joint and the ability to fit a prosthesis” (2007). Rotationplasty will allow the patient to forego the need of a prosthetic mechanical, or microprocessor, knee joint. This means that the patient can skip the processes of having to live with a prosthetic knee and will be able to function with their own biological anatomy.

Choose Tillges for Your Personalized Care

Tillges offers fantastic services for PFFD prosthetic patient care. We have helped many different presentations of PFFD patients over the years and are here to be your Partners For Life! If you are wondering if Tillges Orthotics & Prosthetics is the right partner for you, call us today to schedule a consultation, and we can discuss your prosthetic needs. 

RESOURCES 

  1. Roux, N. & Pieters, S. (2007). Prosthetic management 56 years after rotationplasty due to proximal femoral focal deficiency (PFFD). Sage Journals. Vol. 31, Issue 33. 
  2. Google Images, figure 1, 2 & 3

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