Daniel Masaiti is a tobacco and livestock farmer from Marondera, a town situated just south of Harare, Zimbabwe.  

Now 53, Daniel was only four years old when he fell from a bicycle and sustained injuries that became infected and caused him to develop a condition known as osteomyelitis. 

Osteomyelitis is an infection of the bone, which is often triggered by staphylococcus aureus, a form of bacteria.  Antibiotics are administered upon diagnosis.  Yet, in Daniel’s case, even though he underwent various treatments over a protracted period of time, antibiotics eventually proved to be unsuccessful in alleviating the condition.  To prevent possible spreading or worsening of the situation, in 2016, Daniel elected to have a below knee amputation. 

Says Roger Wolfson:  ‘Amputation is a critical salvage procedure when it comes to septic and tumour patients.  Due to the process of ‘coning’ of the residual limb, which is undertaken in order to facilitate the application of a prosthesis, the rehabilitation process post-surgery is often delayed; which can be extremely costly to the patient as well as the health system.’ 

‘It is also during this time that muscle strength, tone, general fitness and co-ordination may be reduced, which further retards the rehabilitative process.’ 

  • IPOP – a technique that has proven to be both effective and inexpensive

Numerous post-surgery techniques exist in prosthetics to ensure rapid healing and mobility.  A number of these techniques can be extremely costly.  Yet, there is a technique used in prosthetics known as Immediate Post-Operative Prosthetics (IPOP) which is an inexpensive and extremely effective method that involves fitting the patient with a rigid plaster cast immediately following surgery. 

  • IPOP ensures healing and rehabilitation processes occur in tandem

The Immediate Post-Operative Prosthetic (IPOP) technique ensures that the healing of the wound and the rehabilitation process occur in tandem, thereby diminishing the effects of muscle wasting as well as enabling more rapid mobilisation.

  • Materials used in performing the IPOP technique can be found at any Government hospital

In performing the IPOP technique, it is surprising to learn that the materials used to create the rigid plaster cast can be found at any Government hospital which results in an extremely inexpensive method when compared to other, newer techniques.

Doctor recommends Immediate Post-Operative Prosthesis (IPOP)

To aid the recovery process and ensure mobility as soon as possible following surgery, Daniel’s doctor recommended the IPOP technique. 

On 10 November 2016, Daniel underwent surgery and the Immediate Post-Operative Prosthesis (IPOP) was fitted on the operating table. 

Daniel’s journey – a remarkable rate of recovery

From the outset, Daniel showed a remarkable rate of recovery.

In this video Daniel is walking with a temporary prosthesis in only 5 days post-op:

5 days post-op

Two weeks later the IPOP cast was removed and two days after that Daniel received his prosthesis with a test socket. 

This video shows Daniel walking well with a prosthesis only 16 days post-op:

16 days post op

One day later, the beginnings of ‘practise makes perfect’ start to take effect:

17 days post-op

The following week, the test prosthesis socket was replaced with the final prosthesis:

Four weeks post-op

At this point, and one month post-surgery, Daniel returned to Zimbabwe.  During the next few weeks that followed, Daniel continued to recover at a rapid rate.  Twelve weeks later he returned to South Africa for a check-up.

Concludes Roger: ‘When I saw Daniel twelve weeks post-op, he was walking incredibly well.   Since Daniel had experienced some loss of volume, I applied a leather lining to the prosthetic socket and adjusted the alignment.  Daniel’s amazing recovery once again demonstrates the importance of considering the IPOP technique when electing to undergo an amputation.  I firmly believe that the IPOP technique should be considered for all appropriate candidates who require a below knee amputation.’

The results in this video are striking – 12 weeks post-op and going beyond walking comfortably!

12 weeks post-op

Benefits of the Immediate Post-Operative (IPOP) technique

  • The IPOP technique aids in the prevention of swelling that would otherwise need to be reduced using coning bandages which is an extremely time consuming process, and often can take up to six months.
  • The rigid cast is applied in a sterile theatre which significantly reduces the chances of infection.
  • Results in increased psychological well-being post-surgery, in that the patient can mobilise almost immediately thereafter. 

The Immediate Post-Operative Prosthesis (IPOP) technique dates back to 1893

  • The Immediate Post-Operative Prosthesis (IPOP) technique is not new.  In fact, the first reports of the use of the IPOP technique date back to 1893, when a German surgeon, von Bier, reported accelerated rehabilitation with the use of a rigid plaster cast to which a wooden peg leg was attached immediately following surgery.   
  • In 1918, a surgeon by the name of Wilson also reported excellent results having used the IPOP technique on injured soldiers during World War I. 
  • In 1957, surgeons Berlemont and Wiess reported the successful use of a thigh cast attached immediately post-surgery to below knee prostheses following trans tibial amputations.
  • In South Africa, the IPOP technique has been used for several decades.  However, such usage has not been well-documented, and this appears to be the reason behind the fact that the technique has been under-utilised in recent years. 
  • Recently, a prospective study of septic and tumour amputees was undertaken at the Johannesburg Hospital in order to evaluate the advantages and disadvantages of the IPOP technique. 

February 2017