Prosthesis rejection in children with a unilateral congenital arm defect

Objective: To determine the rate of rejection for prosthetic use in children and to investigate reasons for this rejection. Design: Cross-sectional study of a cohort of children. Setting: Rehabilitation centre, St Maartenskliniek, Nijmegen, the Netherlands. Subjects: Thirty-two children (0–18 years) with a unilateral congenital arm defect who visited the clinic between September 1991 and December 1996. Methods: Parents of all children and 19 children (years) completed a questionnaire. Results: Eleven children (34%) rejected the prosthesis. A survival function shows that the rejection can be characterized by three periods: 0–40 months, 40–162 months and after 162 months. In the first and last period a high rate of rejection is seen, while in the second period a low rate exists. Fitting for the first time after 2 years of age seems to be related with higher rejection rate. Lack of functional gain with the prosthesis, as perceived by the subjects and the parents, is significantly associated with increased rejection rate. Increased rejection rate is associated with the parents' disappointment, insufficient involvement of the parents in treatment, and dissatisfaction pertaining to emotional and social guidance. Conclusions: Rejection seems to occur in two main periods: within 3.5 years after being provided with a prosthesis and after 13.5 years of prosthetic use, when most children experience puberty. Fitting before the age of 2 years seems to reduce rejection rate. Preventing the parents' disappointment about prosthetic benefits as well as providing them with sufficient involvement in treatment and adequate guidance are essential for optimal results of prosthetic rehabilitation.