Prosthetics

Prosthesis is an artificial extension that replaces a missing body part. In the United States, there are approximately 1.7 million people living with limb loss. It is estimated that one out of every 200 people in the U.S. has had an amputation. Most lower extremity amputations occur in individuals older than 60 years and result from disease complications. Complications of diabetes, peripheral vascular occlusive disease and other vascular disorders are the leading causes of amputation (70%). Trauma is the second most common cause of lower extremity amputation (25%) and typically occurs in the young male population. Tumors and congenital malformations less commonly (5% each) result in lower extremity amputation.

Ideally, a prosthesis must be comfortable to wear, easy to put on and remove, light weight, durable, and cosmetically pleasing. Furthermore, a prosthesis must function well mechanically and require only reasonable maintenance. Finally, prosthetic use largely depends on the motivation of the individual, as none of the above characteristics matter if the patient will not wear the prosthesis.

We are experts at treatment of all levels of amputations, ranging from partial feet to transfemoral and hip disarticulation prostheses with microprocessor controlled knee units; from digital to myoelectric upper extremity restorations.

Upper Limb

The continuum of prostheses we fit at Orthopedic Arts Laboratory, Inc. ranges from mostly passive or cosmetic types on one end to primarily functional types on the other. The purpose of most prostheses falls somewhere in the middle. Cosmetic prostheses can look extremely natural, but they often are more difficult to keep clean, can be expensive, and usually sacrifice some function for increased cosmetic appearance.

Functional prostheses generally can be divided into the following 2 categories:

  • Body-powered prostheses – cable controlled
  • Externally powered prostheses – electrically powered (myoelectric or switch-controlled prostheses)

Body-powered prostheses

Body-powered prostheses (cables) usually are of moderate cost and weight. They are the most durable prostheses and have higher sensory feedback. However, a body-powered prosthesis is more often less cosmetically pleasing than a myoelectrically controlled type is, and it requires more gross limb movement.

Externally powered prostheses

Prostheses powered by electric motors may provide more proximal function and greater grip strength, along with improved cosmesis, but they can be heavy and expensive. Patient-controlled batteries and motors are used to operate these prostheses. Currently available designs generally have less sensory feedback and require more maintenance than do body-powered prostheses.

Lower Limb

The major components of a lower extremity prosthesis are the socket (with or without a socket liner), a suspension system, interposed joint components (as needed), a shank (pylon), and a prosthetic foot. It is our strong conviction that the most important component of a prosthesis is a socket, which serves as the interface between the residual limb and the prosthesis. It must not only protect the residual limb but must also appropriately transmit the forces associated with standing and ambulation.

This is the part of a prosthesis that is custom made and its comfort and functionality is greatly dependent upon the professionalism and experience of the practitioner. The second most important aspect of a comfortable and a functionally adequate prosthesis is the alignment of its components, or its geometric relationship in space. We, at Orthopedic Arts believe in a comprehensive approach to the selection of prosthetic components for successful prosthetic restoration. The following factors are taken into consideration in designing the best prosthesis for a specific individual:

  • Amputation level and residual limb strength
  • Contour of the residual limb
  • Health status
  • Physical status (ie, balance, strength) and fitness level
  • Activity tolerance from underlying medical comorbidities (ie, atherosclerotic heart disease, ischemia)
  • Effects of peripheral vascular disease and diabetic nephropathy, which may cause unstable residual limb volume
  • Impaired cognition or other neurologic deficits (ie, stroke)
  • Sensorimotor deficits caused by peripheral nerve dysfunction
  • Visual impairments resulting from diabetic retinopathy, or other ophthalmic disorders
  • Expected function and needs of the prosthesis
  • Patient’s vocation (for example, desk job vs manual labor)
  • Patient’s avocational interests (ie, hobbies)
  • The cosmetic importance of the prosthesis
  • The patient’s financial resources (ie, medical insurance, worker’s compensation)

We utilize all available European and US prosthetic systems such as Otto Bock, OSSUR, Endolite, and OWW. In most cases we use ultra-lightweight materials that make artificial limbs lighter and more durable.

The Process

The following is a general outline of what to expect from the prosthetic fitting process, from the first evaluation appointment to the final delivery and follow-up care.

Evaluation

At this time, the prosthetist will ask many questions about your lifestyle, vocation (what you do for a living), hobbies, future plans and expectations for using your prosthesis. If you have used a prosthesis in the past, please bring it to your evaluation appointment.

Your prosthetist will do a thorough evaluation of your strength and range of motion, or flexibility. Try to wear or bring clothing that allows access to your residual limb, such as shorts, a skirt, short-sleeved top or sleeveless top. If needed, we can provide you with disposable paper shorts or another garment to wear for this evaluation. They will then evaluate the condition of your residual limb and ask questions about your general health and present this information to your doctor along with a recommendation for the type of prosthesis that will serve your goals, expectations and abilities.

Your device recommendation will also be forwarded to your insurance carrier for financial verification at this time. Some insurance carriers may take several weeks to review your case and reach a final decision. Before proceeding with fitting and delivery of your device, you will have the opportunity to meet with our financial coordinator to review and approve the device that has been recommended for you.

Measurement and Impression-taking

At your next visit, your prosthetist will take measurements of your residual limb and of your sound limb. They will take an impression of your limb with a plaster bandage as well.

Your prosthetist will need to feel the shape of your residual limb and massage the plaster bandage onto your limb. It is recommended that you wear or bring clothing that allows access to your residual limb. If you are being fit with an above-knee or above-elbow prosthesis, it is likely that your undergarments will get wet during the casting process. If needed, we can provide you with disposable paper shorts or another garment to wear for casting. The plaster bandage will be wrapped around your limb and allowed to harden. Once the cast is set, the prosthetist will remove the cast from your limb and use it as a model to fabricate, or build, your prosthesis. It will normally take up to one week before you return for the first fitting appointment.

Fitting for Your Prosthetic

It can take several fittings to produce a well-fitting, well-functioning artificial limb. Your prosthetist will normally focus on the fit of the socket first. A clear plastic test socket may be fit so that the prosthetist can actually see where the socket fits well and where modifications are needed. Your prosthetist will ask for your feedback regarding comfort and fit.

Your prosthetist will eventually attach your components (foot, knee, hand, etc.) to this test socket to ensure that everything is in the proper position. If you are being fit with a lower limb prosthesis, you should bring the pair of shoes that you plan to wear with your prosthesis. Your prosthetist will then ask you to stand and possibly even take a few steps with the prosthesis, with help if needed. As you walk, your prosthetist will make small adjustments to the angle of the foot, “aligning” the prosthesis, which is necessary for your safety and allows you to walk with the best quality. If you are being fit with an upper limb prosthesis, your prosthetist will adjust the components to find a balance between the function of the prosthesis and the cosmetic appearance.

After fitting is complete, the device will be kept for cosmetic finishing.

Delivery of Your Device

Upon receiving your finished prosthesis, your prosthetist will make sure that you know how to operate all of the features of the prosthesis and will give you information about the care and maintenance required for your device. They will also set guidelines for an initial wearing schedule to give your body some time to get used to wearing the prosthesis. It is important to schedule your first physical or occupational therapy appointment as soon as possible. It is very important that you follow the safety guidelines set by your prosthetist and physical therapist. If you notice any lasting redness or discomfort, stop wearing the prosthesis and contact your prosthetist for an appointment to re-evaluate the fit and function of your device.

Follow-up and Repairs

Once your prosthesis is finished, you will return occasionally for adjustments and minor repairs. Contact your prosthetist if you notice that your socket is fitting differently or that any parts of the prosthesis are worn or not working properly. Your prosthetist will let you know if any parts of your prosthesis require special maintenance.