Prosthetics

The Patient: Howard Tyo

The problem: The patient presented with the complaint that the distance he can walk at one time has been steadily decreasing due to intermittent claudication. He has no complaint of sores or discomfort in any one aspect ofhis prosthesis and no complaint of stability or alignment problems. He is able to walk only about fifty feet maximum at one time before having to stop.

The goal:
Increase the distance and time the patient can stand and ambulate in his prosthesis without developing pain in his residuum.

The challenge:
The patient is an eighty two year old amputee of many years. He has a mid-length residuum with very poor soft tissue coverage, prominent bony structure and a painful neuroma in the mid-distal aspect of his residuum. He has extensive scaring and invaginated scaring due to trauma.

He has PAD and has had several artery transplants and stents. The vascularation to his residuum is poor and there is no way to improve it. The patient needs additional protection to his residuum and would benefit from suction suspension, but no liner will fit his residuum and his skin is too fragile to accept standard suction suspension.

The solution:
A prosthesis was designed to provide maximum flexibility and comfort in specific areas of the socket while providing shock and torsional absorption during ambulation while maintaining the lightest possible overall weight. This was accomplished by adding a custom distal pad to add protection to the very prominent distal femur while creating a shape a suction liner can fit over.

Additionally we constructed an ISNY – (Icelandic / Swedish / New York) style of socket that incorporated a soft flexible socket with a rigid frame structure to maintain the shape of the socket. This allowed flexibility and comfort in specific areas of the socket, such as the area of his neuroma and femoral artery, while incorporating a rigid framework, carbon fiber, spectralon and other high tech, tremendously strong but
lightweight materials to maintain the necessary shape of the socket and connect the socket to the rest of the functional parts of the prosthesis.

Components were selected that would provide shock absorption and torsional absorption to further reduce pressures within the socket/leg interface while maintaining the lightest possible overall system.

The result:
Increased comfort and decreased socket pressure that allows the patient to ambulate for a minimum of one hundred, and at times up to one thousand, feet at a time without the debilitating pain that previously limited his ambulation. This has allowed the patient to resume woodworking and other activities that were becoming increasingly limited.

The Patient: Ada Hackett

The problem:
he patient, an 80-year-old right transfemoral amputee, was referred for a prosthetic evaluation by her physical therapist.

She presented with a prosthetic system recently built by another prosthetist.

The patient complained that she could not stand in her prosthesis because of pain. Her therapist stated that the patient could not lift her foot to ambulate. Her therapist also stated that she could not get the patient’s residuum all of the way into her prosthetic socket.

The patient and therapist stated that the patient has never been able to wear her prosthesis because of extreme pain upon weight bearing.

Evaluation revealed the patient has a mid length, well-healed transfemoral amputation with excellent distal padding. She has good strength and range of motion with no flexion contracture evident.

The patient stated that she has been bed-ridden for almost two years. She can stand with assistance, but she cannot ambulate. Her tissue is in overall good condition and she shows no evidence of edema in her residuum.

Her original socket was apparently designed to be used as a semi-suction socket with a TES belt suspension as primary.

The Evaulation:
Inspection of her prosthesis fit showed the socket is tight to the point that she cannot get all of the way into the socket even with a shrinker as a socket interface, and she fits into the socket with her ischium well above the socket trim rather than in the socket.

The socket was extremely tight in the scarpus area which creates extreme pain to the patient on weight bearing. The socket liner had holes in it that would not allow the patient to be pulled into the socket with a thin or no sock as window edema would occur.

There was no way to increase the socket volume enough to make her fit adequately.

The knee/shin system on her prosthesis was a combination locking/safety knee with an extension assist which is adequate for the patient’s needs.

She had a simple SACH foot which may need to be replaced as she begins to ambulate with a free swinging knee if we can indeed make that a reality. It was, however, adequate for her current needs.

The recommendation:
My recommendation was, for the time being, to replace the socket on her existing prosthesis.

The result:
Patient’s physical therapist reports that patient is doing well with her modified prosthesis.

Patient can again get to standing by herself. The therapist for the first time in two years have been able to re-build her overall physical strength. Her big goal is to be able to walk out to her porch again and watch her birds and her garden. We’re confident we can indeed reach that goal.