<img style="float: right;" src="https://opedge.dev/wp-content/uploads/2021/01/2020-08persp1.jpg" alt="" width="500" />On February 11, 1986, Adam Galicki was working for Palm Beach County, Florida, as a member of a land surveying crew on a busy road north of West Palm Beach. The crew was setting elevation control points in a grassy strip alongside the road when a tractor-trailer veered from the roadway and barreled into Galicki from behind, propelling him high into the air. He landed on top of a parked truck. Perhaps what saved Galicki's life, who was 29 years old at time, was that he says he was concentrating on his surveying instruments, unaware that he was about to be struck by an 18-wheeler. "I was pretty relaxed," he remembers. The accident also occurred close to a hospital. "I was very quickly picked up and taken by ambulance to the ICU," says Galicki, who was born and raised in Poland, and had moved to the United States from Germany one year earlier. The accident left him gravely injured with multiple skull fractures, a shattered lower left leg, and a severely damaged right leg. Galicki's wife, Susan, was contacted and immediately asked to authorize a transfemoral amputation of his left leg. The first thing Galicki says he remembers when waking up in the hospital in a full body cast was asking a nurse if he would still be able to drive a car with standard transmission. <strong><img style="float: right;" src="https://opedge.dev/wp-content/uploads/2021/01/2020-08persp2.jpg" alt="" width="500" />The Finnieston Umbrella </strong> After more than a year of painful recovery and rehabilitation, Galicki was able to return to work for the county. He first received care from a facility in Fort Lauderdale. His first prosthesis was a four-bar linkage knee, which he wore for about four years. Galicki switched care to Arthur Finnieston Prosthetics & Orthotics, Miami, in the early 1990s. Alan Finnieston, CPO/L, fit Galicki with several hydraulic knees, before he switched to Ottobock's C-Leg. "The technological improvements of the knees, which I witnessed and unfortunately experienced, were nothing short of spectacular," Galicki says. "The processor-controlled/assisted knees are much safer than anything else and significantly contribute to the activity level, mobility, confidence, and quality of life I am able to experience as an amputee." When Adam Finnieston, CPO/L, Alan's son, opened Prosthetic Orthotic Designs, Miami, in 2015, Galicki started going to him for care. Adam Finnieston, a former athlete, keenly understands the kinematics and kinetics of the human body. Much of his practice involves working with high-activity clients such as Galicki. "As an ex-athlete, I understand what high-level training requires, and for many of my clients, this means the ability to train and practice their sport daily, not just once a week or once a month," Finnieston says. Galicki currently wears a rims containment straight suction with a flexible inner liner socket and rigid frame that helps achieve some adduction of his femur, which lets Galicki's residual limb in adduction maximize his power, Finnieston says. The socket is paired with an Ottobock Genium X3 Knee, (this is his second X3 Knee; the first one lasted more than four years) and Össur's ProFlex Pivot foot. "This prosthesis has proven to be very functional for him," Finnieston says. Having good containment of the pelvis allows Galicki's limb to utilize as much strength as possible and transfer that energy to the ground, all while reducing energy expenditure, says Finnieston. "As far as and as much as Adam walks, the power and energy savings is critical." In the past, Galicki has had issues with component breakdown due to moisture from perspiration. "The X3 knee has held up and alleviated those issues entirely," Finnieston says. "His foot is an excellent choice as it provides a great deal of ground compliance and helps during inclines and declines on uneven surfaces. These are all environments that he encounters regularly, especially on his trek on the Camino de Santiago." <img style="display: block; margin-left: auto; margin-right: auto;" src="https://opedge.dev/wp-content/uploads/2021/01/2020-08consumer3.jpg" alt="" /> <strong>Popular Pilgrimage</strong> When Galicki, who has been physically fit all his life, told Finnieston his plans to walk the Camino de Santiago—a 500-mile trek leading to the shrine of the apostle Saint James the Great in northwestern Spain—Finnieston says he wasn't worried about his patient's ability to complete the walk, he only wanted to make sure the logistics would be in place to help him complete the journey. "Five hundred miles in one stretch was definitely a different challenge," says Galicki, who trained for six months for his walk in May through July 2017. The walk was in response to a recommendation that Galicki tackle a challenging endeavor upon his retirement. Galicki and Finnieston discussed potential hardware problems from knee and foot failure and socket breakdown to a bigger concern of how Galicki's residual limb would tolerate seven weeks extreme activity inside the socket—chafing, skin breakdown, infection risk, and hygiene as well as volume change. "I have known Adam a long time and have seen his abilities and determination," says Finnieston, whose concerns were more logistical. "We had to plan for and run some scenarios as he was not going to be in a fixed location for a while, making shipment and receiving difficult. We put together a spare parts kit and pads kit as I expected him to be losing a significant amount of not only water weight, but physical weight." Galicki says he wasn't too worried. "The X3 knees have been reliable and if something would have happened, I was in Spain, not Siberia," he says. "I could take a bus or train to the nearest large city with a modern prosthetic facility or hospital and get help, or I could fly back home." The preplanning efforts by both men paid off, as Galicki's journey was safe and successful. <strong>OI Possibilities</strong> Galicki and Finnieston view osseointegration (OI) with uncertainty, albeit also with optimism that it may be an option for Galicki. "When I first heard of OI I was, and still am, skeptical," Galicki says. "While the greatest benefit seems to be the elimination of the socket, I see a whole bunch of reservations." Among them says Galicki: long-term impact on the bone structure; injury and risk of infection; reliability of the implant and replacements; its track record for extensive walking and long-term use; selection criteria for candidates, rehabilitation, walk retraining, and follow-up care; "murky" advertising and US Food and Drug Administration approvals for different techniques; and finally, costs and insurance coverage. "The socket is the most important part of the prosthesis, and it's also the most difficult part to manufacture," Galicki says. "Everybody can purchase a fancy high-end knee, a high-tech foot, and the rest of the hardware. Properly fitting sockets make the prosthesis work or not work." Finnieston agrees. "The foundation for any good prosthesis is the socket fit and design," he says. "For someone as active as Adam to walk hundreds, if not thousands of miles, he needs to be first comfortable and then stable." Galicki says he has had many conversations with caregivers and others who have had amputations and has often heard the same complaint—the socket does not fit right. "Walking is the most basic, healthy form of exercise," Galicki says. "A well-fitting socket should allow for frequent, long-distance walking. Only this way can the benefits of the high-tech components below the socket be put in action." Finnieston says he has been involved with the potential of OI procedures and is knowledgeable in its positives. "It is an ever-advancing technology that has its place in our industry," he says. "The potential is great, but there are some challenges associated with it for certain people, but again, it's an advancing technology that is improving all the time." Finnieston says it's a personal choice for an individual with an amputation to consider an OI procedure. "In many cases it provides a much more comfortable, powerful, and increased proprioceptive situation. There are many variables that would make this viable or not for each patient," he says. "So each amputee must go through those considerations when deciding to proceed with the procedure." Galicki says OI would be a great procedure that he would perhaps consider one day. "If my reservations were put to rest, I think I'd consider it," he says. "After walking 500 miles in 45 days, I can only imagine how it would be to arrive in Santiago de Compostela without chafing, broken skin, without the need of Duo-Derm patches and Body Glide sticks." <em>Betta Ferrendelli can be contacted at betta@opedge.com.</em>
