Saturday, May 25, 2024

socket-less socket summary

Jackie OConnor

Hi all,

Thank you so much for taking the time to respond to my query, greatly appreciated.

I had nearly as many responses asking for the answers to be posted as I did answers, glad its not just me wondering these things!

Responses below, the summary I take from it is that that is value in considering Martin Bionics offerings for hip disartic and upper limb clients but approach the trans-fem option with lots of caution.

Thanks again,

Jackie.

At our facility we have successfully fit both the fabric shoulder
disarticulation socket and the bikini hip disarticulation. Neither myself
or any of the other practitioners I work with have tried the trans-femoral
socket less socket. We have done several of the bikini hip sockets and that
is our go to socket design now for any hip disarticulation. They are both
lightweight and less intrusive for the patient. The casting and
modification for both of these socket designs couldn’t be simpler. I feel
both the hip and shoulder designs have solved a lot of problems associated
with traditional socket designs. The use of compression fabric in his
designs instead of hard sockets seems to work well and makes sense when you
apply the principles. The patients found the designs liberating and easy to
use. For the shoulder disarticulation design, you will have to be able to
sew up custom shirts but it’s not difficult. I hope this helped.

Hi Jackie, I am just now ready to order one for a transfemoral who has worn a CJ Socket successfully for the last 3 years.
One of my former residents/colleagues has fit a couple of Martin hip sockets and had great success. He has not yet fit a Martin TF.

Hi Jackie,
as you may know, Martin Bionics’ Sockless technology is derivative of the Hi-Fi socket which has been developped by Randall Alley. LIM Innovations have also created their own modified version. I’m from Canada and I had contacted Biodesign to get more information on getting the training. To me, it is very expensive and there’s a monthly licence to pay on top of the initial training. For small clinics, it’s very hard to make it economically viable. I asked one of Otto Bock’s senior technician who travels all across the continent about it and he told me he’s seen or heard about a couple of them and the reviews are really mixed; some of them are really good, and some didn’t work at all.

If you ask me, I don’t care about paying the big price to learn a new technique, but paying to have the right to use that technique when I’m doing a cast that I’ll modify myself and build the prosthesis over myself is a little pushy considering I’ll probably have to adapt the technique to each individual patient’s specifities. That said, I’m not a big fan of taking measurements and receiving the final product by mail that may have to be returned to sender for modifications like the Socketless or the LIM. However I do believe that “locking” the femoral bone, on paper at least, seems to be a logical optimisation of the socket designs.

Can you please post all responses just remove the names, cause I honestly feel it’s more or a scam as every pt I saw at the show when I took the course walked horrible.
I have a bent knee client who normally wears a rigid ak socket and keasy. He lost 30 lbs, and developed pre patella bursitis from too much distal weight bearing.
I wanted to get the weight off his knee so I went with the socketless socket.
It’s getting delivered tomorrow.
In the diagnostic fitting, I found that I could not eliminate all distal weight bearing but it’s a big improvement. The client has a lot of soft, fatty tissue and this made it impossible to keep his femur from pistoning down during stance phase and swing phase too. Client wears a silicone liner and two Martin bionic Z-straps were added to the anterior of the socketless socket. Client said he would have to get use to it but he liked it. Client walked many times in parallel bars after I made many adjustments. It was a little overwhelming, but now that I’ve don’t it once, I’ll be able to do the next much more efficiently. I don’t have long term results for you.
I sent a cast to Martin Bionics for pre fitting clinical services. I had to make their pre fitted socketless socket much smaller circumferentially. I think this is because Martin Bionics couldn’t tell just how fatty and soft my client’s tissue was. However, I believe they do attempt to account for some amount of tissue compression because they sent the socketless socket to me with their soft compressible foam they modeled from. I also had to raise the Martin bionics through hole tube clamps up about 2.5 inches because the entire socket mounted too low.

Sorry for long winded response.
To answer your questions:
The first one was not easy to fit but I think the second one will be much easier.
I can’t speak to the durability yet.
My client population is mostly overweight so I think the socketless socket would be geared more toward clients who have difficulty with traditional sockets.
Once Martin Bionics had my cast, it took them about a week to ship it out. I did two fittings. The first took 3 hours and the second took about 2 hours. My tech busted 3 pva bags fabricating this thing.

Honestly, Jackie, I did the training and fit one with help on facetime and it was terrible.

I am licenced in HIFI and thought this would be good. There is just too great a difference between the no contact areas and the weight bearing areas. Very complicated and bulky.

Patient used it for a couple weeks and then asked to have his HIFI put back on.

It’s very bulky with huge buckles. I FaceTime with Jay Martin and two other prosthetist.

This patient also tried the LIM socket. Also not biomechanically sound in my kind, but the brim is comfortable and adjustable and he did like that.

I think the LIM and SLS are marketing gimmicks with little biomechanic principles.

The patient said the SLS was a “POS” (his words). He felt that all the marketing points were false, except that you can feel your thigh when you sit down.

Now the HIFI gives good biomechanical control to the femur. I think the HIFI principles are the future of prosthetics.
If you are interested I will sell you a kit and fitting tools at 50% off, it is difficult and seemed more bulky than a traditional socket. As you can tell I would never use it again. However I will tell you the brim is a pretty cool thing and you can add Martin bionics brim to an existing socket. The LIM socket is to expensive for me to take a risk on $4800-$5800. Both systems are non refundable so you are stuck either way if your patient doesn’t like it.

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