This is a great resource. I had to do two postings to include all of the responses. I appreciate each of your replys. We will be seeing this patient again and we will discuss the options and suggestions that you have made. I will try to remember to post a follow up on our outcomes.
Original post is followed by the responses received.
We have a bilateral amputee who is a hip disarticulation on the right and a
short transfemoral on the left. He has been referred with a prescription for a
left AK prosthesis. He has approximately 55 degrees of functional ROM at the hip
and a femur length of approximately 5 inches. He does not want bilateral
prostheses. But, he says that he is determined to find a way to get out of the
chair and ambulate and that he will find a prosthetist that will help him do
that.
He has very good upper body strength and undeniable determination. We have
advised him that it will probably be best for him to focus his energies on what
he can do to improve his independence and mobility without a prosthesis. But, he
is still insistent that there has to be a way to ambulate and that he will find a way.
My mind is taking me to more of a unipedal sitting prosthesis that would be
utilized with forearm cruthes in a three point type of “gait” vs. a single AK
prosthesis. But, I am very interested in hearing what experience and/or advice
other prosthetist might be willing to share with any similar case(s).
Eddie V. White, CP
Responses:
Depending on his overall strength, weight, and effort, he may do ok with this.
A good physical therapist may be important. I have unfortunately gained a lot
of experience with this combination of amputations having worked at Walter Reed
the last 6 years. While progress is still being made, the most practical
solution for community ambulation is to wear the AK side while in the wheelchair
for situations requiring some standing. Carrying the crutches while on the
wheelchair and using a swing through gait has not been our amputee’s preference.
Rather, the HD leg has been worn for walking during physical therapy and
exercise using bilateral canes. The HD socket is not very comfortable to wear
while sitting in the wheelchair, so it’s more practical to take off throughout
the day except during times when that person plans on walking short distances.
For walking, shorties with manual locking knees are a good option to begin with.
Later, c-legs or similar can be expected. We’ve experimented a bit with
bilateral powerknees as well which shows some promise. I can send you a couple
videos if you are interested in walking on shorties and later progression of
that person to c-legs.
As for the short AK, I’ve found the x5 seal in, a pin lock liner with a good
distal matrix, a double wall socket, and the aura seal with evolution liner to
all be good options. Additionally, a corflex belt may help to provide stability
and support.
I hope this helps. Please let me know if I can be of further help.
Zach Harvey, CPO
*******
I probably shouldn’t reply.
If he has plenty of money and is willing to pay on a time and materials basis,
then do whatever he wants to pay for.
If he is expecting an insurance company or the government to pay for this, you
very well may invest a lot of time, money and effort without ever delivering a
device and therefore never wind up with a billable event.
People seem to love to have us take on impossible cases when it costs them
nothing.
Ed Lydon, C.O.
*******
I had a hemicorpectomy patient some years ago who utilized the swing through
gait with forearm crutches you described. He was very active and independent,
but it took a lot of drive and stamina on his part.
Hope all is well with you!
Joel
Joel J. Kempfer CP FAAOP
President,
Kempfer Prosthetics Orthotics Inc.
4365 West Loomis Road
Greenfield, WI 53220
414-817-1452
[email protected]
**********
Hi Eddie, Trace Klein here from Las Vegas, I fit a 26 year old female in Ecuador
same amputations with very good success using an ak stubbie with pelvic joint
and belt and a bottom load Otto Bock single axis hip joint with lock for the hip
disartic. I had both feet forward, pt. ambulated with a swivel gait but took
right off and really did well . I incorporated both ak and hip into the pelvic
belt for good suspension. Hope this helps you ,good luck, Trace
************
Eddie- What I have done in the past is fashion a “Stubbie” for the one side and
use a locking liner. That will allow him to experience the difficulty level at a
low center of gravity. He’ll either make a decision not to continue or if
successful progess to additional height. Best case scenario is that he is
successful and might choose to try a second Stubbie on the hip side, possibly
with a two piece design socket that would be less cumbersome. Good luck. Jim
Jim Price, PhD, CPO, CPed, FAAOP
*****************
Dear Mr. White,
I think what you are asking for is what we call an RGP here at Fillauer, or a
Reciprocating Gait Prosthesis. We actually have the longer limb drive the hip
disartic side with a rocker bar or cable system. Although more bulky it does aid
in reciprocal gait.
Our C-fab would be glad to help you with it.
Hope that helps,
Gerry Stark
Gerald Stark, MSEM, CPO/L, FAAOP
VP of Product Development & Education
The Fillauer Companies, Inc.
[email protected]
***********
Hey Eddie, have you considered an RGP? (Reciprocal Gait prosthesis?) using an
RGO pelvic section and your HD socket and AK socket. Easy for the patient to
ambulate and rewarding for the patient.. Here are a few pics of those types of
variations.. my mobile is 410-533-1960 if this is something you wish to discuss
further..
Take care,
John
John F. Schulte CPO FAAOP
Clinical Educator
The Fillauer Companies Inc.
www.Fillauer.com
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