Wednesday, November 30, 2022

Responses: HD/Short AK

Beaconpo

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:

Dear Eddie, I think your idea of emphasing indepent transfers with
unilateral AK prosthetics and assistive devices is a practical and possibly
productive place to start. Your client will gain a much more accurate
picture of his restoration and rehabilitation pontenial having this
practical experience. I think the AK prosthesis should be designed, at
least initially, for independent transfers (optimal hieght, no knee, etc.).

Sincerely, Micahel Wilson CPO
******

Make him a well fitting socket, set it up very stable, and play with components.

Let the patient try 5 or six types of knees and feet, try a straight pylon with
out a knee. You said he will find a way! Help him by giving him options. Tell
the mfgs. what is going on and they will be helpful to you. Good luck.

James O. Young Jr., LP, CP, FAAOP
Amputee Prosthetic Clinic
Macon, Tifton, Albany
888-FAKELEG
888fakeleg.com
******
Hi there,

Quite an interesting case you have presented. Despite this gentleman’s
determination and admirable courage, in my experience a single prosthesis on one

side with this high level of amputation to aid ambulation may just be more of a
hindrance and frustration than a help.

I read that he doesn’t want a bilateral prosthesis, but if a truly functional
outcome is desired then may I be so bold as to suggest that revision surgery be
considered? 5″ of femoral stump doesn’t leave a lot to work with. As a
bi-lateral hip-disarticulation patient one could make a comfortable single
self-suspending socket and attach 2 hip joints. I have a case here where we have

done this and the patient ambulates (very well) using standard crutches and a
swing-through gait. OB 7E7 hips (with the internal springs removed) and SAKL
knee joints. This individual is fully independent and never uses a chair (his
choice).

I hope my reply has been of some help and I wish you luck with this case.]

Regards,

Thomas Wickerson
Clinical lead – Prosthetics
opcare
Queen Mary’s Hospital, Roehampton Lane, London SW15 5PN
T: 0208 487 6045/6 E: [email protected]
www.opcare.co.uk
******
Eddie,
Greetings. From the vantage point of absolutely no experience with such a
case, I would recommend bilateral HD sockets and some sort of set up borrowing
the RGO principle. How to do this with HD hip joints is an unknown to me. You
might want to consult with Jerry Stark at Fillauer.

Good Luck
Charles H Pritham
******

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