Thanks to all who responded to my question about a fabrication option
for a knee orthosis style
joint/corset for a BK prosthesis. The most common suggestion was
Townsend. I’ve included other responses as below:
Fabricated a laminated posterior opening knee orthosis to work.. I have
tried multiple knee joints and found the Otto Bock Poly centric knee
joints worked best and most durable. I tried Townsend joints first, she
went through two sets in six months. Steve Marfia at ALLY in Rhode
Island made the most recent set up and it has worked very well, no
problems in two years.
Karl Hager in Edmonton Alberta in Canada. They have a joint system that
they laminate in
Wade Bader at Kinetic Research
Advanced O & P Solutions in hickory hills Illinois
This very thoughtful response made me go back and review the xrays: To
err on the side of safety I would let the physician know of my concerns
regarding your patients varus and ask to see an x ray of his extremity
in his office so you can discuss this case together, or see it on your
computer if you have privileges with your hospital. You will know then
how much of a knee replacement is involved, ie: partial, full, short or
long stem. With this information you may need options such as a full
thigh gator to support the upper and lower articulation with out side
joints. A short knee orthosis or abbreviated trimmed thigh corset could
be the cause of a terrible fracture. Be that as it may the truth is
important to bring up early and the patient may also have enough of a
sever deformity or loss bone strength since their illness that he/she
would require a walker to ambulate using limited wt. bearing on that
side. To be fair I hope I am not over reacting but nobody wants to go
back into a hospital or have risk of further surgery.
I am a BK amputee, and have a knee brace that fits over the socket which
I made for skiing. What I did was take a cast of my leg, with the
prosthetic leg on, with the trim lines marked and everything just like
having a normal Townsend brace made. I shipped the cast and
instructions to Townsend, and they made the brace, which works great.
This might be a good option for the patient, and is really nice since it
is able to remove the brace separately from the prosthesis. One little
thing I did on the socket was to actually fabricate it with a little
lip, or bump/shelf/legde, or watever you want to call it, where the
brace fits up against it to keep it in place better. Withouth this lip
or bump, the brace would probably migrate down, slipping off the socket.
It was simple to do this bump. I did a first lamination on the socket,
with 2 layers of carbon in it, like a normal BK socket. THen I roughed
up the socket, and then just used some gunk (Siegleharz and paper) to
make this bump at the level I wanted it, which is near the distal end of
the socket, right across the tibia section and extending about 3 inches
long (about 1/2 in wide) going from medial to lateral side of tibia.
Then when I took the cast of the leg, I made the cast about 1″ below
this bump, and it was very visible in the cast, so the techs at Townsend
could see it plainly and know where to make the bottom edge of the lower
section of the brace.
John T. Brinkmann, CPO, LPO, FAAOP
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