Thank you to all respondants,
Following are my original question followed by the responses and then my response to the responses.
Nathan Keepers, CPO
———–
I am currently working with the same situation myself. My patient
prefers
the four bar linkage from the DAW line of knees. With the 3R60’s you
may
have to really tighten up the stance flexion on a bilateral. Most
bilats I
have worked with prefer a solid “feel” to the prostheses and don’t like
the
“springy” feel of too much stance flexion. I think the luxon foot
would
work out great. I have had much success using Endolite’s DR2
foot’ankle
combination as well.
Hope this will help. Let me know how it works out.
————
Is your amputee young / old…..activity level???? I personally like
single axis feet for bilateral T/F. C -walk have had good
results…..Recently I used bilateral stance control knees on an
elderly
active individual that lives indecently…..shops, drives a car,
unlimited
community ambulator…..it depends on the amputee.
————-
I prefer the hydraulic units especially for bilateral amputees. The 3r60 is OK but ineffective better suited to a reasonably active unilateral, who have better control over the knee unit and can ensure the stability of the joint. The range of adjustment is limited and more often that not the adjustments end up being set at maximum, with the gait requiring more (both in flexion and extension). The Mauch/Catech units offer so much more stability in stance phase and this is what bilateral amputees need, as well as being able to set up the swing phase nicely to suit the patients gait (probably slow with the need for stronger extension). I would also like to suggest the sure flex, it is to my mind the best all round low activity foot, especially when cost is considered. I have also had success with the collage Park, both these feet work very well on bilateral amputees. The Luxon feet are just too rigid, which result in the ground reaction forces being transferred to the resid!
ual limb
directly, without absorbing the forces as the Sure Flex and Collage Park do. Something to think about, your patient would probably be more comfortable with the old Otto Bock Greissinger foot with its multi-axis movement than with the Luxon feet!! I am not trying to trash the Luxon feet only that they are better suited to higher activity amputees who have greater control over the prosthesis and can use the shock absorbing on heel strike and take advantage of the smooth roll over and assisted toe off. Whereas the bilateral usually does not have this control. I hope that this makes sense, feel free to e mail me back to clarify any points.
I have just completed a Masters degree paper on this exact subject and the hydraulic units seemed to offer the best all round stability.
————
I am currently working with a Bilateral AK patient, 84 years of age.
Patient
has bilateral hip flexure contractures, more severe on lt, side.
Patient was
initially fit with Ottobock 3r60 and though he liked the stance flexion
feature, the weight and lenght of the prosthesis has caused problems.
Have
since replaced the 3r60 with the OWW Geoflex and patient is doing well.
Left
limb is utilizing Otto Bock cable lock and release knee that is only
unlocked for sitting.Patient has 12″isch to distal femur on rt. and 10
1/2″
lentgh on left. He whore the 3r60 for only a week before deciding that
he
was too tall to keep control of his balance. Patient has asked if I can
sell
his 3r60 to finance other modifications to his residence to better
enable
him to navigate his home. The 3r60 is in origoal box w/instruction and
adjusting tool. It was purchased in June of 05 and has been on the
shelf
ever since. Patient is quite remarkable given his age and determination
to
walk.
——
YOUR COMBINATION SOUNDS A LITTLE ON THE HEAVY WEIGHT
SIDE. WHAT ID THE PATIENT BODY WEIGHT? ARE YOU SURE
THE PT. IS A K3 LEVEL AMBULATOR? I PERSONALLY HAVE
NEVER WORKED WITH A BILATERAL TRANSFEMORAL K3 LEVEL
PT. I HAVE WORKED WITH 6-7 K2 LEVEL BILATERAL
TRANSFEMORAL PTS. AND I COUILD GIVE YOU
RECOMMENDATIONS THERE IF IT IS APPLICABLE. I HAVE YET
TO WORK WITH ONE WHO WAS AMBULATING WITHOUT ANY
ASSISSTIVE DEVICES. FOR LIGHTWEIGHT K2 LEVEL PT.
CANNOT BEAT OTTOBOCK 3R95=1 KNEE WITH OTTO BOCK AXTION
FOOT ON ONE SIDE AND TOTAL KNEE OR OTTO BOCK 3R36 AND
AXTION FOOT ON THE OTHER SIDE.
————
If being “lightweight” is one of your primary goals I really think your headed down the wrong path. The 3R60 (850 g) and the Luxon Journey (465 g) are “heavier” components. If these are sufficient as far as lightweight is concerned I would truly consider a C-Leg (1100 g) combined with a Axtion foot (385 g). This combination has been successful in our practice for bilateral transfemoral amputees. With an anatomically correct socket and excellent suspension, the difference in weight is insignificant and stability is unmatched
———————-
Sounds like an overprescription to me. Community ambulator + bilateral
TF
(to me) = sitting in a wheel chair 95% of the time and the remainder
doing
transfers or walking short distances with a cane. I would go with more
stable knees (the 3R60s bounce can throw off a novice, weak or
bilateral
amputee) and light weight feet.
——————–
Yes! – that combination makes for good reimbursement.
—————-
Sounds great… I love the combination…..
—————-
My response:
Naturally, my first response is, “yes it does make for good reimbursement, but perhaps could we do better yet?”
(just for the benefit of anyone who cannot tell, this is sarcasm)
The gentleman that I am inquiring about is 67 years old, 6’1″, 155 lbs, in good health and has ambulated with sturdily built exoskeletal legs for the past 50 years. His legs were lost in an accident at work at 17y.o., when there wasn’t very good work comp or good lawyers to make him an instant millionaire. He has worked at real jobs all his life and has not had new prostheses in 10 years. His primary mode of transportation has been ambulation with crutches until recent months the prostheses have been causing abrasions too painful to ambulate. I think he is well deserving of any technology that is going to help him remain an active, independent ambulator.
Relatively, any knee/foot combination we provide should end up being lighter than the tanks he has been wearing.
I suppose that some out there might be concerned about the reimbursement level getting out of hand. I can guarantee the reimbursement won’t come close to the cost of a prosthesis told about in a recent article in Field and Stream Magazine about a soldier returning from Iraq. Direct quote from the article: “Eleven surgeries and a $100,000 prosthesis later, he is getting back to civilian life one hunting trip at a time.” (Sidenote: if any practitioner out there is associated with the provision of the prosthesis alluded to in the article, I believe you should ask Field and Stream for a correction to the article, or, if in fact you have received $100,000 (doughtful) for one Transfemoral prosthesis, should stop ripping us all off (taxpayers).
Nathan Keepers, CPO
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