Hi
Great Summary,….just don’t like the following line
“All the materials O&P uses are good in salt water. Regular steel set
screws should be replaced with stainless steel.”
Probably best to assume the opposite and that is that NONE of the
materials we use in O&P are good in salt water and would need particular
care and attention. The combination of materials only compounds the
problems.
Just my 2 cents
Bill
John T. Brinkmann wrote:
>Here are the responses to my question about a patient who is interested in an AK prosthesis for swimming (saltwater).
>
>Thanks to all who responded.
>
>John Brinkmann, CPO, FAAOP
>
>
>
>John, If you are going to use a liner, Fillauer makes the Gator Locks which are corrosion resistant. They can be used in a swim prosthesis without a problem. If you would like more information just let me now. Jackie Bradford Region Sales Manager The Fillauer Companies 561 Division Street Campbell, CA 95008 Email: [email protected] Ph: 408-379-5151 Fax: 408-379-5263
>
>*************************
>
>Over the years, I have provided a few water-type prostheses for patients. There a few options for you to consider. I recommended you consider using Ferrier Couplers (L5617?) to enable him to interchange knees/feet. The Aulie knee and a swim foot are appropriate choices for use in water, as is the Active Ankle from Rampro. There are better choices for land activities. Using Ferrier Couplers will enable you to provide one socket and multiple knees/feet (and other components) so he can switch from water components to land components. I have had success placing a Ferrier Coupler proximal to the knee and a second Ferrier Coupler proximal to the Active Ankle. This enables the patient to switch out components as needed. It also enables the patient to attach the Active Ankle directly to the socket, plantarflex the foot and attached swim fin/flipper. This eliminates the added length/lever arm of the knee and makes it easier for the patient to utilize the swim fin/flipper. it also gi!
v!
> es him
> the ability to ambulate safely to and from the water. The suction insert/lanyard system is a good choice, but you may want to consider a second suspension method if he plans to use swim fins/flippers when swimming. The extra force from the swim fin/flipper could cause socket rotation problems. The Summit Lock or even a second lanyard strap can reduce socket rotation. I hope this information helps you with your decision.
>
>**********************
>
>A full A/K prosthesis in the water is a real liability. My adviseis to make the prosthesis so that it is functional enough for him to walk to the beach or to get onto the boat, but include a quick disconnect so that once he is in the water (at the beach) he can remove the knee/shin/foot, (or before he goes overbaoard from the boat). If you use the quick disconnect, you can adapt a foot/fin combination for use in the water is he is serious about swimming. This is not necessary but I’ve had some amputees who wanted it. Ultimately, only the amputee can decide if this is really worth the effort and the bucks.
>
>He will have to be really diligent about removing the liner once he leaves the water as an accumulation of salt can abrade him badly if he is careless.
>
>If you haven’t used the Aulie knee, don’t be suprised by a huge amount of varus moment in the knee at midstance. Unless they have redesigned it, it is genuinely freightening, but I’ve not heard of any breakage.
>
>Use a zero heel height foot so that he can wear “reef shoes” both in and out of the water if he chooses. They are really light and don’t negatively impact bouyancy.
>
>***************************
>
>I’ve fitted several swim limbs with Aulie knees. My preferred choice of foot is Luxon Max DP. It also looks great with the black Aulie knee and all graphite socket lamination. If you could get away with a full suction socket, i think it would be ideal, but I used Transfemoral liners as well. I think wearing the prosthesis in water is fine as long as he makes sure that the knee lock is engaged.
>
>
>*********************
>
> I am a Ak amputee who has been using the Aulie knee for over 2 years now. I use it for everything outdoor as it is very sturdy, durable knee and very light. I use a suction socket which is not an issue when I go in the water plus a Ferrier cplg to take off the knee or alternatively leave the knee on and swim with it. I can’t speak for the use of a lanyard but can only think it might stretch with water. I also attach a fin to my socket at the Ferrier connection for snorkling and scuba diving. Suction socket has worked well for scuba diving too.
>
>*************************
>
>As far as an AK Swim Prosthesis, the components you mentioned are fine but not necessarily for what he wishes to do. The use of the prosthesis for some of the activities you mentioned could be contraindicated due to reduced mobility if the person is not an experienced swimmer he could have some trouble with the weight /boyancy combination of the foot and knee. I have found that most AK s end up using the prosthesis for entering and leaving the water but the prosthesis to many feels like a big rudder. For ocean swimming it allows them to get in and out of the surf easier but can be troublesome in heavy surf or undertow. The independence of having the prosthesis sometimes out weighs the negatives. As far as suspension a silesian belt would be a good auxillary suspesnion since you mentioned saltwater. Be aware that silicone liners deterorate faster in salt water and must be rinsed and cleaned thoroughly after swimming. Take a little extra time to discuss the components and cos!
m!
> etics of
> the swim prosthesis with the patient. It is helpful to just assemble the parts , even with an old socket so that the patient can visually see what it will look like. Remeber that the prosthesis must have the ability to balast out otherwise he will be spending an awful lot of time fighting to control the prosthesis and not enjoying his swim.
>
>**********************
>
>I can speak as a former SCUBA instructor, AK amputee and Prosthetist. I think the Aulie works very well, and if your pt wants to swim with it, the lock will come in handy. The swim ankles that allow full plantar flexion are nice too, for swimming without a fin. Swimming with a fin is very difficult on the prosthetic side. The hips will work over time trying to move the fin through the water, due to the locked knee. I personally perfer to SCUBA, skin dive or swim without any prosthesis on. However, for pools, hottubs, boating or the like a swim leg is really nice. Suspension wise, I like full suction. I don’t know how a roll on liner will do with an AK in the water. If you have any questions feel free to write me back.
>
>***********************
>
>If the patient needs to wade into the water a full A/K is useful. I personally do not see the advantage of a full A/K in water over the navel unless the patient has almost a knee disartic length for leverage. Most A/K amputees do better in water over their navel without a prosthesis. I have never made one, but I understand some do use a flipper type attachment to a shortened pylon.
>
>***********************
>
>All the materials O&P uses are good in salt water. Regular steel set screws should be replaced with stainless steel.
>
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—
Bill Contoyannis
Manager / Rehabilitation Engineer, REHAB Tech
Centre for Biomedical Engineering – Monash University
Dept of Electrical and Computer Systems Engineering
Room G19 Bldg 35 Clayton Victoria 3800
AUSTRALIA
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