Dear Colleagues,
I received several responses and some good questions about my post an the
patient that , essentially has rejected, three different IC controlled
knees, and four 4bar knees, and a Mauch knee. (Original post at the end of
this one)
Some practitioner suggest that people become used to a certain kind of knee,
which is entirely reasonable. My pt’s experience is that at slow speeds and
walking through grass, thick carpet, uneven ground etc., the toe clearance
was very important. And remember , he is an excellent walker.
He also like the ease of adjustable heel height with the hydracadence. Of
course that can be accomplished with the Ossur Elation or the Freedom
Runway.
Some asked about duration of testing on each prosthetic knee. He was on the
C-leg for at least 7 months and went on several trips including the
Antarctica, all with good function.
He was on the DAW IC controlled knee for about 8 weeks. We had noise
problems with that one and he did not experience the flexion resistance that
is supposed to develop to aid in fall prevention. We tried two different
knees.
He was on the OHC knee for more than a year, a Gaitmaster Jr that he liked
immediately until the next day when he said it was feeling too much effort
when going into extension. I was intending this to be the back up for the
C-leg. And yes, the settings were as low as possible.
He is currently on the Adaptive knee and has been for at least 3 weeks.
He also has a back up with a Total knee but doesn’t see a particular
distinct advantage to this knee and I will probably take it back
I forgot to mention that I also had him on the Hosmer 4 bar knee. I had one
for another pt that had a problem with the cylinder seizing up after a week.
This was the new replacement but it had noise problems.
Again, he walks very well with all these knees (I wish all my pts looked
like that!)
But again, the active dorsiflexion remains significant.
A new problem arises when considering the Proteor hydracadence type knee,
and that is the choice of feet available. The foot has to have a flat
surface for the Proteor knee. That rules out many lighter more responsive
feet, but the flat surface is needed for the linkage to the knee to occur.
Some responses hinted at active dorsiflexion ankles coming onto the scene.
There was the Rincoe ankle in the past but I have never tried it and have
not heard about it recently. It seemed like a good idea but I was told it
was heavy. I also heard about one case where it failed and the pt was left
with a totally free swinging ankle.
Having an active dorsiflecting ankle adds extra weight distally which may
not be optimal, but may be irrelevant for some pts.
Another point was made was that reimbursement in the United States, does not
allow for any profit to be made using this knee.
This is a strong consideration for the private facility, but unfortunately
means we may be overlooking an important feature because of limited
reimbursement.
Perhaps re-coding would be appropriate. Maybe if it was , other
manufacturers would work toward creating active dorsiflexion linked with
their knee.
Finally I heard from only one practitoner who has used it once. He was
unsure that the hydraulics were more reliable.
Perhaps the knee has a greater market in France (where it is made) or Europe
in general. If anyone else has used the knee, i would like to hear from
them.
There seems to be a significant number of prosthetic research projects going
on in Universtiy settings that are often irrelevant to prosthetic practice.
This might be a good project for an interested engineering student . Also,
can it be made cost effectively for developing countries as well, where
uneven terrain and thick grass are the norm?
(Original post below)
Mark Benveniste RN BS CP
MEDVA Medical Center
Houston, TX
USA
> Dear Colleagues,
>
> I have an interesting case of an AK amputee who is an excellent walker and
> has been an amputee since the 1950’s.He was originally on a suction
socket,
> I changed him to a lanyard and then changed him to a Ossur Seal-in liner.
>
> He was originally on the Hydracadence knee. Since that time he has been on
> an OHC 4 bar knee, an Ossur Total Knee, a DAW IC controlled knee and Otto
> Bock C-leg , an Ossur Mauch SNS knee, and currently on an adaptive knee.
>
> The Otto Bock C-leg was dialed in by Otto Bock professionals, and the
> Adaptive dialed in by an expert as well.
> He walks well up and down ramps and can walk down stairs but finds it more
> of a “trick” than something he find useful.
>
> He rejected the OB because he could not adjust the heel height…. By the
> way , this man walks on a treadmill everyday at 3mi per hour.
>
> I put him on the Endolite Adaptive because I could put an adjustable foot
on
> it which he liked. Interestingly enough, he thought the Adaptive was more
> stable for him. He has a long residuum and obviously has good control.
>
> Despite his outward excellent gait, and his preference for the Adaptive
with
> an adjustable heel height,
> he feels he prefers the hydracadence because of the active dorsiflexion.
>
> This makes me think that theories or facts about increased toe clearance
> with 4 bar knees, and improved toe clearance with the timing of IC
> controlled single axis knees, may still be less of a consequence than the
> dorsiflexion provided by a hydracadence type knee.
>
> As I said, he is an excellent walker. If he feels he
needs/wants/appreciates
> dorsiflexion, this is significant to me.
>
> I will be putting him on a hydracadence type knee. However, I have known
for
> sometime that Proteor (in France) manufactures an improved lighter weight
> hydracadence knee with improved and presumably more reliable hydraulics, a
> carbon fiber frame,
> an integrated pylon that can be cut to length and the ability to use any
> foot that doesn’t have a pyramid.
>
> In the USA, DAW is the distributor. I look forward to using / learning
> about it. Wondered if anyone else has used it.
>
> Mark Benveniste RN BS CP
> MEDVA Medical Center
> Houston, TX
> USA
