In “K2 Ambulator Options Evolve” in the February issue, we write about the growing number of K2 ambulators and the variety of prosthetic devices available to help those patients achieve their mobility goals. In addition to improvements in prosthetic components approved as K2-appropriate, experts discuss studies that continue to explore the benefit of higher-tech components for safety and increased mobility for K2 ambulators. In this Online Exclusive, we asked O&P professionals to identify the unique challenges of designing prosthetic solutions to serve the K2 patient population. Here’s what they shared.
 Tom Nomura, CPO, director of clinical services, Proteor USA, Tempe, Arizona: The K2 market presents unique challenges for manufacturers. First and foremost is developing a product that will improve outcomes for the K2 user while also taking into consideration the business case for the practice.
 Andreas Kannenberg, MD (GER), PhD, executive medical director, Ottobock North America, Austin, Texas: I think the biggest challenge is working within the L-Codes; basically the only strategy Medicare currently allows for is to improve products within the coding system. Otherwise, we do have to do studies to convince the payers, and especially Medicare, to pay for that technology that K2 patients currently do not have access to.
 Gary Wall, MSPO, CPO, West Coast Brace and Limb, headquartered in North Tampa, Florida: When it comes to K2 componentry, especially with knees, you’re boxed into locking knees, weight-activated stance control knees, or friction knees—the simplest knees that you can have. You have to go to a K3 level just to get a hydraulic to have resistance. To add a microprocessor, you also have to go to K3. The divide between what you can get, mechanically, for K2 patients is so vast it’s like comparing the major leagues to high school ball.
 Ben Auzenne, vice president of sales and marketing, Blatchford US, Miamisburg, Ohio: When they work with a new K2 patient, each prosthetist considers, “Is this patient going to be K2 ambulator for life? Or are they going to move from K2 to K3 and become a lot more active and do the things they dreamed about doing?” That choice is actually a real engineering challenge when you think about it: K2 ambulators require more stability and the K3 ambulator seeks free movement with the ability to exercise. Those are very distinct needs with distinct requirements.
 Jonathan Cook, CPO, clinical education manager, College Park Industries,Warren, Michigan: You could create a product that would be the best thing ever for everybody out there—but if it doesn’t fit into established reimbursement codes and customary K-level qualifications, you’re not going to be able to sell it here—and we’re not going to be able to get it to the market.
That’s a big challenge. Domestically we’ve got to build to the structure that we have here in the States.
I always used to talk to my patients about the balance of stability and mobility. So the more movement there was in the foot, the more stable the patient has to be in order to walk with that type of foot. So I think that the biggest challenge really is coming up with that blend of stability and mobility for the K2 or the elderly patient population.
 Justin Pratt, CP, director of clinical education, prosthetics, Össur Americas,Foothill Ranch, California: Performing contextual inquiry enabled us to observe this population in their living environment and guided us in identifying their challenges. Difficulty in donning their prosthesis—also the biggest contributor to their lack of utilization of a device to conduct activities of daily living—led us to develop the Connect TF. Their limitations regarding transportation was also a driver to reduce the number of visits required to have a device that was easier to don.
