The prosthetic socket
Where all lower limb prostheses are concerned, whether:
- Above knee (trans femoral)
- Below knee (trans tibial)
- Ankle disarticulation (Symes)
- Through knee (knee disarticulation), or
- Hip disarticulation
By far, the most important component is the prosthetic socket. Because the prosthetic socket acts as the interface between the human body and the prosthetic limb, everything stems from this most important part of all lower limb prostheses.
When it comes to casting, manufacturing and fitting prosthetic sockets, Roger Wolfson and Associates is constantly seeking new methods and improved technology to offer patients the best possible solutions.
Does your prosthesis hurt? Are you walking with difficulty?
While various levels of amputations are carried out, by far, the most common involve:
- Below knee (trans tibial)
- Above knee (trans femoral)
No matter the amputation level, there is a great deal your dedicated prosthetist can do to diagnose and employ the right measures in order to alleviate any painful conditions associated with prosthetic use.
At Roger Wolfson and Associates, should a patient experience pain when using a prosthetic, our pledge is to continue to remodify the prosthetic until such time as any painful conditions are eliminated.
There are two major factors involved in the cause of pain during prosthetic use:
- The prosthetic socket does not fit properly
- Incorrect alignment
Owing to the variety of different materials and techniques available in the construction of prosthetics, numerous options exist to ensure pain-free, comfortable use. Even the more costly knee or ankle prosthesis can be of little or no value should the prosthetic socket be ill-fitting or incorrectly aligned.
Should one become ill, this can cause a volume change within the prosthetic socket; and should this occur, the dedicated prosthetist will need to make immediate alterations to the prosthetic fitting in order to accommodate the change in volume.
The alignment of a prosthetic limb is of critical importance, especially in the case of a trans femoral (above knee) prosthesis, since, if it is not correctly positioned, walking with a poor gait will ensue.
No problem is too small to be addressed, should any pain be experienced during prosthetic use there is always an underlying reason. In this regard, it is vital that a patient get in touch with their dedicated prosthetist and seek immediate attention in order to alleviate any painful conditions.
At what stage is the residual limb ready for measurement?
- If the patient is a trans femoral (above knee) amputee, the process of measuring and fitting of the first walking prosthesis can take three to five days.
- If the patient is a trans tibial (below knee) amputee, the process of measuring and fitting of the first walking prosthesis can take anything from one hour to two days. This timeframe largely depends upon the number of fittings required for both the patient and the prosthetist to be satisfied with the fit.
Upon creating the final prosthesis, the timeframe required up to the last fitting should not exceed longer than three weeks.
At Roger Wolfson and Associates we go the extra mile to do whatever it takes to ensure that the outcome of the prosthesis is to the complete satisfaction of the patient
Once the initial measurements have been taken, a number of test fittings are carried out which are vital to the comfort of the patient.
At Roger Wolfson and Associates, we like to compare the creation of the prosthesis to the making of a wedding dress. Inasmuch as it is of critical importance to the bride that the fabrication and fit of the dress be of the highest possible standards, so it is to the patient when it comes to the fitting of the prosthesis.
A dedicated dress maker will go the extra mile to ensure the best possible results, and will go above and beyond the usual number of fittings even if that means at no extra cost. In the very same manner, Roger Wolfson and Associates go the extra mile to do whatever it takes to ensure that the outcome of the prosthesis is to the complete satisfaction of the patient. Irrespective of the time it takes or number of fittings required to deliver the best possible results, our goal is to ensure patient comfort, mobility and confidence.
During the prosthetic fitting process the patient also has the option to engage in an extensive rehabilitation exercise programme in consultation with an experienced team of physiotherapists. The decision to carry out this part of the process is largely dependent upon available funding. However, since having initially invested in the prosthesis, the medical aid fund in question would more often than not cover any costs incurred in order to ensure the patient reaps the full benefit of the prosthesis.
Patients report that the rehabilitation exercise programme is highly-intensive, yet, it can also be fun. Roger Wolfson himself can testify to this fact since he regularly participates in the process and especially enjoys the dance class sessions!
‘Walking with a Prosthesis in three weeks!’
From post-op to prosthesis in three weeks!
From post-op to crutches within five days and walking with a prosthesis in as little as three weeks! The idea of walking with crutches within five days post-op and being able to walk with a final prosthesis in as little as three weeks after undergoing an amputation sounds like science fiction. Yet, it is even more surprising to learn that the technique used in creating a prosthesis designed to do just that has been around for many years.
Why surgeons should regularly use the services of a prosthetist when performing an amputation
Should a surgeon perform the amputation procedure in consultation with a prosthetist that is familiar with this technique, the results can be extremely beneficial to the well-being of the patient, and result in considerable cost savings to both patients and funding sponsors alike.
A scientific paper pertaining to this very topic was presented at an Orthopaedic Surgeons Congress that took place in South Africa a few years ago. However, despite the fact that the Chairman of the Congress raised the burning question as to why, in fact, surgeons don’t regularly consult with a prosthetist around the surgical procedure, the fact still remains that as things currently stand, the number of surgeons that use the services of a prosthetist nevertheless remains fewer than desired.
Immediate Post-Operative Prosthesis (IPOP)
Introduction to Immediate Post-Operative Prosthesis (IPOP)
Amputation is a critical salvage procedure when it comes to septic and tumour patients. Due to the process of ‘coning’ of the residual limb, which is undertaken in order to facilitate the application of a primary prosthesis, the rehabilitation process post-surgery is often delayed; which can be extremely costly both to the patient as well as the health system.
It is also during this time that muscle strength, tone, general fitness and co-ordination may be reduced, which further retards the rehabilitative process.
The Immediate Post-Operative Prosthesis (IPOP) technique attempts to address these problems with the application of a rigid cast immediately post-surgery while the patient is still in the operating theatre, and the attachment of a temporary prosthesis soon thereafter. This ensures that the healing of the wound and the rehabilitation process occur in tandem, thereby diminishing the effects of muscle wasting and enabling more rapid mobilisation with the primary prosthesis.
The Immediate Post-Operative Prosthesis (IPOP) technique dates back to 1893
- The Immediate Post-Operative Prosthesis (IPOP) technique is not new. In fact, the first reports of the use of the IPOP technique date back to 1893, when a German surgeon, von Bier, reported accelerated rehabilitation with the use of a rigid plaster cast to which a wooden peg leg was attached immediately following surgery.
- In 1918, a surgeon by the name of Wilson also reported excellent results having used the IPOP technique on injured soldiers during World War I.
- In 1957, surgeons Berlemont and Wiess reported the successful use of a thigh cast attached immediately post-surgery to below knee prostheses following trans tibial amputations.
- In South Africa, the IPOP technique has been used for several decades. However, such usage has not been well-documented, and this appears to be the reason behind the fact that the technique has been under-utilised in recent years.
- Recently, a prospective study of septic and tumour amputees was undertaken at the Johannesburg Hospital in order to evaluate the advantages and disadvantages of the IPOP
The Immediate Post-Operative Prosthesis (IPOP) technique: six-step process
What follows is a brief six-step process outlining the technique involved in creating an ‘Immediate Post-Operative Prosthesis’ otherwise known as ‘IPOP’:
- The surgeon first performs the surgical procedure and isolates the sterile wound.
- Orthopaedic wool is then wrapped around the residual limb (stump), following which, a crêpe bandage as well as Elastoplast bandages are also applied.
- Further padding and a stockingnette is applied at this stage.
- A layer of plaster bandage is then applied to ensure a smooth rigid cast with no sharp edges.
- Fibreglass bandages are then applied.
- A peg leg should be attached within two days post-surgery which enables the patient to walk within two to five days thereafter.
Benefits of the Immediate Post-Operative (IPOP) technique
- The IPOP technique aids in the prevention of swelling that would otherwise need to be reduced using coning bandages which is an extremely time consuming process.
- The rigid cast is applied in a sterile theatre which significantly reduces the chances of infection.
- Results in increased psychological well-being post-surgery, in that the patient can mobilise almost immediately thereafter.
Should the patient be contracted with Roger Wolfson and Associates, an Immediate Post-Operative Prosthesis (IPOP) is offered free of charge. However, costs will be incurred should the patient already be in consultation with another prosthetist.
What follows is a step-by-step illustrated process involved with the application of the Immediate Post-Operative Prosthesis (IPOP) technique:
Figure 1: Materials used in IPOP fabrication
Figure 2: A dry dressing and padded Elastoplast® pressure bandage is applied to the residual limb.
Figure 3: A pre-manufactured proximal brim is applied.
Figure 4: The brim is suspended from the shoulder then covered with orthopaedic wool and stockingette.
Figure 5: Plaster of Paris bandage is applied.
Figure 6: Fibreglass cast is added to provide a rigid exterior.
Figure 7: Felt is cut, shaped and applied to protect bony prominences.
Figure 8: Orthopaedic wool and stockingette are pulled over the dressings in the case of a trans tibial (below knee) amputation.
Figure 9: Plaster of Paris and fibreglass bandages are applied to create a hard exterior in the case of a trans femoral (above knee) amputation.
Figure 10: Patient has mobility with IPOP.
Figure 11: Patient fitted with primary prosthesis 3-4 weeks post-surgery in the case of a trans femoral (above knee) amputation.