Name of the Procedure:

Addition to Lower Extremity Prosthetic Type (BK) Socket, Molded to Patient Model
Common name(s): Below-Knee Socket Addition, Prosthetic Socket Customization
Technical or medical terms: HCPCS L2350, PTB (Patellar Tendon Bearing) Socket Addition

Summary

This procedure involves creating a custom-molded socket for a below-knee (BK) prosthetic limb. The socket is tailored to the patient's specific limb shape to ensure a comfortable and effective fit. This customization is essential for the prosthetic to function effectively and to avoid discomfort or skin issues.

Purpose

The main purpose of this procedure is to customize a prosthetic socket to ensure a proper fit for patients requiring a below-knee prosthetic limb. It addresses issues with poorly fitting prosthetics, which can cause pain, sores, and difficulty in mobility. The goal is to provide a comfortable and effective prosthetic that enhances the patient's mobility and quality of life.

Indications

• Patients with a below-knee amputation.
• Discomfort or pain with a current prosthetic limb.
• Fit issues with an existing prosthetic socket.
• Skin irritation or sores due to improper socket fitting.

Preparation

• Patients may need to provide medical history and details about their daily activity levels.
• Measurements of the residual limb will be taken.
• No specific fasting or medication adjustments are typically required.

Procedure Description

1. Assessment: The prosthetist assesses the residual limb and takes precise measurements.
2. Casting: A mold or cast of the residual limb is created.
3. Modeling: The mold is used to create a detailed model of the limb.
4. Customization: A custom socket is crafted based on the model, using durable and lightweight materials.
5. Fitting: The patient tries the socket for fit, and adjustments are made as necessary.
6. Finalization: Once the fit is deemed satisfactory, the socket is finalized and attached to the prosthetic limb.

Tools and equipment: Casting materials, modeling tools, prosthetic socket materials.

Anesthesia: Generally not required for this procedure.

Duration

The total process, including assessment, casting, modeling, and fitting, usually takes several hours over multiple sessions.

Setting

This procedure is performed in a prosthetist's office or a specialized prosthetic and orthotic clinic.

Personnel

• Prosthetist (the specialist who fits and customizes the prosthetic limb)
• Occasionally, an orthopedic specialist may be involved.

Risks and Complications

• Common risks: Discomfort during the fitting process, minor irritation or pressure sores from the initial fitting.
• Rare risks: Allergic reactions to materials used, significant skin issues.

Benefits

• Improved comfort and fit of the prosthetic limb.
• Enhanced mobility and function.
• Reduced risk of skin irritation and pressure sores.
• Benefits are typically realized immediately after the final fitting.

Recovery

• Follow any care instructions provided by the prosthetist.
• Monitor the limb for signs of irritation or pressure sores.
• Regular follow-up appointments may be necessary to ensure proper fit.

Alternatives

• Pre-fabricated prosthetic sockets.
  • Pros: Quicker and less expensive.
  • Cons: May not fit as well, leading to discomfort and reduced functionality.
• Silicone or gel liners.
  • Pros: Additional comfort and cushioning.
  • Cons: May add bulk and require regular replacement.

Patient Experience

During the casting and fitting process, the patient may experience some discomfort due to manipulation of the residual limb. After the procedure, there may be an adjustment period to get used to the new socket. Any pain is usually managed through adjustments to the socket and use of liners or padding. Regular communication with the prosthetist helps in ensuring ongoing comfort and functionality.