Preparatory Above-Knee Disarticulation Ischial Level Socket (L5580)

Name of the Procedure:

• Common Names: Above-Knee Disarticulation Prosthesis Fitting, AK Prosthesis, Knee Disarticulation Socket
• Technical/Medical Term: Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon, no cover, SACH foot, thermoplastic or equal, molded to model (HCPCS Code L5580).

Summary

This procedure involves fitting a preparatory prosthetic for individuals who have undergone an above-knee amputation. The prosthetic includes a socket, pylon, and SACH (Solid Ankle Cushion Heel) foot, typically made from thermoplastic materials. It is designed to be a temporary solution to help patients adapt before being fitted with a definitive prosthesis.

Purpose

• Medical Conditions Addressed: Limb loss above the knee.
• Goals/Outcomes: To provide an interim prosthetic that aids in mobility and stabilization during the initial rehabilitation phase. It helps the patient adapt physically and emotionally to the use of a prosthetic limb before transitioning to a more permanent solution.

Indications

• Symptoms/Conditions: Above-knee amputation, knee disarticulation.
• Patient Criteria: Suitable for patients who have recently undergone amputation and are in the early stages of rehabilitation. Ideal for those who need an initial prosthesis to begin walking and regaining function.

Preparation

• Pre-procedure Instructions: No specific instructions are typically needed, though patients may be advised to manage their wound care and maintain proper hygiene.
• Diagnostic Tests/Assessments: Evaluation by a prosthetist to ensure readiness for fitting, potential X-rays or imaging to assess residual limb condition.

Procedure Description

1. Consultation and Assessment: Patient meets with a prosthetist for an evaluation of the residual limb.
2. Casting/Molding: A cast or digital model of the residual limb is created to design a custom-fit socket.
3. Prosthetic Fitting: The fabricated socket, pylon, and SACH foot are assembled and fitted onto the residual limb.
4. Adjustment and Alignment: Adjustments are made to ensure the prosthetic fits comfortably and allows for proper alignment and weight distribution.
5. Training and Education: Patients receive instructions on how to use and care for the prosthetic, along with exercises to improve balance and mobility.

• Tools/Equipment: Casting materials, digital imaging tools, thermoplastic materials, alignment jigs.
• Anesthesia/Sedation: Not applicable as this is a non-surgical procedure.

Duration

• Typical Duration: Approximately 1-2 hours, including fitting and initial training.

Setting

• Location: Typically performed in an outpatient clinic or a specialized prosthetic facility.

Personnel

• Healthcare Professionals: Prosthetist, possibly a physical therapist for gait training.

Risks and Complications

• Common Risks: Skin irritation, discomfort, improper fit.
• Rare Risks: Pressure sores, allergic reactions to materials.
• Management: Regular follow-up visits for adjustments, addressing skin issues with protective liners or creams.

Benefits

• Expected Benefits: Improved mobility and stability, increased independence.
• Realization Time: Benefits can be seen immediately after fitting, though optimal use may require several weeks of use and adjustments.

Recovery

• Post-Procedure Care: Regular cleaning and inspection of the prosthetic and the residual limb, adherence to a physical therapy routine.
• Recovery Time: Varies by individual; typically, patients adjust within several weeks to months.
• Restrictions: Avoid excessive moisture and high-impact activities.
• Follow-Up: Regular check-ups every few weeks to monitor progress and make necessary adjustments.

Alternatives

• Other Treatment Options:
  • Custom definitive prosthesis
  • Wheelchair or other mobility aids
  • Osseointegration (for eligible candidates)
• Pros and Cons of Alternatives: Definitive prosthesis provides a long-term solution but requires time and multiple fittings. Wheelchairs may reduce mobility independence. Osseointegration is a surgical option with a longer recovery time and potential complications.

Patient Experience

• During the Procedure: Patients may feel mild pressure during the casting or fitting but should not experience significant pain.
• After the Procedure: Initially, some discomfort as they adjust to the prosthetic. Pain management may include over-the-counter medications. Physical therapy aids in improving comfort and function.