Name of the Procedure:

Common Name: Knee Disarticulation Prosthesis
Technical Term: Addition to Lower Extremity, Endoskeletal System, Above Knee - Knee Disarticulation, 4 Bar Linkage, with Friction Swing Phase Control (HCPCS Code: L5611)

Summary

This procedure involves fitting a specialized prosthetic limb for individuals who have had an above-knee amputation or knee disarticulation. The prosthesis uses a 4 bar linkage system with friction control to mimic natural knee movement.

Purpose

The procedure aims to provide mobility and stability for patients who have undergone amputation above the knee. The 4 bar linkage with friction swing phase control helps replicate a natural gait, facilitating better support and movement efficiency.

Indications

• Above-knee amputation due to trauma, infection, vascular disease, or congenital conditions.
• Knee disarticulation.
• Patients requiring enhanced mobility and stability via advanced prosthetic technology.
• Individuals capable of utilizing a mechanical prosthesis.

Preparation

• Detailed medical history and physical examination.
• Pre-prosthetic assessment, including measurements and casting of the residual limb.
• Patients should follow the specific instructions provided by their healthcare team, which may include fasting or adjustment of current medications.
• Psychological preparation and counseling may be advised.

Procedure Description

1. Casting and Measurement: Measure and cast the residual limb to create a custom socket.
2. Fabrication: Construct the prosthesis, including the 4 bar linkage knee joint with friction swing phase control.
3. Fitting: Attach the custom prosthesis to the residual limb and make necessary adjustments for comfort and functionality.
4. Training: Patient undergoes training to learn how to use the prosthesis effectively, including walking and maintaining balance.

Duration

The entire process, from assessment to fitting and training, can take several weeks. The fitting procedure itself usually takes a few hours.

Setting

This procedure is typically performed in a specialized prosthetics and orthotics clinic, often as an outpatient service.

Personnel

• Prosthetist
• Orthopedic surgeon (if surgical intervention or adjustments are required)
• Physical therapist
• Rehabilitation specialist

Risks and Complications

• Skin irritation or pressure sores on the residual limb.
• Misalignment of the prosthesis causing discomfort or gait issues.
• Mechanical failure of the prosthetic components.
• Initial difficulty in mobility leading to potential falls or injury.

Benefits

• Improved mobility and independence.
• Enhanced quality of life.
• Better weight distribution and balance.
• Reduction in the energy required for walking compared to other prosthetic options.

Recovery

• Initial adaptation period where the patient learns to use the prosthesis.
• Follow-up appointments for adjustments and monitoring.
• Physical therapy to strengthen muscles and improve balance.
• Most patients see significant improvement in mobility within a few weeks.

Alternatives

• Traditional above-knee prostheses without advanced knee mechanisms.
• Wheelchair use for mobility.
• Osseointegration prosthetics (where the prosthesis directly attaches to the bone).
• Each alternative has its own set of benefits and challenges, necessitating a thorough discussion with healthcare providers.

Patient Experience

Patients might feel initially overwhelmed but will gain confidence with training and practice. Some discomfort and soreness are expected, but effective pain management and support from the rehabilitation team can help. The adaptation period is crucial, and with persistence, patients often experience significant improvement in their daily lives.