Name of the Procedure:

Addition to Lower Extremity, Above Knee or Knee Disarticulation, Acrylic Socket (HCPCS L5631)

Summary

This procedure involves fitting a prosthetic socket made from acrylic resin to the residual limb of a patient who has undergone an above-knee amputation or knee disarticulation. The socket serves as the interface between the patient's limb and the prosthetic device, enabling improved mobility and comfort.

Purpose

This medical procedure aims to provide a functional prosthetic socket that optimizes comfort and support for individuals with above-knee or knee disarticulation amputations. The primary goals are to enhance mobility, ensure the proper fit of the prosthetic limb, and improve the overall quality of life for the patient.

Indications

• Patients with lower extremity amputations above the knee or at the knee disarticulation level.
• Individuals experiencing discomfort, instability, or poor fit with their current prosthetic socket.
• Those requiring an upgrade to a more durable and functional prosthetic interface.

Preparation

• The patient may need to undergo a thorough assessment by a prosthetist to measure the residual limb and analyze the patient's unique anatomical and functional needs.
• Diagnostic imaging or physical evaluation may be performed to ensure proper socket fitting.
• No special fasting or medication adjustments are typically required.

Procedure Description

1. Measurement and Casting: The residual limb is measured, and a cast or digital scan is taken to create a custom-fit acrylic socket.
2. Fabrication: The socket is fabricated using high-quality acrylic materials tailored to the patient's specific dimensions.
3. Fitting: The prosthetist fits the socket to the residual limb, making any necessary adjustments for comfort and alignment.
4. Attachment: The socket is attached to the prosthetic limb, ensuring secure and functional integration.
5. Final Adjustments: The prosthetist may conduct several fitting sessions to ensure the optimal fit and function of the socket.

Duration

The process of creating and fitting the acrylic socket can take several weeks, including multiple appointments for fitting and adjustments. Each fitting session itself typically lasts 1 to 2 hours.

Setting

The procedure is usually performed in a specialized outpatient prosthetics clinic or orthotics center equipped with the necessary materials and tools.

Personnel

• Prosthetist (prosthetic specialist)
• Prosthetic technician (if involved in fabrication)
• Occasionally, a physical therapist may assist with post-fitting rehabilitation.

Risks and Complications

• Skin irritation or sores from socket friction
• Improper fit leading to discomfort or instability
• Potential need for multiple adjustments to ensure a proper fit
• Rarely, allergic reactions to materials used in the socket

Benefits

• Enhanced mobility and stability
• Improved comfort and functionality of the prosthetic limb
• Better fit and customization compared to older or non-custom sockets
• Increased overall quality of life for the patient

Recovery

• The patient may need some time to adjust to the new prosthetic socket, including guidance on proper care.
• Follow-up appointments are often necessary to fine-tune the socket fit.
• Any minor skin irritation or pressure points can typically be managed with additional adjustments.

Alternatives

• Standard or non-custom prosthetic sockets (less customized fit)
• Other materials for sockets, such as carbon fiber or thermoplastics
• Each option has its own set of benefits and limitations, which may be discussed with the prosthetist.

Patient Experience

During the fitting process, patients may feel slight discomfort but should communicate this to the prosthetist for adjustments. Post-procedure, some initial discomfort or irritation might be experienced as the patient adapts to the new socket, managed through follow-up care and adjustments. Pain management and comfort measures, including padded liners and proper hygiene, are critical for a positive outcome.