Name of the Procedure:

Addition to Lower Extremity, Below Knee, Total Contact (HCPCS L5637)

Summary

In simple terms, this procedure involves adding a custom-made, total-contact prosthetic extension below the knee. This type of prosthesis ensures optimal weight distribution and minimizes pressure sores by fitting closely to the residual limb.

Purpose

The procedure addresses the need for a well-fitting prosthesis in patients with below-knee amputations. The goal is to improve mobility, functionality, and overall quality of life while preventing skin irritation and pressure sores.

Indications

This procedure is indicated for:

• Individuals who have had a below-knee amputation.
• Patients experiencing discomfort or skin issues with their current prosthetic device.
• Those needing a more stable and secure prosthesis for improved mobility.

Preparation

Patients may need to:

• Follow specific instructions about fasting or medication adjustments if anesthesia is required.
• Undergo a pre-procedure assessment to measure the residual limb and ensure proper fitting.
• Have diagnostic tests like X-rays or CT scans to provide detailed limb measurements.

Procedure Description

1. Assessment: A detailed assessment of the residual limb is conducted using measurements and imaging.
2. Design and Fabrication: A custom-wrapped mold of the residual limb is made, then used to design the prosthesis.
3. Adjustment: The prosthesis is checked for fit and comfort, and adjustments are made as necessary to ensure total contact.
4. Final Fitting: The final prosthesis is fitted once optimal adjustments are completed. Tools and Equipment Used:
   • Measuring tools
   • Molding materials
   • Advanced imaging (X-rays, CT scans)
   • Prosthetic fabrication devices

Anesthesia: Typically, local anesthesia is used if there is a need for minor surgical adjustments to the residual limb.

Duration

The entire procedure, including both the assessment and fitting phases, may take several hours spread over multiple sessions.

Setting

The procedure is usually performed in a specialized prosthetics and orthotics center, outpatient clinic, or a hospital with a dedicated prosthetics department.

Personnel

• Certified Prosthetist
• Orthotist
• Nurse
• Anesthesiologist (if anesthesia is necessary)

Risks and Complications

• Common risks include pressure sores, skin irritation, and infection.
• Rare complications could involve allergic reactions to materials or poor fit leading to discomfort.

Benefits

• Improved comfort and mobility.
• Reduced risk of skin irritation and pressure sores.
• Enhanced quality of life and functional independence.

Benefits typically become noticeable within a few weeks after fitting and adjustment periods.

Recovery

• Follow-up appointments for monitoring and adjustments.
• Instructions on prosthesis care and maintenance.
• Normal activities can often be resumed soon after the procedure, but some adjustments and adaptations may be necessary.

Alternatives

• Traditional prosthetics without total contact.
• Advanced robotic prosthetics.
• Physical therapy alone.

Pros and Cons:

• Traditional prosthetics may be less expensive but can be less comfortable.
• Advanced robotic prosthetics offer high-tech benefits but may be costly and have a steeper learning curve.

Patient Experience

During the procedure, patients can expect some discomfort while measurements are taken but minimal pain, especially if local anesthesia is used. Post-procedure, patients may experience minor aches as they adjust to the new prosthetic but should find it significantly more comfortable as they adapt. Pain relief measures include medications and physical therapy exercises.