Name of the Procedure:

Common Name(s): Below Knee Prosthesis Addition Technical/Medical Term: Addition to Lower Extremity, Below Knee, Flexible Inner Socket, External Frame (HCPCS Code: L5645)

Summary

This procedure involves adding a flexible inner socket with an external frame to a below-knee prosthesis. The flexible inner socket provides comfort and a better fit by accommodating the residual limb's shape, while the external frame offers structural support.

Purpose

The procedure aims to improve the fit and comfort of a below-knee prosthesis for individuals with lower limb amputation. This enhancement helps to reduce irritation and pressure sores, and improves the functional ability of the prosthesis for daily use.

Indications

• Individuals with a below-knee amputation experiencing discomfort with their current prosthesis.
• Patients who require a more customized fit due to changes in the residual limb's volume or shape.
• Those experiencing skin irritation or pressure sores from their existing prosthesis.

Preparation

• Patients may need to undergo a physical evaluation to assess the residual limb's condition.
• Any current prosthetic devices should be examined for appropriateness and fit.
• No specific pre-procedure fasting or medication adjustments are typically required.

Procedure Description

1. Assessment and Measurement: The prosthetist assesses the residual limb and measures it for a customized fit.
2. Socket Fabrication: A flexible inner socket is fabricated based on the measurements and fitted over the residual limb.
3. External Frame Attachment: The flexible inner socket is secured into an external frame that supports and stabilizes the prosthesis.
4. Adjustment and Alignment: Adjustments are made to ensure the prosthesis fits properly and aligns correctly for optimal function.
5. Final Fitting: The patient tries on the prosthesis to ensure comfort, proper fit, and function.

Tools and Equipment:

• Measurement tools (tape measure, calipers)
• Fabrication materials for the inner socket (thermoplastic sheets)
• External frame materials (carbon fiber, lightweight metals)

Anesthesia or Sedation: Not applicable; the procedure is non-invasive.

Duration

The fitting and adjustment process typically takes 1-2 hours.

Setting

The procedure is performed in an outpatient prosthetics clinic or a specialized prosthetic fitting center.

Personnel

• Prosthetist
• Prosthetic technicians (as needed)

Risks and Complications

• Minor skin irritation during the initial adjustment period.
• Potential for pressure spots that may require additional adjustments.
• Possible need for subsequent follow-up visits for fine-tuning the fit.

Benefits

• Improved comfort and fit of the prosthesis.
• Reduced risk of skin irritation and pressure sores.
• Enhanced mobility and functionality of the prosthesis.
• Benefits can be felt immediately but may take a few days to fully realize as the patient adapts to the new socket.

Recovery

• Minimal recovery time since the procedure is non-invasive.
• Patients can resume normal activities immediately but should monitor for any discomfort or issues.
• Follow-up appointments may be scheduled to ensure proper fit and make necessary adjustments.

Alternatives

• Standard rigid socket prosthesis: less flexible but more common.
• Custom-molded liners: provide a custom fit but may not offer the same flexibility.
• Adjustable socket systems: allow for volume changes but can be more complex and expensive.

Pros and Cons:

• Flexible inner socket: more comfort and adaptability but might be more costly.
• Rigid socket: lower cost but may be less comfortable and adaptable.

Patient Experience

During the procedure, patients can expect little to no discomfort as it involves measurement and fitting rather than invasive techniques. Post-procedure, some initial adjustments might be necessary to ensure optimal fit. Patients may experience minor irritation during the breaking-in period, managed with the help of the prosthetist. Pain management is typically not required due to the non-invasive nature of the procedure.