Name of the Procedure:

Addition to Lower Extremity, Above Knee, Flexible Inner Socket, External Frame (HCPCS Code: L5651)

Summary

This procedure involves adding a flexible inner socket and an external frame to a prosthesis for the lower extremity, specifically above the knee. The flexible inner socket provides comfort and better fit for the user, while the external frame offers structural support and stability.

Purpose

This procedure is used to enhance the comfort and functionality of a lower extremity prosthesis. It is designed to help individuals who have had an above-knee amputation gain better mobility and comfort with their prosthesis. The flexible inner socket reduces pressure points and improves overall fit, while the external frame provides necessary support and stability for optimal prosthetic use.

Indications

• Above-knee amputees experiencing discomfort or fit issues with their current prosthesis.
• Patients requiring enhanced mobility and stability from their prosthetic limb.
• Individuals experiencing skin irritation or pressure sores due to a poorly fitting prosthesis.

Preparation

• Pre-procedure assessment by a prosthetist to determine the exact fit and design requirements.
• No specific fasting or medication adjustments are generally necessary.
• Measurement of the residual limb may be taken to ensure a customized fit.

Procedure Description

1. Assessment: A detailed assessment of the residual limb and current prosthesis is performed.
2. Design and Fabrication: A customized flexible inner socket and external frame are designed and fabricated based on the patient’s measurements.
3. Fitting: The flexible inner socket is inserted into the existing prosthesis, ensuring that it conforms precisely to the patient’s residual limb.
4. Adjustment: The external frame is carefully adjusted to provide the necessary structural support.
5. Testing: The patient tests the modified prosthesis for fit, comfort, and functionality.
6. Final Adjustments: Any necessary final adjustments are made to ensure optimum performance.

Duration

The entire process, including assessment, design, fabrication, fitting, and adjustments, can take several appointments over a few weeks.

Setting

This procedure is typically performed in a prosthetic clinic or an outpatient facility specializing in prosthetic care.

Personnel

• Prosthetist
• Prosthetic Technician
• Possibly a Physical Therapist

Risks and Complications

• Minor skin irritation due to material sensitivity.
• Temporary discomfort as the patient adapts to the new fit.
• Rarely, improper fit may require additional adjustments.

Benefits

• Improved comfort and fit of the prosthesis.
• Reduced pressure sores and skin irritation.
• Enhanced stability and mobility, making daily activities easier and less painful.

Recovery

• Minimal recovery time; patients can typically use the modified prosthesis immediately after fitting.
• Follow-up appointments may be necessary to make further adjustments.
• Patients should monitor for any signs of skin irritation and report these to their prosthetist.

Alternatives

• Custom made rigid prostheses without a flexible inner socket.
• Alternative socket designs, such as vacuum-assisted or elevated vacuum sockets.
• No socket modification, which may result in continued discomfort and mobility limitations.

Patient Experience

During the fitting process, the patient might feel some minor discomfort as adjustments are made. After the fitting, patients generally experience a significant improvement in comfort and mobility. Pain management is usually not required, but the patient should communicate any ongoing discomfort to their prosthetist for further adjustments.