Addition to Lower Extremity Socket Insert Above Knee (HCPCS Code L5658)

Name of the Procedure:

Common Name: Socket Insert Addition Technical Term: Addition to Lower Extremity, Socket Insert, Above Knee (Kemblo, Pelite, Aliplast, Plastazote or Equal)

Summary

This procedure involves adding a specialized insert to a prosthetic socket for an above-knee amputee. The insert provides cushioning and improves the fit of the prosthetic limb, enhancing comfort and functionality.

Purpose

The primary aim is to address issues related to discomfort or poor fit of the prosthetic socket. It ensures the prosthesis fits snugly and comfortably, reducing friction and pressure points. The goal is to improve the user’s mobility and overall quality of life.

Indications

• Discomfort or pain from the current prosthetic socket
• Poor fit or instability of the prosthetic limb
• Skin irritation or pressure sores attributed to the prosthetic device
• Patients requiring enhanced comfort or support in their prosthetic limb

Preparation

• No specific fasting or medication adjustments required.
• A thorough evaluation of the current prosthetic fit and physical condition.
• Potential diagnostic tests or assessments to determine the precise needs for the insert.

Procedure Description

1. Assessment: Initial evaluation of the prosthetic fit and identification of pressure points.
2. Custom Insert Design: Based on the assessment, a custom insert is designed using materials such as Kemblo, Pelite, Aliplast, or Plastazote.
3. Insertion: The customized insert is fitted into the socket of the prosthetic limb.
4. Fitting and Adjustment: The socket with the new insert is tested on the patient. Adjustments are made to ensure optimal comfort and fit.
5. Finalization: Once the fit is satisfactory, the procedure is concluded, and the patient is provided with instructions on use and care.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

It is usually performed in an outpatient clinic or a prosthetics fitting center.

Personnel

• Prosthetist (specialist in prosthetic devices)
• Possibly a physical therapist for functional assessment

Risks and Complications

Common Risks:

• Minor discomfort during the initial fitting period
• Temporary skin irritation

Rare Risks:

• Persistent discomfort or improper fit may necessitate further adjustments or another fitting.
• Allergic reaction to the insert materials

Benefits

• Improved comfort and fit of the prosthetic limb
• Enhanced mobility and reduced risk of skin irritation
• Increased user satisfaction and quality of life
• Benefits are usually noticed immediately after the fitting and adjustment.

Recovery

• Minimal recovery time; normal activities can typically be resumed immediately.
• Initial follow-up appointment to ensure the correct fit and make any necessary adjustments.
• Instructions on maintenance and care of the new insert.

Alternatives

• Over-the-counter cushioning pads (less customized, may not provide the same level of comfort).
• Surgical revision of the residual limb for better prosthetic fit (more invasive, longer recovery).
• Use of different prosthetic socket designs (may require additional costs or adjustments).

Patient Experience

• During the procedure: Mild discomfort can be expected during the fitting process.
• After the procedure: Patients may feel immediate relief and improved comfort during prosthetic use. Minor adjustments and follow-up may be required to perfect the fit.
• Pain management: Minimal pain expected; over-the-counter pain relief if necessary. Proper instructions on adjusting to the new insert will be provided to ensure optimal comfort.