Name of the Procedure:

Additions to Lower Extremity, Below Knee, Knee Joints, Polycentric, Pair
Common Name(s): Polycentric Knee Joint Addition, Pair
Technical/Medical Term: HCPCS Code L5677

Summary

This procedure involves adding polycentric knee joints to a below-knee prosthetic device, providing improved mobility and stability for the user. "Polycentric" refers to the multiple axes of rotation in the knee joint, which mimics the natural motion of a human knee more closely than a monocentric (single-axis) design.

Purpose

Medical Conditions/Problems: This procedure is typically indicated for individuals with lower limb amputations below the knee.
Goals: The primary goal is to enhance the range of motion, stability, and comfort of the prosthetic limb, promoting a more natural gait and reducing the risk of falls.

Indications

Specific Symptoms/Conditions:

• Below-knee amputations
• Need for enhanced prosthetic knee function
• Active lifestyle requiring greater knee joint mobility
  Patient Criteria:
• Individuals who have undergone a below-knee amputation
• Patients requiring a prosthesis upgrade to improve function and flexibility

Preparation

Pre-Procedure Instructions:

• No specific fasting or medication adjustments required
• Ensure prosthetic limb and residual limb are clean and in good condition
  Diagnostic Tests/Assessments:
• Evaluation of the residual limb by a prosthetist
• Gait analysis to determine specific needs

Procedure Description

Step-by-Step Explanation:

1. The prosthetist evaluates and takes measurements of the residual limb.
2. The existing prosthetic limb is prepared for modification.
3. Polycentric knee joints are carefully assembled and attached to the prosthetic limb using specialized tools.
4. Adjustments are made to ensure a proper fit and optimal alignment.
5. The patient tests the modified prosthetic limb under the supervision of the prosthetist.
6. Final adjustments are made based on the patient's feedback and gait analysis.

Tools/Equipment:

• Polycentric knee joints
• Specialized alignment and adjustment tools

Anesthesia/Sedation: Typically, no anesthesia or sedation is needed as it is a non-invasive modification to an existing prosthetic limb.

Duration

Typical Duration: 1 to 2 hours for evaluation, fitting, and final adjustments.

Setting

Performed At: Outpatient clinic or prosthetic fitting center.

Personnel

Healthcare Professionals Involved:

• Prosthetist
• Physical therapist (optional for gait analysis and training)

Risks and Complications

Common Risks:

• Discomfort due to initial adjustment period
• Minor skin irritation at the attachment site

Rare Risks:

• Poor alignment leading to improper gait
• Mechanical failure of the knee joint

Management of Complications: Routine follow-ups and adjustments by the prosthetist can address most issues.

Benefits

Expected Benefits:

• Improved knee joint function and flexibility
• Enhanced stability and reduced fall risk
• More natural gait and comfort

Realization Timeline: Benefits can often be noticed immediately after fitting, with gradual improvement as the patient adapts to the new joints.

Recovery

Post-Procedure Care:

• Regular follow-up appointments for adjustments
• Skin care and inspection of residual limb

Expected Recovery Time:

• Immediate use post-fitting with progressive adaptation over a few weeks

Restrictions/Follow-Up:

• Activity may be limited initially; follow-up visits are essential for optimal adjustments.

Alternatives

Other Treatment Options Available:

• Monocentric knee joints (single axis)
• Manual locking knee joints

Pros and Cons:

• Monocentric joints may be simpler but less functional
• Manual locking joints offer high stability but limit range of motion compared to polycentric joints

Patient Experience

During the Procedure:

• Patients may experience some discomfort as adjustments are made.
• Active participation is needed for gait testing and feedback.

After the Procedure:

• Initial period of adaptation and possible minor discomfort

• Improved stability and mobility with proper alignment

  Pain Management and Comfort Measures:

• Adequate cushioning and adjustments to minimize discomfort
• Close monitoring and quick addressing of any issues by the prosthetist