Name of the Procedure:

Common Name: Custom Socket Insert
Technical Term: Addition to Lower Extremity, Below Knee/Above Knee, Custom Fabricated Socket Insert (HCPCS Code L5683)

Summary

This procedure involves the creation and fitting of a custom socket insert for a prosthetic limb for individuals who are not congenital or atypical traumatic amputees. The insert is made from materials such as silicone gel or elastomeric options and can be used with or without a locking mechanism.

Purpose

Medical Conditions Addressed

• Amputation (excluding congenital or atypical traumatic cases)

  Goals and Expected Outcomes

• Enhance the comfort and fit of a prosthetic limb
• Improve functional mobility and quality of life for the patient
• Reduce irritation and pressure sores on the residual limb

Indications

Specific Symptoms or Conditions

• Discomfort or poor fit of an existing prosthetic limb
• Skin irritation or pressure sores from the prosthetic use

Patient Criteria

• Above knee or below knee amputees (non-congenital or non-atypical traumatic)
• Individuals requiring a better-fitting prosthetic limb

Preparation

Pre-Procedure Instructions

• Maintain normal activities unless otherwise directed by the healthcare provider
• Ensure the residual limb is clean and free from infections or open wounds

Diagnostic Tests or Assessments

• Detailed assessment of the residual limb
• Fitting session to create a mold or scan of the limb for custom fabrication

Procedure Description

• The patient undergoes an initial fitting session, during which a healthcare professional takes precise measurements or a digital scan of the residual limb.
• Based on these measurements, a custom socket insert is fabricated using silicone gel, elastomeric, or equivalent materials.
• Upon completion, the insert is fitted into the patient's prosthetic limb, and adjustments are made for optimal comfort and fit.
• If a locking mechanism is required, it will be incorporated into the insert.

Tools and Equipment

• Digital scanner or measurement tools
• Custom fabrication materials (silicone gel, elastomeric compounds)

Anesthesia or Sedation

• None required for the fitting and fabrication process

Duration

• Initial fitting and measurement session: 30 minutes to 1 hour
• Custom fabrication: 1 to 2 weeks
• Final fitting: 30 minutes to 1 hour

Setting

• Outpatient clinic or specialized prosthetic center

Personnel

• Certified Prosthetist
• Medical Assistant (if required)

Risks and Complications

Common Risks

• Initial discomfort during the fitting period
• Temporary skin irritation or pressure points

Rare Risks

• Infections if the socket is not properly cleaned and maintained

Complications Management

• Follow-up appointments to make adjustments
• Advice on proper cleaning and maintenance of the prosthetic

Benefits

• Enhanced comfort
• Improved mobility
• Reduced risk of skin irritation and pressure sores

Realization Timeline

• Most benefits are noticeable immediately after the fitting, with continued improvement over a few weeks as adjustments settle.

Recovery

Post-Procedure Care and Instructions

• Regular cleaning of the socket insert
• Routine follow-up appointments for adjustments

Expected Recovery Time

• Immediate use after fitting
• Full adaptation within a few weeks

Restrictions and Follow-ups

• Limited to no restrictions on activities
• Regular follow-up visits for maintenance and adjustments

Alternatives

Other Treatment Options

• Standard off-the-shelf prosthetic inserts
• Gel liners or socks

Pros and Cons of Alternatives

• Standard inserts: Less expensive but may not fit as well
• Gel liners: Easier to obtain but may not provide the same level of customization and comfort

Patient Experience

During the Procedure

• Minimal discomfort during the measurement and fitting sessions
• No pain as no surgical intervention is involved

After the Procedure

• Some initial discomfort as the limb adapts to the new socket insert
• Pain management includes over-the-counter medications if necessary, and the prosthetist's guidance for adjusting the fit.