Name of the Procedure:

Addition, Endoskeletal Knee-Shin System, Polycentric, Hydraulic Swing Phase Control, Mechanical Stance Phase Lock (HCPCS Code: L5814)

Summary

This procedure involves fitting a leg prosthesis with a specialized knee-shin system that includes a polycentric hinge for natural knee movement, hydraulic control for smoother swings of the limb, and a mechanical lock for stability while standing.

Purpose

The procedure primarily helps individuals who have lost a leg above the knee. It aims to restore mobility, improve walking efficiency, and enhance the quality of life by providing a more natural gait and better stability.

Indications

• Above-the-knee amputation.
• Difficulty walking or instability with a current prosthesis.
• Desire to improve mobility and knee function.
• Need for enhanced stability during standing and walking.

Preparation

• A thorough medical evaluation by a prosthetist and possibly a physical therapist.
• Diagnostic tests to assess stump condition and overall health.
• Measurements taken of the residual limb.
• No specific fasting or medication adjustments are generally required, but individual plans may vary.

Procedure Description

1. Initial Assessment: Evaluation of the patient's needs, stump condition, and overall health.
2. Measurement and Casting: Accurate measurements and possibly a cast taken of the residual limb.
3. Fitting Session: The endoskeletal knee-shin system is customized and fitted to the patient.
4. Adjustment: Initial adjustments are made to ensure proper fit and comfort.
5. Training: The patient receives training on using the new prosthesis effectively.

Tools and Equipment:

• Measurement tools.
• Casting materials.
• Prosthetic components (polycentric knee, hydraulic swing mechanism, mechanical stance lock).

Duration

The fitting and initial adjustment session typically takes 1-2 hours. Training sessions may be spread over several days or weeks.

Setting

The procedure is generally performed in a specialized prosthetics clinic or outpatient facility.

Personnel

• Certified Prosthetist
• Physical Therapist
• Medical support staff for assistance.

Risks and Complications

• Skin irritation or sores at the stump interface.
• Mechanical failure or malfunction of prosthetic components.
• Initial discomfort as the patient adjusts to the new system.

Benefits

• Improved mobility and walking stability.
• More natural gait and smoother movement.
• Enhanced quality of life and independence.
• Benefits may be realized within a few weeks of use with proper adjustment and training.

Recovery

• Regular follow-up visits for adjustments.
• Continuous physical therapy to improve mobility.
• Most patients can expect to return to daily activities within a few weeks, though full adaptation might take longer for some.

Alternatives

• Other types of prosthetic knee systems, such as single-axis or microprocessor-controlled knees.
• Wheelchair use for mobility.
• Each alternative has its pros and cons, such as cost, ease of use, and the level of mobility provided.

Patient Experience

Patients might feel an initial awkwardness or discomfort as they adjust to the new prosthesis but will experience increased stability and smoother gait over time. Pain management typically includes over-the-counter pain relief and proper stump care. Regular adjustments and physical therapy contribute to comfort and successful adaptation.