Prosthetic Fitting after Surgery
MyHandicap went to the German ORTHOPÄDIE + REHA-TECHNIK 2010 in May. The offer by the prosthetics industry was overwhelming. But how can a newly affected person find the right prosthesis in this huge offer?
After the surgery, one has other worries than looking through the wide offer of prosthesis. Needless to do so anyway, since there are experts for this job, so-called orthopaedic technicians.For example Christian Hartz, one of the two CEOs of EproTec GmbH in Berlin.
Most hospitals work together with a standard supplier that contacts the patient directly. However, a patient can also ask for an orthopaedic technician of trust.
If the amputation is an elective one, that means for which the patient can be prepared, it is also possible in some hospitals to consult the orthopaedic technician before the surgery. With such a close cooperation of medicine and technology, the optimal prosthetic fitting is facilitated.
Each prosthesis fitting usually begins with a personal consultation. There, are all applicable facilities and processes according to the current state of the technology are discussed and the activity and degree of mobility of the patient is noted.
The single parts of the prosthesis are selected at the manufacturers according to the respective degree of mobility of the insured person. If a patient wishes pieces of a higher mobility class, he/she usually has to fund this by him/herself.
"To find the appropriate prosthesis, it requires a thorough consultation. It must be clarified what is important for the insured person", explains orthopaedic technician Hartz.
According to the German Federal Social Court, every person has the right to compensation for his/her disability. However, a prosthesis must bring functional advantages and the patient must be able to use them. This requires the consideration of the physiological and intellectual conditions of the insured person.
After the surgery, the tissue at the stump usually becomes swollen. This swelling (edema) is a normal reaction to the operation. It can be reduced by large scale pressure.
With this pressure, the edema can be reduced and the stump can be formed for the fitting of the prosthesis later. With the compression of the stump, the patient can be fitted with a prosthesis as soon as possible and the prosthesis is easier to adjust. It also supports blood circulation. Thus, patients have less pain and the scar heals better.
In the compression therapy, different techniques are used: Either the stump is wrapped with elastic bandages, compression stockings, or a prefabricated silicone dressing, the silicone liner, is used.
After wound closure (between two weeks and three months) is the action and production of an interim prosthesis. The temporary prosthesis is usually worn for between three and six months. It is to ensure that the patient becomes used to the prosthesis and the stump develops its permanent shape.
“This allows the shaft to be gradually adjusted and different component combinations can be tried”, explains orthopaedic technician Christian Hartz. "The form of the prosthesis during the trial phase is optimised again and again by the orthopaedic technician. This prevents from problem with the final prosthesis", says Sascha Grebestein, technical expert of Otto Bock.
“It all depends on the shaft! It must fit; it is the most important element of the prosthesis”, knows Christian Hartz.
Whether the shaft fits well first depends on the work of the orthopaedist and secondly on the physiologic conditions of the patient. "A 22-year-old athlete with a prosthetic leg will achieve a better functionality than an overweight 65-year-old," says the orthopaedist.
The final prosthesis
“When the patient says, this is my prosthesis; this is the crucial step for the patient accepting the prosthesis. This usually means it’s time to fit the final prosthesis”, says Christian Hartz.
A distinction is made between active (functional) and passive (aesthetic) prosthesis. Exoskelettal prosthesis of the lower limbs mainly consist of the same basic components: Shaft system, dynamic pass parts (feet, knee) and static control parts (adaptation parts).
How long it takes to become used to a prosthesis cannot be answered universally, according to Sascha Grebestein: "It always depends on how quickly the patient learns to deal with the prosthesis. Additionally, of course, factors such as amputation cause, disease and healing process for duration and habituation are crucial"
"The more experience a patient has with his/her prosthesis, the better the feel for the prosthesis and possible mistakes," says Christian Hartz.
MyHandicap user Katharina S. had to wait over a year for her prosthetic arm due to difficulties with the insurance company but she became very quickly used to it. "I am very proud of my prosthesis," says the young woman.
In the sector of arm prostheses, one would wish for more movement possibilities in the wrist and fingers. This now exists, for example, with the Michelangelo hand by Otto Bock (available on the market by the end of 2010) or the i-LIMB hand by Touch Bionics. Whether such a prosthesis is eligible for Katharina and whether her health insurance would agree to finance, is still written in the stars.
Pictures: C. Hartz/EproTec