Replies: "Knee Disarticulation"
William Velicky
Description
Collection
Title:
Replies: "Knee Disarticulation"
Creator:
William Velicky
Date:
12/20/1997
Text:
Thank you all who responded to my posting. Below is my original query
followed by the reponses.
------------------------------------------------------------------------
--
Dear All,
I'm seeing a 37 year old male with a knee disarticulation. His height
is 6'1'' and weight is 155. He's very active and sails competitively.
He is always getting his prosthesis wet. Currently he's using an Otto
Bock 3R30 titanium 4-bar with internal spring assist and a flex foot.
His residual limb is mature with very prominent condyles and is end
bearing. The socket is not ischial level and is open anteriorly to
permit entry with a leather tongue and velcro closure.
This is a perfect patient! And I haven't fitted one of those in a
while! I'd appreciate recommendations for knee componentry for this
activity level. What endoskeletal knees are people having success
with? Which knees have a high level of function and are durable?
Also, I'd appreciate comments on socket design for the prominent
femoral condyles. I'd like to use suction using a silicone type liner
without socket lock. What suction designs are being used that would
accommodate the condyles?
Thank you for your comments.
Bill Velicky
----------------------------------------------------------------
I suggest using S/C suspension with a window like a symes. You can add
something like an alpha liner or the iceross comfort liner if you like.
I have not seen any literature supporting the use of suction on a k.d.
that end bears. As for knees the Total Knee high activity is pretty
good.
Tom Current, CP
---------------------------------------------------------------
Ronny Grave's U-flate skin sleeves (PRS) could seal the whole mess up,
as
the proximal aspect of the cosmetic skin can extend up to seal the
proximal trim line. Thus the skin doubles as suspension and waterproof
cover.
The Total knee works very well with this amp level. There is a new,
heavy-duty version that's ideal for very active people. Our foot and
this knee also work very well together.
Chris (CJ) Johnson, Engineering Director
College Park Industries, Inc.
Home Office (616) 664-4173
at CPI (810) 294-7950
<Email Address Redacted>
-----------------------------------------------------------------------
Bill,
I have a similar patient, only older who I use a TEC liner with. I am
a firm
believer in TEC liners and I have fit him with a TEC and we use a 3/4
circumference insert just above the condyles to slide him in to a
laminated
socket. I can adjust the suspension by adding/subtracting to the insert
wedge. He is very comfortable and using a Flex foot and 4
bar/pnuematic Otto
Bock knee. He is very happy with the configuration.
Email me back if you have any specific questions.
Jerry Nelson
------------------------------------------------------------------------
Dear Bill & List
I hope you can find a solution for your patient.
You may want to checkout the waterproof
XeroSox vacuum-sealed cast and prosthesis cover at
<URL Redacted>
Hope this helps
Best Regards
Tom Benoit
------------------------------------------------------------------------
Bill I have a patient similiar to yours. His old prosthesis I used a
Century
22 Knee but he never liked it very much and we had hydrolic problems.
This
time I am fitting with an Endolite 4 bar pneumatic. I have received
huigh
recommendation from my fellow peers on this knee but it will be the
first time
for me to try it.
as for the Silicone liner I am also using this but my patient is able
to push
in past a built in pelit wedge built into the socket. I have heard other
people using the silicone liners with the hypobaric socks for
suspension and
rotation control.
If you would like to hear how I like the Endolite Knee I will E mail
you next
week after I fit him. I am courios about your other responses.
Good Luck
Ron
------------------------------------------------------------------------
------
Dear Bill,
For many years I've been using the range of Otto Bock knees, however,
recently decided to try out the the Centuary knee, with the hydraulic
unit.
I think it's called the Centuary 2100, unfortunately I'm at home, so
don't
have all the info on me.
It's easier to set up, with respect to placing the socket more posterior
(if needed) than one is able to with the cradles that are provided with
the knee disarticulation setups by Bock. The only drawback is your
limited
alignment once you have laminated your cradle into your socket, however,
doing dynamic alignment prior to completion should avoid having to do
any
readjustments.
In terms of the socket. I've recently made two suction KD's. Both have
worked out really well and I'll certainly consider it in any future
ones I
have. While only one patient had prominent condyles, I manufactured
distal
cups for both using Bocklite foam and left the proximal portion of the
socket free, so that it would enhance the suction.
I've been contemplating using a silicon sleeve with a lanyard kit, but
have
not looked into it.
Should you need any more info, please email me.
Regards
Peter.
------------------------------------------------------------------------
---
Hi Bill
I find myself firmly in indicision rregarding the knee. I recenly fit
a young
KD with outside joints and a lot of modification to Hosmer's Dupaco
outside
joints setup. He really likes the accurate knee center but likes the
weight
and smooth action of his earlier total knee. He has a variflex on both.
The
real improvement was in the iceross suspension. I used a velcro strap
sewn to
a Durr Fil D-ring. The strap exited the socket distally and after
pulling the
stump into the socket snugly the strap lays up onto the velcro mate on
the
exterior of the socket. I didn't need to crowd the condyles and it was
much
more comfortable than his prervious socket. I think Molly saw this at
my
office during the TEC course. Call me if you'd like.
Keith Cornell CP
------------------------------------------------------------------------
----
Hello Bill,
It sure has been a long time, hope all is well with you.
A couple of suggestions for your patient.
The USMC Black Max units have a design available which incorporates a
pyramid adaptor into the knee unit (models P24830 & P24850) reducing the
over all length requirements. Laminating a rotatable socket adaptor
directly into the distal aspect of the socket also helps reduce the
length requirements. Length is always an issue, but it may allow you to
introduce a hydraulic unit, a definite bonus for active patients. It
will tend to be a higher maintenance unit than the 3R30, the trade off
is
increased function.
As for socket design, I have fabricated sockets with a window design
similar to that of a Symes' prosthesis. Utilizing an Alpha liner to
provide tissue compression, fabricate a socket with a window cut-out
over
the prominent condyle. With a second lamination fabricate a window,
with
a positive lock design and velcro closures, to both secure the window in
place and provide suspension.
Just a couple of idea's to kick around. Best to you, keep in touch, and
write back. I'd love to hear from you after all these years.
Kelly said to say hello!!
Michael Madden
----------------------------------------------------------------
Bill,
I haven't fitted a KD recently, and I haven't tried some of the newer
setups; but I've always gotten good results with the OHC setup and
DynaPlex
unit from U.S. Manufacturing. One very active patient went through four
years of college with no loss of function in his DynaPlex.
Unfortunately, this combination is not very water-friendly,
particularly in
the case of salt water. Of course, endoskeletal covers are not
water-friendly either. Are you expecting to use no cover, or a
protective
skin? I live in a coastal area, and some of our patients have a
secondary
monolithic prosthesis for use at the beach or for boating.
For suspension I like to use a Pelite insert with integral supracondylar
wedges. The insert can be full-length, but a distal insert works well
and
keys to the socket better. Either type is easily adjustable for fit,
distal weight bearing, and suspension.
C. Martin, CPO
----------------------------------------------------------
Have you considered a silicone liner and a medial door similar to a
symes?
The liner could be left longer and reflected over the proximal brim to
create some suction effect along with the mechanical locking effect of
the
medial door.
I have used the high activity version of the Total Knee with good
sucess.
However durability depends on the use-and-abuse factor. Good luck.
Brian L. Gustin CP.
-----------------------------------------------------------
Bill,
I have had great success with the Total Knee. It folds up nice and
small
and has great function. The design is so functional and alignment is
easy. They have a new high performance version as well.
It appears you are back from Tanzania. I hope all is well with you.
Lane Ferrin
---------------------------------------------------------------
End of Responses.
followed by the reponses.
------------------------------------------------------------------------
--
Dear All,
I'm seeing a 37 year old male with a knee disarticulation. His height
is 6'1'' and weight is 155. He's very active and sails competitively.
He is always getting his prosthesis wet. Currently he's using an Otto
Bock 3R30 titanium 4-bar with internal spring assist and a flex foot.
His residual limb is mature with very prominent condyles and is end
bearing. The socket is not ischial level and is open anteriorly to
permit entry with a leather tongue and velcro closure.
This is a perfect patient! And I haven't fitted one of those in a
while! I'd appreciate recommendations for knee componentry for this
activity level. What endoskeletal knees are people having success
with? Which knees have a high level of function and are durable?
Also, I'd appreciate comments on socket design for the prominent
femoral condyles. I'd like to use suction using a silicone type liner
without socket lock. What suction designs are being used that would
accommodate the condyles?
Thank you for your comments.
Bill Velicky
----------------------------------------------------------------
I suggest using S/C suspension with a window like a symes. You can add
something like an alpha liner or the iceross comfort liner if you like.
I have not seen any literature supporting the use of suction on a k.d.
that end bears. As for knees the Total Knee high activity is pretty
good.
Tom Current, CP
---------------------------------------------------------------
Ronny Grave's U-flate skin sleeves (PRS) could seal the whole mess up,
as
the proximal aspect of the cosmetic skin can extend up to seal the
proximal trim line. Thus the skin doubles as suspension and waterproof
cover.
The Total knee works very well with this amp level. There is a new,
heavy-duty version that's ideal for very active people. Our foot and
this knee also work very well together.
Chris (CJ) Johnson, Engineering Director
College Park Industries, Inc.
Home Office (616) 664-4173
at CPI (810) 294-7950
<Email Address Redacted>
-----------------------------------------------------------------------
Bill,
I have a similar patient, only older who I use a TEC liner with. I am
a firm
believer in TEC liners and I have fit him with a TEC and we use a 3/4
circumference insert just above the condyles to slide him in to a
laminated
socket. I can adjust the suspension by adding/subtracting to the insert
wedge. He is very comfortable and using a Flex foot and 4
bar/pnuematic Otto
Bock knee. He is very happy with the configuration.
Email me back if you have any specific questions.
Jerry Nelson
------------------------------------------------------------------------
Dear Bill & List
I hope you can find a solution for your patient.
You may want to checkout the waterproof
XeroSox vacuum-sealed cast and prosthesis cover at
<URL Redacted>
Hope this helps
Best Regards
Tom Benoit
------------------------------------------------------------------------
Bill I have a patient similiar to yours. His old prosthesis I used a
Century
22 Knee but he never liked it very much and we had hydrolic problems.
This
time I am fitting with an Endolite 4 bar pneumatic. I have received
huigh
recommendation from my fellow peers on this knee but it will be the
first time
for me to try it.
as for the Silicone liner I am also using this but my patient is able
to push
in past a built in pelit wedge built into the socket. I have heard other
people using the silicone liners with the hypobaric socks for
suspension and
rotation control.
If you would like to hear how I like the Endolite Knee I will E mail
you next
week after I fit him. I am courios about your other responses.
Good Luck
Ron
------------------------------------------------------------------------
------
Dear Bill,
For many years I've been using the range of Otto Bock knees, however,
recently decided to try out the the Centuary knee, with the hydraulic
unit.
I think it's called the Centuary 2100, unfortunately I'm at home, so
don't
have all the info on me.
It's easier to set up, with respect to placing the socket more posterior
(if needed) than one is able to with the cradles that are provided with
the knee disarticulation setups by Bock. The only drawback is your
limited
alignment once you have laminated your cradle into your socket, however,
doing dynamic alignment prior to completion should avoid having to do
any
readjustments.
In terms of the socket. I've recently made two suction KD's. Both have
worked out really well and I'll certainly consider it in any future
ones I
have. While only one patient had prominent condyles, I manufactured
distal
cups for both using Bocklite foam and left the proximal portion of the
socket free, so that it would enhance the suction.
I've been contemplating using a silicon sleeve with a lanyard kit, but
have
not looked into it.
Should you need any more info, please email me.
Regards
Peter.
------------------------------------------------------------------------
---
Hi Bill
I find myself firmly in indicision rregarding the knee. I recenly fit
a young
KD with outside joints and a lot of modification to Hosmer's Dupaco
outside
joints setup. He really likes the accurate knee center but likes the
weight
and smooth action of his earlier total knee. He has a variflex on both.
The
real improvement was in the iceross suspension. I used a velcro strap
sewn to
a Durr Fil D-ring. The strap exited the socket distally and after
pulling the
stump into the socket snugly the strap lays up onto the velcro mate on
the
exterior of the socket. I didn't need to crowd the condyles and it was
much
more comfortable than his prervious socket. I think Molly saw this at
my
office during the TEC course. Call me if you'd like.
Keith Cornell CP
------------------------------------------------------------------------
----
Hello Bill,
It sure has been a long time, hope all is well with you.
A couple of suggestions for your patient.
The USMC Black Max units have a design available which incorporates a
pyramid adaptor into the knee unit (models P24830 & P24850) reducing the
over all length requirements. Laminating a rotatable socket adaptor
directly into the distal aspect of the socket also helps reduce the
length requirements. Length is always an issue, but it may allow you to
introduce a hydraulic unit, a definite bonus for active patients. It
will tend to be a higher maintenance unit than the 3R30, the trade off
is
increased function.
As for socket design, I have fabricated sockets with a window design
similar to that of a Symes' prosthesis. Utilizing an Alpha liner to
provide tissue compression, fabricate a socket with a window cut-out
over
the prominent condyle. With a second lamination fabricate a window,
with
a positive lock design and velcro closures, to both secure the window in
place and provide suspension.
Just a couple of idea's to kick around. Best to you, keep in touch, and
write back. I'd love to hear from you after all these years.
Kelly said to say hello!!
Michael Madden
----------------------------------------------------------------
Bill,
I haven't fitted a KD recently, and I haven't tried some of the newer
setups; but I've always gotten good results with the OHC setup and
DynaPlex
unit from U.S. Manufacturing. One very active patient went through four
years of college with no loss of function in his DynaPlex.
Unfortunately, this combination is not very water-friendly,
particularly in
the case of salt water. Of course, endoskeletal covers are not
water-friendly either. Are you expecting to use no cover, or a
protective
skin? I live in a coastal area, and some of our patients have a
secondary
monolithic prosthesis for use at the beach or for boating.
For suspension I like to use a Pelite insert with integral supracondylar
wedges. The insert can be full-length, but a distal insert works well
and
keys to the socket better. Either type is easily adjustable for fit,
distal weight bearing, and suspension.
C. Martin, CPO
----------------------------------------------------------
Have you considered a silicone liner and a medial door similar to a
symes?
The liner could be left longer and reflected over the proximal brim to
create some suction effect along with the mechanical locking effect of
the
medial door.
I have used the high activity version of the Total Knee with good
sucess.
However durability depends on the use-and-abuse factor. Good luck.
Brian L. Gustin CP.
-----------------------------------------------------------
Bill,
I have had great success with the Total Knee. It folds up nice and
small
and has great function. The design is so functional and alignment is
easy. They have a new high performance version as well.
It appears you are back from Tanzania. I hope all is well with you.
Lane Ferrin
---------------------------------------------------------------
End of Responses.
Citation
William Velicky, “Replies: "Knee Disarticulation",” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/210157.
