Summary of responses - Gel liners vs. TEC Interface (long)

Summary of responses - Gel liners vs. TEC Interface (long)

Bill Lifford

1/13/2000

Colleagues and friends,

Here is the summary of responses I received to my post Gel
liners vs. Tec Interface. I've included the original post here,
and on the replies I have deliberately omitted any personal
information. If you want to know more about a specific reply,
I'll put you in touch with the replier.

thanks! I'm weighing my options now and will post to the list
which solutions I tried and which worked.

Bill Lifford, CP

==========================================
The Original Post:
==========================================
Hello everybody,

I was wondering if any of you have any first-hand experience with
the TEC custom interface or the
TEC Profile liner.

A client of mine is a 35 yr. old female, approx 105 lbs, with a
roughly 2 BK residuum that is quite bony around the fibular
head, the distal cut end of the tibia and tibial crest. She has
been walking with a preparatory prosthesis that includes a pelite
liner and silipos gel socks. She walks quite well but her bony
prominences are somewhat painful despite socket reliefs,
fenestrations, alignment changes, etc.

I originally had thought to use a gel liner such as the Alpha
when casting/measuring for her definitive prosthesis, but I am
curious about the TEC custom interface and its material's flow
characteristics. It would seem that (if I understand correctly)
the flow of the urethane material would do a great deal to evenly
distribute the pressures on her residuum during weightbearing,
possibly better than would an Alpha or other gel liner without
the flow characteristics of the urethane.

The problem is that her insurance is unlikely to cover this
expensive interface and she has said she'd pay out of pocket if
need be, as she is eager to walk more than she does. I know that
paying out of pocket would be burdensome, so I want to make sure
we are going in the right direction before she commits her $$ to
the cause.

have any of you worn either the custom interface or the profile
liner? Was the weight penalty worth it? Are the qualities of
flow and pressure distribution as claimed? Most importantly, if
you had to pay out of pocket for the item, would you still use
it?

Thanks in advance for your assistance with this. I have posted
this to both O&P-L and Amp-L, and will gladly post a summary of
all replies on both lists within a few days. Please respond to
me privately.

Bill Lifford, C.P.


======================================
 The Replies:
======================================
I have fitted quite a number of active trans tibial amputees with
both custom TEC liners and profile TECs. Some patients had
problem stumps with e.g. scar tissue others just wanted comfort
and protection for a high activity level. Nearly all patients
found it the most comfortable system they had worn. One
complained about the weight but he wore a TEC liner with distal
pin and locking mechanism which increased the weight. The TEC's
work well both with the distal pin or proximal sleeve although I
am not impressed with the longuevity of the ultralink sleeve.
Most of my younger active patients had no problem with paying for
one privately given the comfort they are getting. To get a good
result, it is very important that your socket design reflects
total (and I mean total) weightbearing. Stick to the
rectification instructions that come with them. Hope this helps.

----------------------------------------------------------------------

With a 2 residuum a Tec would be an excellent choice. My
patients with very short BK residual limbs are the ones that love
TEC most. Combined with a valve and suction sleeve you can
maximize proprioception and surface for weight bearing. Yes, the
material does flow nicely.Talk to TEC in advance. Carl Caspers is
a very short BK as is Fred who use to be with TEC but is now at
Tandem O&P in St Cloud. Call Carl or Fred for their
recommendations. As far a expense goes, what is comfort and
quality of life worth. You can bill it as a L5669. If you need to
make more than that educate your insurance company as to why she
will be better off and where they will save in the long run.
Regarding the weight. There is no penalty especially if she is
that short. If you have a good suction suspension it will feel
much lighter than her preparatory. One last thought. Fit the TEC
in accordance with their methods the way they recommend or you
will have problems. Make sure she maintains proper volume and
accomodates for change in volume with socks and or Spots. If
proper socket fit is maintained the TEC will last if not the TEC
will break down. Hope this helps. Good Luck.

--------------------------------------------------------------------

Your patient poses some very interesting challenges for you and
the available components of today. As I try to form a mental
image of her limb presentation in my mind, I would be very
interested to see how she might respond to a total surface
bearing style socket with the Iceross liner. The concept, as you
may know, is based on pressure casting the patient with our
IceCast Compact over the Iceross liner. The weight bearing in he
socket is uniform from the height of the posterior wall down and
has proven successful in some difficult cases. The best liner in
the world cannot properly function without a socket designed for
her specific needs.

As for the weight issue, many patients do not notice the increase
in weight due to the increased proprioception and positive
suspension qualities if gel interfaces. I have occasionally had
the new definitive prosthesis weight a few ounces more than the
old prosthesis but the feeling of reduced weight is often what's
reported. It often feels as if the prosthesis is lighter in
weight due to the suspension. The larger question is how the
patient would fit into the Iceross liner and might she need a
Distal Cup, if she appears conical in
shape. Any voids between the patients skin and the Iceross liner
itself could be a problem. Feel free to contact me at
1-800-423-9727 to discuss this further or if you would be
interested in having a liner sent for you and your patient to
evaluate.

------------------------------------------------------------------

I don't work for TEC although after you read this you may think I
do. I am replying because TEC works for me.
I am a 43 y.o. BK (TT) amputee with a 9 residuum, very bony and
a neuroma to boot. I have used the TEC liner for about 3 years.
During those three years I have gone from running 3 miles with
pain, to having run the New
York Marathon last November with no pain. (Well, at least no pain
related to the wearing the prosthesis.)
I give a lot of the credit for this improvement to my TEC liner.
I use a TEC custom liner without reinforcement. I have found that
reinforcing covers on any liner, reduce the flow of material and
I have used
most of them. My liner has additional urethane at the distal end
to cushion the distal tibia, which is very bony and the skin
covering it is thin. In addition my prosthetist fabricated a
distal cushion into the socket itself using a #2 TEC SPOT.
Another key to the success of my system has been finding a good
lubricant for the liner. I use the ALPS prosthetic ointment (A&D
in a white petro base.) I found the medicated A&D didn't provide
enough lubrication unless you put it on very heavy. It also dries
out my skin too much and can irritate my skin. The regular A&D
smelled too fishy. The key is not to use too much or too little
lub, that's something the amputee needs to learn by trying
varying amounts of lube. For suspension I use an evacuation value
and flexible airtight suspension sleeve (EZ Sleeve by ALPS.) My
foot is a Springlite Advantage DP in case you were interested in
the ground interface portion of the system. There is a lot more
to tell about this system, call me if you want more information.
------------------------------------------------------------------

I don't want to sound like I'm doing a sales pitch for the Alpha
Liner, but I did want to make sure that you were aware of the
10-day patient acceptance period we offer with the Alpha. If the
patient does not love it within the first 10 days after the
prosthesis is delivered (the fitting date recorded on the
warranty card you return to us), she can return it to you and you
can call us for a return authorization. We'll credit your
account for the price of the liners.

Just wanted to make sure you had that information in your
decision making process.

----------------------------------------------------------------------

I have experience with both custom TEC liners and the profile.
There is definitely a place for the TEC liner. I have had
difficult skin patients for whom the TEC was the only answer. My
biggest complaint with the TEC was stability. I have had more
than one patient complain that it was to squishy. I have tried
the profile only once or twice. Unfortunately, durability was a
problem. The liner came apart pretty quickly. The other issue
was the thickness, and stiffness, of the liner. Pretty tough. I
use many Alpha gel liners and have had good
sucess with them. For some people, durability is still a problem,
but the characteristics and benefits outway the downsides.

---------------------------------------------------------------------

I have experience with all types of liners and suction suspension
systems for the past ten years. I have used the TEC on
unilateral and bilateral amputees. All have changed to a
different type. I have had a great deal of success with the
AEGIS - Z Cushion Liner and Suspension System on especially
lean/bony residual-limbs. I could put you in touch with a number
of amputees who are very active with varying degrees of
bony-ness
so you could speak directly to the questions you have. There is
no assuredness that any material will absolutely work, but it is
very worthy to pursue. I'd be happy to discuss more on the
telephone if you
wish
------------------------------------------------------------------

Using the orginal technique with lube and the TEC should be
ideal. However, patients quite often are not clean enough and
it will be nasty if not fastidous in hygeine. You can try a 3mm
cushion style with
present socket as a good trial of her response and hygeine.
-----------------------------------------------------------------

My 18 yr. old, 115 lb.,daughter is a Boyd amputee; similar to a
Symes, but with a piece of calcaneous fused to the tibia to add
length. She has a heel pad, the malelli have been trimmed to
minimize the bulbous end.
She has distal weight bearing ability. Her prosthesis is
suspended by an Alpha liner with a distal pin
that locks into a device in the bottom of the socket.
Additionally she has a cosmetic restoration that is connected by
a silicon suction socket, and is fabricated totally of silicon.

She has found both are considerably more comfortable with a
urethane TEC Spot, placed in the socket, immediately below her
residual limb. It seems to unload some of the point load at the
distal bony promenance. I thought you may be able to experiment
using a TEC Spot as they are relatively inexpensive. Hope this
is of some value to you!

-----------------------------------------------------------------------

I went almost exclusively to TEC Profile liners after so many of
my patients had sensitivities to silicone types and durability of
them was so pathetic. These are much more forgiving, easier to
wear, little problem
with posterior bunching, few sensitivities, more padding over
prominences, easier to care for, easier to don; heavier, yes,
black, yes. They get my vote in most of the cases I see.

----------------------------------------------------------------------

Have you considered possibly using the Alps liner? It has a 12mm
thick distal end to address the bony issues. They come in 3mm
and 6mm thickness and also a 6 to 3 mm taper. Call to see if
they may comp. you one to try on her, 800-545-5426 ext. 317.

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