Bilat AK- exo 2 endo

Bilat AK- exo 2 endo

Joan Cestaro, CP

1/24/2001

Dear fellow peers,

I have a very interesting and quite challenging case for which I seek advice from those more experienced than me. I have a 49 year old congenital female (long time patient, wonderful lady who runs a child's daycare center). She is bilat. AK and also unilat. BE. She is currently wearing EXO prostheses that are very heavy and have S/A knees only aligned with the centers about 2 posterior to TKA (i.e. recurvatum) for safety or stability. Ugh! I cannot explain exactly how she is able to maintain suspension with her AK's, but she uses one cast sock and only has the distal 1/2 of her residuals into the sockets. No belt, no valve, no nothin'! Her quad sockets do not fit in the conventional manner whatsoever and she seems to have defied all the prosthetic principals I ever learned about suspension. It appears that her 9 year old sockets were orignally fit in the conventional manner with book correct trimlines. Since she fits into them now only 1/2 way, this leaves a 2 - 3 gap distally. I first acquired her as my own patient a few years ago while helping alleviate her verrucose hyperplasia with custom end pads.

She now wants new prostheses and desires ENDO design. We have had many discussions concerning the advantages and disadv. of both styles. My plan is allow her limited home use with check sockets for a week or so as a trial run before she needs to confirm the endo/exo decision. I am just going to hold my breath on achieving suction in these new sockets- I alginated her existing ones as well as took casting impressions and will do my best there.

I seek advice on the knees. I can assume with the S/A only, posterior TKA alignment, and heavy exo legs, she will have extreme terminal impact with a lighterwt. design. So, my thoughts are for a hydraulic system where I can max out the extension resistance if necessary. She is used to a maintenance free knee (and this was discussed as a disadvantage to the endo knees) and prefers the smaller hydraulic units over the standard Mauch or SNS styles- cosmetics only there. Options are open to anything, though. I am concerned with safety issues, so the hydraulics again seem appropriate. She is very used to EASY breaking/bending knees and I fear that a polycentric design, such as Bock's EBS, will not break as easy and she won't accept this. She is also, I'm sure, quite used to a certain gait pattern and will have difficulty with any change (also discussed). My advice to her was to remain with the exo design. I view this case like the old polio KAFO wearers. DON'T CHANGE ANYTHING!!!!! But, she wants to try it and it is HER decision to make. So, I seek any and all help.

This one will be probably the biggest challenge of my career. I face it with excitement, but great anxiety as well. I Would be appreciative of any comments and advice.

Thanks in advance,

Joan Cestaro, C.P.<br clear=all><hr>Get your FREE download of MSN Explorer at <a href= <URL Redacted>> <URL Redacted></a><br></p>

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