RESPONSES: Preparatory Sockets
Kelsey Holden
Description
Collection
Title:
RESPONSES: Preparatory Sockets
Creator:
Kelsey Holden
Date:
12/15/2021
Text:
Thank you to everyone who responded! I had to cut out a few in order to submit the responses.
1. I always start a brand new amputee in a preparatory prosthesis. This offers several advantages. I do my preps in the style that I think is going to be best for them: suction, pin/lock or what not. Between prep and definitive I almost always do a socket replacement. The socket replacement may or may not be the same style, it's an opportunity to evaluate the patients success and struggles of the past several months. Finally, with the definitive prosthesis, they should be at or near their optimal K-level with plenty of empirical data to support the justification of the definitive device. So the advantages are: Patient ends up with a a definitive prosthesis that best for them, with an opportunity for them to have prosthetic experience, The patient is able to take the preparatory leg and have it as a backup or water leg after delivery of definitive, Better patient care through assessment after prosthetic use with prep, to create definitive, Increased revenue over the long term at the sacrifice of short term loss. Disadvantages? none that I am aware of. I see doing a prep as simply quality care for the patient.
1. Before I retired last year, we fit K1 or K2 with definitive and then socket replace. Logic was to train them on the device they would ultimately use vs retraining on different components.
2. K3/4 we'd use prep then move to definitive and convert the prep to a useable spare, thrasher leg, or shower/pool/ beach leg. On several occasions we cloned the new definitive socket onto the prep components. Patient would pay for that but allowed use of same liners, sleeves, etc.
3. I do definitive right away and then do a socket replacement when they significantly shrinker around 6-12 months later.
4. I always used a preparatory prosthesis with thermoplastic socket for several reasons. The first is the obvious issue of volume change after time and activity wether it be edema or atrophy. The second and most important reason is to use the preparatory for a tool in determining the potential of the patient. I never had the ability or clairvoyance to guess which patient will be K-2, K-3, etc. some patients disappoint you in their functionality while others surprise you. Also important is to be able to use the prep to document the patient’s functional abilities in order to make a sound judgement for their long term needs.
5. I mainly fit definitive and do socket replacements, but with payers like uhc that make a pt be a K2 nearly no matter what, do a prep K2 and then a definitive k3, then socket replacements after they prove in prep they are k3. I don’t use adjustable sockets that often for preps, but it’s fine if you want to go that route. I prefer the Pts not develop gait characteristics in a prep that does not fit their progression to definitive and also prefer the Pts learn in a design if prep that will help them learn how to manage the transition to their definitive suspension and function that the pt will be transitioning toward so the education is building through the process and the patient learns how to better understand the adjustments they will need when changing designs. That’s just my thoughts.
6. I haven’t used the ifit. I’ve looked at it extensively and while I think it’s a viable option, it doesn’t fit with our patient care model on a normal basis. I like to evaluate, test fit, and deliver a prep within the first two weeks of being healed. While it is a quick and easy set up, I see a large geriatric population and many would reject it on looks and weight alone.
7. I have used the revo fit and do all the fabrication in house, for a new amputee it’s not bad, but most don’t fully comprehend the idea of volume management in the beginning anyway. So they end up leaving it loose, until they come for a follow up, then I tighten it, then they call the next day saying they can’t get the leg on…..so it gets loosened and they don’t actually utilize the adjustability. On mature amputees, I see much better results with an adjustable socket.
8. Yes, I fit preps except on younger folks who are going to be high k3 to k4 users. Then I'll go straight definative w/better components & socket replacement when needed.
9. I always try to do prep px for both upper and lower. The thought is after 6 to 9 months, i can upgrade them to a better system and i have documentation to proof it, MD, PT, OT, etc. Even sometimes when i want to do an MPK or Myo, there is nothing in the LCD that says you can't do it, but my current employer won't support me if i get audited. I have done it in private practice, no problem.
10. I don't do adjustable sockets for prep. I tried the one by Custom Composites and it went ok, but the other systems...LIM and Martin are too expensive to do often
11. I almost always did a prep socket first, especially for BKA. Generally I used an OWW pin system and casted over a 3 ply sock. I only did minor cast modifications (not aggressive) and always used draped copoly with the seam posterior. I used 3/16 for anyone under 200 lb and 1/4 for over 200 lb. I usually used OWW clutch locks and pulled the copoly over the OWW blue dummy. I left the seam about 1/4” for added strength where needed, which is posterior at toe load and push off. Since the OWW lock screws through the copoly into the dummy, it’s quite strong. Copoly works great and is available in colors (I usually used black). There is a code for thermoplastic prep. Usually I’d cast in the morning and often could deliver in the afternoon. I found them to consistently work very well and it was easier then to do a definitive in 1-2 months once they’ve shrunk a bit. Then a socket replacement as needed later. Hope that helps.
12. We usually do a definitive using Ortrans Stiff for the plastic test socket. We let them use the prosthesis for several weeks and then make the definitive socket once patient and us are happy with fit. A lot of problems only show up after days of wearing the test socket. I know a lot of places make a test socket, slip it on the limb (without any weight bearing) and then go to definitive socket.
13. I always try to do a Preparatory Prosthesis first. Too many changes with residual limb in the first few months. Then I can determine their actual functional level with their specific needs and it help justify for an appropriate definitive foot. Then after that I can do a socket replacement as needed
14. It really depends on the patient and what K level I think they will or can achieve. If I have an elderly or very low activity patient that II do not think will increase in activity or have significant volume change I will place them into a definitive prosthesis right away and then just do replacement sockets as needed. If I believe someone is going to achieve a high activity level where I will need to provide a true justification of activity level or change in activity level I will fit a laminated prep either L5540 or L5590 then move to a definitive when level is achieved or residual limb volume has stabilized(3-6months) then I will move them into their definitive then proceed with replacements as needed. To me this benefits the patients and our business better and the numbers seem to back Th is way of thinking. Personally I think most practitioners are too worried about the initial reimbursement but I feel we win long term. The only time I used a prefab socket it was an extremely poor fit so to save myself and the patient from too much frustration; I avoid these.
1. I always start a brand new amputee in a preparatory prosthesis. This offers several advantages. I do my preps in the style that I think is going to be best for them: suction, pin/lock or what not. Between prep and definitive I almost always do a socket replacement. The socket replacement may or may not be the same style, it's an opportunity to evaluate the patients success and struggles of the past several months. Finally, with the definitive prosthesis, they should be at or near their optimal K-level with plenty of empirical data to support the justification of the definitive device. So the advantages are: Patient ends up with a a definitive prosthesis that best for them, with an opportunity for them to have prosthetic experience, The patient is able to take the preparatory leg and have it as a backup or water leg after delivery of definitive, Better patient care through assessment after prosthetic use with prep, to create definitive, Increased revenue over the long term at the sacrifice of short term loss. Disadvantages? none that I am aware of. I see doing a prep as simply quality care for the patient.
1. Before I retired last year, we fit K1 or K2 with definitive and then socket replace. Logic was to train them on the device they would ultimately use vs retraining on different components.
2. K3/4 we'd use prep then move to definitive and convert the prep to a useable spare, thrasher leg, or shower/pool/ beach leg. On several occasions we cloned the new definitive socket onto the prep components. Patient would pay for that but allowed use of same liners, sleeves, etc.
3. I do definitive right away and then do a socket replacement when they significantly shrinker around 6-12 months later.
4. I always used a preparatory prosthesis with thermoplastic socket for several reasons. The first is the obvious issue of volume change after time and activity wether it be edema or atrophy. The second and most important reason is to use the preparatory for a tool in determining the potential of the patient. I never had the ability or clairvoyance to guess which patient will be K-2, K-3, etc. some patients disappoint you in their functionality while others surprise you. Also important is to be able to use the prep to document the patient’s functional abilities in order to make a sound judgement for their long term needs.
5. I mainly fit definitive and do socket replacements, but with payers like uhc that make a pt be a K2 nearly no matter what, do a prep K2 and then a definitive k3, then socket replacements after they prove in prep they are k3. I don’t use adjustable sockets that often for preps, but it’s fine if you want to go that route. I prefer the Pts not develop gait characteristics in a prep that does not fit their progression to definitive and also prefer the Pts learn in a design if prep that will help them learn how to manage the transition to their definitive suspension and function that the pt will be transitioning toward so the education is building through the process and the patient learns how to better understand the adjustments they will need when changing designs. That’s just my thoughts.
6. I haven’t used the ifit. I’ve looked at it extensively and while I think it’s a viable option, it doesn’t fit with our patient care model on a normal basis. I like to evaluate, test fit, and deliver a prep within the first two weeks of being healed. While it is a quick and easy set up, I see a large geriatric population and many would reject it on looks and weight alone.
7. I have used the revo fit and do all the fabrication in house, for a new amputee it’s not bad, but most don’t fully comprehend the idea of volume management in the beginning anyway. So they end up leaving it loose, until they come for a follow up, then I tighten it, then they call the next day saying they can’t get the leg on…..so it gets loosened and they don’t actually utilize the adjustability. On mature amputees, I see much better results with an adjustable socket.
8. Yes, I fit preps except on younger folks who are going to be high k3 to k4 users. Then I'll go straight definative w/better components & socket replacement when needed.
9. I always try to do prep px for both upper and lower. The thought is after 6 to 9 months, i can upgrade them to a better system and i have documentation to proof it, MD, PT, OT, etc. Even sometimes when i want to do an MPK or Myo, there is nothing in the LCD that says you can't do it, but my current employer won't support me if i get audited. I have done it in private practice, no problem.
10. I don't do adjustable sockets for prep. I tried the one by Custom Composites and it went ok, but the other systems...LIM and Martin are too expensive to do often
11. I almost always did a prep socket first, especially for BKA. Generally I used an OWW pin system and casted over a 3 ply sock. I only did minor cast modifications (not aggressive) and always used draped copoly with the seam posterior. I used 3/16 for anyone under 200 lb and 1/4 for over 200 lb. I usually used OWW clutch locks and pulled the copoly over the OWW blue dummy. I left the seam about 1/4” for added strength where needed, which is posterior at toe load and push off. Since the OWW lock screws through the copoly into the dummy, it’s quite strong. Copoly works great and is available in colors (I usually used black). There is a code for thermoplastic prep. Usually I’d cast in the morning and often could deliver in the afternoon. I found them to consistently work very well and it was easier then to do a definitive in 1-2 months once they’ve shrunk a bit. Then a socket replacement as needed later. Hope that helps.
12. We usually do a definitive using Ortrans Stiff for the plastic test socket. We let them use the prosthesis for several weeks and then make the definitive socket once patient and us are happy with fit. A lot of problems only show up after days of wearing the test socket. I know a lot of places make a test socket, slip it on the limb (without any weight bearing) and then go to definitive socket.
13. I always try to do a Preparatory Prosthesis first. Too many changes with residual limb in the first few months. Then I can determine their actual functional level with their specific needs and it help justify for an appropriate definitive foot. Then after that I can do a socket replacement as needed
14. It really depends on the patient and what K level I think they will or can achieve. If I have an elderly or very low activity patient that II do not think will increase in activity or have significant volume change I will place them into a definitive prosthesis right away and then just do replacement sockets as needed. If I believe someone is going to achieve a high activity level where I will need to provide a true justification of activity level or change in activity level I will fit a laminated prep either L5540 or L5590 then move to a definitive when level is achieved or residual limb volume has stabilized(3-6months) then I will move them into their definitive then proceed with replacements as needed. To me this benefits the patients and our business better and the numbers seem to back Th is way of thinking. Personally I think most practitioners are too worried about the initial reimbursement but I feel we win long term. The only time I used a prefab socket it was an extremely poor fit so to save myself and the patient from too much frustration; I avoid these.
Citation
Kelsey Holden, “RESPONSES: Preparatory Sockets,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 22, 2024, https://library.drfop.org/items/show/255805.
