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Lower Extremity Prosthetics is the most common prosthetic device that we create. Whether it's a simple below knee prosthesis for everyday ambulation or a high activity prosthesis, or even a shower/beach prosthesis. They have been around as long as there has been materials available and a little imagination. There is a story of an Troy officer that escaped a Greek prison by amputating his own foot to escape the shackles that held him. He created a below knee prosthesis for himself and went on to become a General.

The first prosthesis that many people receive is called an Initial or Temporary Prosthesis. This is generally the first prosthesis that a patient receives. It is sometimes placed on the patient while they are still under anesthesia post amputation. The prosthesis is composed of a cast applied directly to the patient. A pylon or pipe that's adjustable in different angles and planes. There is a foot attached to the bottom of the pylon. This foot is called a post-op foot and has a heel height built into it. Having the heel height built into the foot means that the patient will not be able to wear a shoe on this prosthesis until a later time. When the patient finally is ready for a shoe, the Prosthetist will add SACH foot to the Initial prosthesis. The SACH foot can be fit into a regular heel height shoe. The beauty of this device is that the cast or socket can be changed easily. This prosthesis is not designed to take too much punishment- it could break if they are too active. If the patient has too much edema on the front end, the Prosthetist might utilize a stump-shrinker for a couple weeks to reduce that swelling. This is a rudimentary device that's only designed to produce 4 effects.

Bilateral BKA amputee with permanent components- Unfinished prosthesis. Patient walks without any assistive walking aides even outside on un-even ground. This is a 3S design (suction suspension) utilizing energy storing leaf-spring feet.

The next prosthesis that the patient will receive is a Preparatory Prosthesis. This is given to the patient when they have pretty much stabilized in volume/edema. It is composed of more permanent components that will aide in the patient's gait training and enable them to start more stringent activities that the Initial Prosthesis cannot take. The socket can be changed easily to fine-tune the fit for the optimal comfort and to get the most bang for the buck for the patient. These can be worn for several months while adjustments are made. Once everything has settled down so to speak, the patient will be ready for the next step.

The patient is usually fit with a Permanent Prosthesis after the Preparatory Prosthesis. This usually occurs 4-5 months after the amputation-depending on the healing factor.

The above finished prosthesis weighs approximately 2¾ Lbs. with the cosmetic skin. This is a PTS-suspension designed prosthesis.

The above finished prosthesis is a 3S design utilizing suction suspension and has an energy storing leaf-spring design foot for high activities and light weight. This prosthesis weighs 2¼ lbs. before finishing. **NOTE the Custom finishes on the sockets**

There are several suspensions used in below knee prosthesis. Among them are the 3S design. 3S stands for -silicone suction suspension-thus the 3S. We do not use silicone, we use another material that is composed of elastomer and mineral oil. Much less skin irritations. This is composed of a liner with a locking pin in the end that is rolled onto the residual limb. The liner's locking pin slides into a locking mechanism that ratchets the pin inward and holds it securely. The main drawback to this suspension system is the problem of dermatitis that can form when the skin is in contact with the gel material for as many hours a day as the prosthesis is worn.

Another strapless form of suspension is the PTS design. It is held on by a built in depression that fits above the knee and does not interfere with knee function. It tends to be less secure than the 3S system (pictured).

Once a prosthesis fits the residual limb well, we can fabricate a shower/beach prosthesis. You will not want to swim in this due to the weight and awkwardness of the prosthesis-you'll probably drown. Most insurance companies will not cover this type of prosthesis with the exception of workers compensation. The main difference between a shower/beach prosthesis and a regular prosthesis is the fact that a regular prosthesis will absorb direct water like a sponge. Imagine how that will smell in about 2 weeks. A shower/beach prosthesis is a bare bones design that is only intended to perform 1 function- allow the amputee to submerge the prosthesis in total water for extended periods.

BK Prosthesis Including finishing with 3 S suspension= 2 1/4 lbs (about 1 kilogram) unfinished- cosmetic finish usually adds about 1 lb or 28 grams.

Flex-Foot style foot totally cosmetically finished usual and customary charge- $13, 987.86

College Park foot style totally cosmetically finished usual and customary charge- $14,756.68

Harmony style vacuum suspension w/ 2 liners and Flex-foot style foot- $18,879.88

We see many bilateral amputees and have a very high success rate. Medicare allows us as preferred providers to fit bilateral amputees with prosthesis in order that they may gain much more independence than the wheelchair can ever provide. *Note* that everyone is different in their abilities, however we do have many bilateral amputees that are able to walk without any walking aide inside their homes and some even outside on un-level ground. There are many that can operate normal activities of daily living. It is our opinion as well as Medicare's that it is much cheaper to provide a patient with bilateral prosthesis and allow them to keep up their physical activities than to allow their health to deteriorate and medical expenses rise. Therefore it is considered a medical necessity for a bilateral amputee to receive prosthetic care. Most Physicians do not understand that concept and need to be educated on those facts. The few that do realize the benefits of prosthetic care are staunch advocates of that position. If by chance your physician does not approve of this, our strong advice is for you to seek out another physician that has you best interest at heart.

Shown is a bilateral amputee walking without any walking aides utilizing a leaf spring design-energy storing feet and 3S suspension. The average weight of each prosthesis is less than 3lbs.

We can fabricate a flexible inner wall Prosthesis that discards the window that does not require the use of any straps or buckles to hold on the Prosthesis. This also prevents rotation of the Prosthesis on the limb. This is another innovative design that we have found useful for patients. We can also a add top of the line high activity foot to this prosthesis which increases the independence of the patient. The weight of this prosthesis including the foot is less than 3 1/2 lbs and is composed of high strength carbon fiber reinforcement which just about guarantees no breakage during normal high activity daily functions. The prosthetic foot has a 2 year warranty from the manufacturer.

Knee disarticulation patient have a hard time matching the length of the lower section-shank of the prosthesis with the actual length of the opposite side. This is because the amputation is thru the knee joint itself. When a knee joint is added, the Knee axis is usually at least 1" to 1½" further than the opposite limb. This sometimes prevents the foot on the prosthesis from touching the ground while sitting. The older knee joints used on endoskeletal prosthesis had the axis further out than today's newer knee joints. Many knee disarticulation patients cannot

tolerate bearing weight on the end of their residual limb. Therefore sometimes we need to bring the weight bearing area to the ischeal tuberosity level. This enables weight bearing on the area of the pelvis where people normally sit. This helps to relieve the weight from the distal end of the femur and make the socket feel much more comfortable. If you notice the pictures above, this patient has conventional suction suspension with a valve. This is not a very easy task to accomplish due to the problem of removing the prosthesis over the boney condyles. Notice the picture to the right. Look at the trim lines on the upper section. You can't see them. This is because we paid attention to the details of the trim lines to prevent gapping and we're utilizing in special cases the new MAS socket design system (Mario Anatomical Socket) that allows more motion as well as actually having your natural shape around the buttocks. Females generally prefer this type of trim line.

AKA patient in a preparatory prosthesis with permanent components-Unfinished, showing the weight-bearing area of the socket. By placing weight on the ischeal tuberosity, the patient will not bear weight on the end of the residual limb, this makes the prosthesis comfortable and feel secure allowing much more control over the prosthesis. The design of the above prosthesis is suction suspension with a heavy-duty, strong titanium knee frame, a hydraulic swing and stance phase knee unit, and an energy storing, leaf-spring design prosthetic foot for the high activities that the patient performs but also the light

weight of the shin / foot unit, less than 1 lb.

As with the BK Prosthesis, the AK Prosthesis also has Initial Prosthesis and Preparatory Prosthesis in use. Generally under the same timetables.

Above knee prosthetic designs have changed as much as the prosthetic feet that have been developed over the last decade. There are literally dozens of different knees on the market that claim to be the best. A word to the wise- manufactures tend to try to sell you their items to increase the bottom line. A well-trained ABC Prosthetist is the best judge.

Perhaps the most revolutionary knee on the market today is the Otto Bock C-Leg. It is a computer operated hydraulic knee-foot that actually enables the amputee to walk without thinking about how to walk. They can ascend and descend stairs foot over foot among it's many unique capabilities. I have personally witnessed a young man roller blading with his C-Leg. There are only 1800 people in the world who are certified to fit these prosthesis and we are certified by the manufacturer. These are extremely expensive and many regular insurance companies are denying coverage as being experimental. With all of the wounded military personnel receiving the C-Leg, many insurance companies will soon be forced to authorize this knee shin system. Medicare covers part of the cost, Workers Compensation will usually cover the entire cost of this prosthesis. It is hands down the best above knee prosthesis that is on the market today.

The Otto Bock C-Leg™ represents the worlds first and fully microprocessor -controlled knee with hydraulic swing and stance phase control. This innovative knee joint features on-board sensor technology that reads and adapts to the individual's every move. By using special software and a Personal Computer attached to the prosthetic knee, the ABC Certified Practitioner can make fine tune adjustments to tailor the C-Leg™ to the amputee. Angles and movements are measured 50 times per second on the sensors ensuring the dynamic gait is as similar to natural walking as possible. Amputees can operate on flat terrains at variable speeds with confidence. Thanks to the hydraulic stance control feature, it's easier to tackle slopes, stairs, and other uneven surfaces. The C-Leg™ allows the amputee to sit down utilizing the C-Leg's hydraulic knee mechanism. The amputee relies entirely on the C-Leg while sitting down. The C-Leg is designed for use on a variety of foot, pylon, and other options. The Lithium-Ion battery loaded inside the knee provides enough energy ( on a 2.5 hour charge) to operate the knee for 25-35 hours. A :15 minute quick-charge operates the knee for 2.5 hours. There is a car cigarette lighter adapter that attaches to the battery charger. The battery gives warnings ( 2 hours, 1 hour, and right before it is drained) whenever the charge is getting low. If the battery loses charge completely, the knee goes into a safe mode, that is it will become extremely stable. The knee is still able to be used, just not as before. This knee is not for operation around water, strong magnetic fields, nor high powered electrical fields. These will either damage the entire knee or cause it to operate inappropriately. The manufacturer gives a full 3 year warranty. A 5-year extended warranty is available from the manufacturer at the time of purchase. Trying to get a C-Leg? Simply email: mbscpo@yahoo.com and tell us that you are interested in receiving a C-Leg. We have received authorization from several independent insurers for this prosthesis. Can we justify one for you? You have to write us so that we can put our heads together and find out if you are qualified to receive the C-Leg.

Other Microprocessor Knees

With many prosthetic knee joints, people have to think (and sometimes worry) about each step they take. Times have changed. Thanks to the Compact, they can move more freely in everyday situations — speeding up or slowing down, responding to uneven terrain, tackling slopes or descending stairs. The security comes from the microprocessor adjusting the knee in real time — not a step early, not a step late.

The Otto Bock Compact™ microprocessor-controlled knee is designed to deliver the best in stability and reliability. It has easy-to-charge lithium ion batteries with 40-45 hours of power, and is appropriate for people who:

There are Microprocessor Knees on the market such as the Rheo™ by Ossur. This has just came on the market this year. We have examined this knee and compared it to the C-Leg™. In our professional opinion, it's much heavier than the C-Leg™ yet it functions similarly. The redeeming quality of the Rheo™ knee is that you have more options of feet choices.

There are several other types of great knees on the market that insurance companies such as Medicare WILL cover. The main determining factor for these knees depends on functional levels and goals. Naturally if a person is only able to utilize a prosthesis for transferring from a wheel chair to bed, the functional level is considered to be a K1. If however the amputee performs sports, the person is considered a K4-the highest functional level given. A K1 amputee needs only a prosthesis that will allow basic functions-no bells and whistles. A K3-K4 amputee needs a prosthesis that will not restrict their abilities nor lifestyles.

These are perhaps the most difficult Prosthesis to wear as well as master walking. The most important part of wearing a very high amputation lower extremity prosthesis is to have a well made prosthesis. These take a lot of Physical Therapy and many hours of break-in time until the amputee gets used to the feel of this type of prosthetic containment. For stability purposes, we cannot stress the need enough to get some extremely good components such as knees and feet. The success of wearing this prosthesis depends on the fit, and components, and the amount of Physical therapy the patient receives. Fortunately we have some very experienced Prosthetist associated with our company that can deliver the best prosthesis available. The patient below was denied by the VA. They told him that he was not a candidate. Luckily he had Medicare part B and a secondary insurance plan. This covered his entire cost of the prosthesis. He stated that his number one goal was to walk into the VA and ask them exactly how he was not a candidate for a Prosthesis. That was the motivation he needed. He has a high activity knee and foot. These are very stable and he has mastered walking without anything. His Physical Therapist makes him utilize a quad cane just for security purposes. The cost for this non-computerized knee/foot Prosthesis with a flexible inner socket and rigid frame with high tech knee and foot runs $24,873.42. If you add a C-Leg knee/foot the total cost runs $48,694.37

For patients that have to pay out-of-pocket, we have the ability to offer financing plans. This can ease the burden from immediate payments. This also helps to relieve sticker shock from the costs of health care. The application qualification process is FREE- NO CHARGE.

We have partnered with Care Credit Financing to offer financing for the total cost of Rehab including the Prosthesis. They offer special terms and various lengths of financing. The application process is relatively easy and we can find out within a few hours if you qualify. For exemplary credit, they can offer over $36,000.00 credit line payable up to 48 months with payments as low as $25.00 per month on minimal of $1,000.00 credit.

Care Credit Financing is one of a few companies that have gotten into the financing end of health care. They will pay our total bill and break it down into monthly payments with interest. Because we help subsidize this service by discounting our service to Care Credit Financing, we are unable to offer a 15% discount off our usual and customary prices. Another words, they have received a discount in order to offer you the financial structuring.

To receive an application to see if you qualify, send us an e-mail with “Credit application” in the subject box. You can mail or fax it to our office for quick verification.

C-Leg costs with Rehab

This is a very close estimate for treatment and rehab for your patient. The total cost may be + or – 5%-usually it’s almost an exact quote. The reason that there may be a change is the fact that the patient may have less or more needs both Prosthetic and Therapy wise. We assure you that we will control the costs as closely as possible while guaranteeing a first class job.

This does not include transportation, food or housing.

We provide a 15% pre-payment discount off of our U&C charges this will save your company real money.

C-Leg Charges including Therapy

The price quoted is for a standard suction suspension not a 3S locking suspension. Those charges will be at an additional rate increasing the cost by over $2300.00 with additional yearly cost of 4 suction liners per year-every year. The length of the femur at the amputation level can also disqualify a 3S system. This also does not include a cosmetic finish on the prosthesis which will add an additional $2096.31 before the discount. We will quote a U&C charge and give a 15% pre-payment discount at the bottom.

Code	Description		Cost
L5320	AK endoskeletal prosthesis		$4258.28
L5624	AK test socket- 2 required@ $536.48 each		$1072.96
L5631	AK acrylic socket		$648.35
L5649	AK ischeal containment, narrow ML socket		$858.58
L5650	AK total contact		$633.59
L5651	AK flexible inner socket, rigid exterior frame		$1772.10
L5652	AK suction suspension		$565.68
L5828	Hydraulic swing and stance SNS knee feature		$3125.29
L5845	Stance Flexion Feature		$2005.79
L5846	Microprocessor-controlled swing phase feature		$6066.11
L5847	Microprocessor control stance feature		$17331.83
L5920	AK alignable system		$782.94
L5930	High activity control frame for knee		$2304.85
L5950	AK ultra light material-carbon fiber reinforcement		$1148.05
L7368	Lithium Ion battery charger		$564.79
L5999	Car battery charger		$197.98
Total cost before 15% prepayment discount U&C charges		$43337.17
Total cost AFTER 15% pre-payment discount		$36836.59

In-house Physical Therapy Services Provided

Procedure	CPT Code	Price		Quantity	Total
Evaluation	97001	$ 160.00		1	$ 160.00
Therapeutic Exercise	97110	$ 65.00		12	$ 780.00
Gait Training	97116	$ 50.00		25	$ 1250.00
Total			$2190.00
Prepayment 15% Discount			$1861.50

This includes the total Therapy needed for the first visit. The next visits can be less time consumed in therapeutic exercises and are not included in the above price structure.

Goals for Therapy

• Learn proper gait training techniques to eliminate “limps”

• Learn about donning and doffing

• Learn “the proper way to fall” and NOT get hurt

• Learn how to balance on the prosthesis and bear weight properly

• Learn weight shifting techniques

• Learn how to stand up from the floor

• Learn activities of daily living

• Learn how to utilize the prosthesis in a vocational setting

• Learn how to master stairs, ramps, un-even terrain

Once the patient has mastered all of the above items, they will lead a more normal lifestyle. This will save both taxpayer dollars and rehabilitation expenses.

Total cost for the C-Leg, Therapy and Prosthetic care including 15% pre-payment discount: $ 38,698.09

To receive the pre-payment discount, the entire payment must be made before the patient arrives for the rehab care. This discount is provided to enable us to purchase the components which are quite expensive. If you would like to discuss this further, please feel free to contact our office.

**Note** If CareCredit is used as your form of payment, there is no prepayment discount. We give CareCredit the discount. They will bill you the total Usual and Customary charges plus interest.

Spears Prosthetics and Orthotics
722 N. White Station Rd.
Memphis, TN. 38122
(901) 763-6999
866 763-6999 toll free

M. Britt Spears CPO: American Board for Certification Certified Prosthetist Orthotist-Licensed in Florida practicing in Arkansas, North Mississippi, and Tennessee with over 28 years experience. C-Leg and Myo-electric arm certified, accustomed to utilizing high tech NASA engineered technologies.

Other Microprocessor Knees

Prosthetics

Below Knee Prosthetics

Above Knee Prosthetics

Upper Extremity Prosthetics

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