Seasoned amputees—those living with amputation for a number of years—frequently ask, "What's new in the marketplace?" They are interested in the technologies that are coming down the pipe, so to speak. As a prosthetist who has ridden the wave of emerging technology, I enjoy the thrill of working with a manufacturer to develop and trial any technology that promises to improve the outcome for amputees.
Similar to the way most sports have evolved, amputees today are stronger, live longer, stay as healthy and fit as possible, and do not allow amputation to hinder their lifestyles. Sometimes their curiosity develops in response to a prosthetic device that hinders or interferes with their ability to increase activity or to perform certain tasks. The prosthesis becomes the limiting factor, not the amputation.
Despite today's economic slowdown, the leaders in our industry continue to move forward in their thinking. There continues to be discussion of integrating the knee and ankle joint for those amputated through the femur. Interestingly, coordination of the knee and ankle movements was clinically achieved some 30 years ago. Those of us who rode the crest of that technological advance will recall the difficulty of attempting to convince amputees to wear something other than what they were used to, even when faced with the reality that what they were used to would no longer be available.
The Ertl family continues its legacy with the next generation of dedicated surgeons committed to providing the best possible amputation techniques. I see this as very important and perhaps the model for the most humane, cost-effective approach to amputation. I expect that the Ertl procedure will become more widely adopted throughout the surgical community.
From the perspective of prosthetic intervention, what has shown clinically in my practice as the best option for carefree, long-term comfort and control is the total surface bearing (TSB), elevated vacuum environment. TSB (using the entire surface of the residuum to bear load) was introduced to the field by Carl Caspers twenty years ago as an effective, teachable method of managing limbs, especially transtibial amputations. Elevated vacuum (a method of securing the prosthesis to the body) was introduced eight years ago. Since then, most manufacturers of prosthetic liners and components have come to recognize the value of, and develop products with, this fitting protocol in mind.
Manufacturers know that, for an amputee, being active is a must. The physiological benefits of TSB, elevated vacuum are being studied scientifically. In my own clinical practice, I know that wound healing occurs with the proper management of limb volume. While the initial outlay for the various sockets required to address shape and volume change may be off-putting for the payors, the outcome—a healthy residuum that has good skin, length and structure—is worth it. A healthy limb translates to an active and productive amputee.