There was an excellent set of questions posted by a colleague on the O and P listserv. I will reprint them here and comment with my initials on each question:
1. What sleeves have you found to be the best? Obviously, the sleeves tend to be one of the weakest points of the system, and I'm wondering which sleeves have had the greatest durability in actual practice, rather than just theory. I've had patients using the OWW Alpha Flex sleeve, but they haven't lasted longer than their warranty period yet.
JB: For transfemoral, flexiblity is unimportant so resitance to wear, tear, and puncture is key. I have has good success with the Harmony sleeve or its equivalent. For transtibial, the ALPS Easy Sleeve or its equivalent has worked well.
2. Which of the electronic pumps do you prefer, and why? I got disgusted with the harmony ePulse, due to my having to send nearly every one of them back, but I've heard it's been retooled. I've only used two limblogics, and I wonder how well they do, and how reliable they are.
JB: I have heard no complaints from any pump other than the ePulse, which did not work. I have not tried it lately either. DAW has a new one which looks promising and attaches around the pylon resulting in no added build height.
3. What do you think of the Harmony mechanical pump in comparison to the electronic ones?
JB: The harmony is an excellent choice if there is suffient room for it with the desired componentry.
4. Is there some other elevated vacuum suspension mechanism you may know of that you prefer?
JB: Evolution has recently released some exciting componentry. One is a distal attachment plate with a built in resevoir for vacuum, and the other is a sealing liner that allows the prosthetist to decide on the vertical location of the seal on the liner. They also offer custom made liners fro elevated vacuum.
5. Does your answer differ between AK and BK patients, and why?
JB: Choice of suspension mechanism certainly depends on AK and BK, due to the often limited space available bewteen the AK distal socket and the knee. Almost any system can be used, but it is much less cumbersome if the pump fits between socket and knee.
6. Especially regarding BK patients, how effective have you found it for them vs other types of suspension?
JB: Harmony offers the advantage of no chargin required, very simple to use, and the built in vertical shock absorber.