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Trans-USA Hip Disarticulation/Transpelvic Prostheses Tour: Part One = Steve Taylor's Investigations

I recently spent two solid weeks criss-crossing the United States with a colleague from England, Steve Taylor. I first met Steve in Liverpool after making an invited presentation at the United Kingdom meeting of the International Society of Prosthetics and Orthotics. [See December 2002 Corner for a brief report.] Steve has a special interest in the management of transpelvic and hip disarticulation level amputations, and has done some very interesting work comparing laminated silicone flexible sockets with the traditional molded leather socket that remains commonplace in England.

What makes Steve's investigations particularly valuable is that he has taken the initiative to obtain some objective data along with the subjective information we all gather. He uses the Stanmore Socket Comfort Scale to document patient satisfaction, and gathers heart rate and gait velocity data to calculate the Physiologic Cost Index for each of his hip disarticulation and transpelvic patients. Since many of his recent fittings have been socket replacements with the same components being used in both the new and old prostheses, this allows a more direct comparison of the effect of a change in socket design than if the patient simultaneously received new and different components.

Thus far, Steve has noted that almost all patients prefer the silicone socket over the leather one, and they demonstrate a reduction in PCI scores suggesting that their gait may be more efficient with the silicone design. With permission, an example of the data he has gathered is presented below.

These data suggest that the increase in walking efficiency is at least partly due to an increase in the pace, stride length, and velocity this patient demonstrated with the silicone socket. The heart rate also decreased slightly, although not by a very large percentage.

The HD/TP Tour

Steve came up with the idea of touring the USA to see first-hand how these high level amputees are currently being managed and asked me if I could organize such a trip. I agreed, and contacted a dozen practitioners across the country with significant current experience fitting these high level patients. Everyone was willing to host a one-day visit, and agreed to see if they could arrange for at least one patient who would be willing to meet with us and answer any questions Steve might have.

When it became time to finalize our itinerary, not everyone was available during the time when both Steve and I could travel together. And, we had to limit our visit to those cities that had direct flight connections so we could visit as many different facilities as possible.

The basic plan was to arrive in the late evening, stay at a hotel near the airport, and then drive to the host facility in the morning. Typically, Steve would make one or two PowerPoint presentations to share his work, and then we would meet with one or more local patients who were successful long-term prosthesis wearers. Often, the local practitioner would have a special procedure or method to demonstrate, and we would review the details and generally discuss prosthetic issues into the afternoon. By 3PM or so, we would head back to the airport to catch our flight to the next destination so we could repeat the process the following day.

We were able to visit seven facilities in the time available, and everyone was very generous in sharing information and discussing best practices for this specialized population. Over the course of 11 days, we visited the following sites and met with the following practitioners and their patients:

Next month: What we learned in Minnesota and we started our adventure by heading up to Minnesota to visit Mike Gozola CP and his colleagues at Prosthetic Labs of Rochester.