Trans-USA Hip Disarticulation/Transpelvic Prostheses Tour: Part Three = Durham, NC
The third leg of our transcontinental tour included a stop at Duke University, where Mike Schuch CPO and his staff were our hosts. Mike has been a proponent of silicone sockets for high-level lower limb amputees, and has followed up several successful fittings using this fabrication method for a number of years. In view of Steve's interest in this technique, I knew this would be an important opportunity to exchange information.
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As always, Mike was very generous with his time. He had prepared a formal slide presentation summarizing his experience and the fabrication methods he found effective. As it turned out, it was quite similar to what Steve's technicians had independently developed, although perhaps not as straightforward. Steve left with a copy of Mike's fabrication recommendations, and he left a copy of his own fabrication protocol for Mike's staff.
Click HERE to download a PDF file with Steve Taylor's fabrication technique for silicone HD sockets.
Mike reported many of the same experiences that Tony van der Waarde and others have previously noted. He felt that the silicone sockets were among the most comfortable alternatives available, and that patients did not find the significantly heavier weight of the material objectionable. Although the fabrication was difficult, Mike's experience has been that durability was pretty good with many sockets lasting several years without requiring replacement due to wear and tear.
Unfortunately, Mike was not able to schedule a visit from a local HD or TP patient who had been wearing a silicone socket for several years. Many of the Duke patients come from outlying areas and surrounding states, so it is not always a simple matter to "drop in to see a visiting colleague". We did have a chance to meet with a gentlemen being fitted after a recent traumatic transfemoral amputation, and he did quite well with an initial suction socket, fluid controlled knee, and dynamic response foot. His gait improved so markedly during the fitting appointment that it became clear that as soon as he became a bit stronger he would be an independent community ambulator and probably return to work within a matter of months, if all went well.
One intriguing aspect of this visit was Mike's comment that he was no longer seeing as many hip disarticulation amputees as he had in prior years. Rather than fitting a dozen or more new HD patients per year, in some recent years he did not see any new high level amputees, even though Duke is a regional cancer treatment center. Mike speculated that better cancer therapies, and more advanced surgical methods including the implantations of endoprostheses, were the factors that explained the increased rarity of these levels. If this is true, and medical and surgical advances are gradually eliminating the need for such high level amputations, the care of these patients may become even more of a specialty niche in future decades.
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