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.

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.

Reader Comments: Read all user comments continued#3 As for myself, I am an average middle aged Ertl Amputee with load of wonderful antidotal information. My surgery was primary amputation not a revision. 16 months after my surgery, I cycled 3800 miles in 52 day across American to demonstrat... read more - Daniel Sheret   1/12/2004 Re: continued#3 Thanks for sharing your experiences, Mr. Sheret. I wish we had more evidence to rely upon, but documenting individual results is the first step toward sorting out all the potential benefits of this procedure. --John Michael CPO - John Michael   1/12/2004 ERTL/BRIDGE Sir, I work at a manufacturing facility that puts great effort into educating amputees of all ages so they can make wise choices. We work with a wide array of amputees both with and without the ERTL/bridge. While the Ertl may not be a b... read more - Larry Corley   1/16/2004 Re: ERTL/BRIDGE I agree with Larry. Although the "data" may not be out there, why would people choose to ignore what Ertl amputees have to say about the whole deal? I mean, good grief, who better to discuss the procedure with than those who can tell you th... read more - AJ Johnson   1/16/2004 continued #2 I also appreciate your interest and curiosity of The Facts as you put it, that “Ertl keeps reappearing every 15 years or so, and that it is largely driven by amputee enthusiasm and the support of experienced prosthesists.” I cannot speak f... read more - Daniel Sheret   1/12/2004 Ertl Procedure #1 Dear Mr. Michaels, I wanted congratulate you on a well written rebuttal to the information posted the Drs. Ertl on your web corner. I would agree with you that you do leave your reader with more questions than answers. According to your s... read more - Daniel Sheret   1/12/2004 John Michael's "Face #3" I think there is a point you have forgotten in your third "fact." You stated "many surgeons are very cautious about adopting new methods that carry even slightly increased risk for complications" as one of the reasons that surgeons aren't e... read more - AJ Johnson   1/11/2004 Re: John Michael I've heard similar speculation from time to time but have never found any evidence whatsoever to support that opinion. All the surgeons I've worked with have done what they believed was in their patient's best interest regardless of whethe... read more - John Michael   1/11/2004