Trans-USA Hip Disarticulation/Transpelvic Prostheses Tour: Part Four = Ventura, CA

The fourth leg of our transcontinental tour included a stop at David Littig's facility in Ventura, California. In addition to running a successful solo practice, Dave has developed a number of commercially successful products for lower limb amputees. As the developer of the Littig Strut, which provides a hip flexion assist for the high level amputee, he undoubtedly has more experience with this technology than almost anyone else in the world. Steve and I were very interested in learning from David's work, and he was very open and candid in his comments.


David Littig CP designed this carbon fiber strut to provide the HD and TP amputee with a dynamic hip flexion assist.
David Littig CP designed this carbon fiber strut to provide the HD and TP amputee with a dynamic hip flexion assist.

Dave has long had a special interest in this population, and was involved in the development of a "half-socket" approach to fitting high-level amputees. The details of this technique were published in Clinical Prosthetics and Orthotics in 1983. [The UCLA anatomical hip disarticulation prosthesis. Littig D Lundt JE Clinical Prosthetics & Orthotics 1988: 12, 114-118] This was another incentive to meet with Dave: to see first hand how his socket variation fit and functioned.


The laminated portion of this socket terminates near the midline of the body. A custom-molded thermoplastic half-socket encompassing the contralateral pelvis will be attached to the laminate by two sets of crossed straps.
The laminated portion of this socket terminates near the midline of the body. A custom-molded thermoplastic half-socket encompassing the contralateral pelvis will be attached to the laminate by two sets of crossed straps.

Dave arranged for two patients to drop in and share their experiences with us. The first was a very petite young lady who was mid-way through the process of receiving her first prosthesis with a half-socket and Strut. She had previously worn a more encompassing socket with a free-motion hip joint. This fitting was complicated by a pronounced fixed scoliosis associated with her high-level congenital absence.

This very petite young lady has a marked scoliosis associated with the high-level congenital absence of her left leg.
This very petite young lady has a marked scoliosis associated with the high-level congenital absence of her left leg.

One of the advantages of the two-part socket design is that the contralateral portion tends to "float" with the hip anatomy, potentially increasing both comfort and control. The key to success is placing the straps optimally and determining the proper tension. This is largely a matter of iterative trials based on clinical experience, so this is a challenging method for the prosthetist to master. In the case of this young lady, it may have offered added benefits because her scoliotic curves would make fitting with a one-piece socket very difficult.

Dave advised that he prefers to have patients who are accustomed to walking with other hip joints use the new prosthesis without a cover for as many weeks or months as it takes for them to adapt to the added mobility the Strut can offer. The more effectively the amputee learns to load the prosthesis, the greater the hip flexion that results. There seems to be a "sweet spot" when the amputee is loading and unloading the Strut at the optimal rate, and then the gait really flows smoothly. At other times, there will be limited or excessive hip motion, particularly in the learning phases. David prefers to begin with a fairly stiff strut, coaching the amputee to learn to load it more effectively and increase the amount of dynamic hip flexion.

With permission, I have posted a short video clip demonstrating this young lady's gait in parallel bars at this point in the fitting process. With more time and practice, the overall pattern should become less abrupt and "jerky". [Click here to download this clip.]

The "floating" thermoplastic portion of the socket conformed nicely to the hip anatomy, despite the scoliotic deformity.
The "floating" thermoplastic portion of the socket conformed nicely to the hip anatomy, despite the scoliotic deformity.

The second patient who was kind enough to meet with us was a vivacious and multi-talented Associate Professor of Drama from the University of California Santa Barbara. Professor Cole had been using her prosthesis with the Strut since her amputation secondary to cancer a few years ago. Her gait was much more consistent and generally smooth, although she sometimes demonstrated a tendency to circumduct. A short clip illustrating her gait pattern is available by clicking here.

In one of the unexpected pleasures in this series of trips, Professor Cole gave us a videotape of an excellent dance theatre piece she has created titled "Five Foot Feat". She removes her prosthesis at the start of the performance and dances on one leg, as this work explores the impact of the loss of one's entire limb in a series of clever skits that are performed with non-amputee actors. This production has met with critical acclaim and is scheduled to be on tour starting in June. For more information, or to learn about future performance dates, go to www.fivefootfeat.com .



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