Name: Ryoji Kojima
Phone: 03 470 9428
Date: March 2021
Event Number: RK202001-SG
(The event number should start with your initials, then the year, then which case study submission this is for you, then an internal job number that will allow you to identify the case in your practice. E.g. jcs-2009-01/1435b)
All sections below must be filled in for case study to be accepted.
Section1: Job Details
|Start Date: 10/12/2020|
Section 2: Abstract
|Summary of case study. Include details of patient, method and outcome
The patient is a traumatic transfemoral amputee, a 39-year-old female, who had her left above knee amputated following a traffic accident in 1994. She lives with her husband and two young kids. She started long waking over seven years ago, has developed her walking ability and participated in numerous races. The distance became longer and longer. She also has daughters and wants to catch up with them running around.
She showed interest in a blade foot for a faster walk to participate in longer races. I discussed this with my manager and decided to provide her with a running leg with Otto Bock 3S80 running knee and 1E91 Runner Blade.
She has used a Sub Ischial Suction socket with top seal with Ossur Seal In X liner for years. The socket works well overall, but it tends to rotate when she walks long distances, and the liner tends to get slippery when perspiration increases.
I changed the interface liner type from the top seal to both top and bottom seal using Otto Bock Sealing liner to prevent the socket rotational movement. The liner is less slippy than her previous liner because it has a textured inner surface less susceptible to perspiration.
The patient had fittings as well as running training with our physio.
The fitting of the running leg went well, and now she found she can walk much faster with less fatigue and even jog for a short distance.
Section3: Initial Assessment
The patient wants to increase her ability to walk/run longer distances with ease.
The patient is an experienced transfemoral amputee aiming to expand her ability to walk or even run to participate in long-distance races. Enabling her to walk/run faster with less fatigue would be her goal.
To provide a prosthesis designed for a faster walk and running.
To provide training to use the prosthesis efficiently and safely.
To provide a comfortable and secure socket for an intense situation.
|Discussion with Mulidisciplinary Team:
I proposed my manager the best prescription for the patient, based on her goal, and the manager agreed with it.
· Sub Ischial Socket with Otto Bock Sealing liner with sleeve and one-way valve.
· Otto Bock 3S80 Running knee
· Otto Bock 1E91 Runner blade
After I confirmed the prosthesis fit, walking/running training was carried out by our physiotherapist.
Section 4: Literature Review
Summary and critical appraisal of literature used in clinical management, and/or in support of clinical management. Add more table rows for more articles.
If you are unsure how to reference and or you require a referencing guide/tool then please use La Trobe University’s referencing tool: https://www.lib.latrobe.edu.au/referencing-tool/
You will need to select the style: APA 6
If you do not reference the articles you may be suspected of plagiarism, which may come with your membership & accreditation being suspended.
Schmalz T, Bellmann M, Sottong J, Altenburg B (2017). Advantages and Limitations of New Sports Prosthetic Components Developed for Running in Lower Limb Amputees. Sports Med Rehabil J. 2017; 2(2): 1018, 1-7. Retrieved from
Ryan Caldwell and Stefania Fatone (2018). Technique modifications for a suction suspension version of the Northwestern University Flexible Sub-Ischial Vacuum socket: The Northwestern University Flexible Sub-Ischial Suction socket. Prosthetics and Orthotics International 2018, 1-7.
Section 5: Consultation details:
|Consultation 1 (initial meeting)
S – Pt stated she felt pain on the distal end of her residuum, which sank into the socket too much.
– Pt thinks the residuum gets shrunk.
– Pt also stated she has the intention to try a 21 km walk (or run) soon and asked me about the running blade option.
O – Pt appears well and residuum in good condition but reduces its size.
– New socket required as the size difference is too much. Also, pt needs a smaller liner.
– Unfortunately, we don’t have the one sized smaller liner, size 28cm, for casting, but I decided to cast over OS Synergy Wave liner 30cm to reduce the visits number for her.
– New socket will be the same as her current style, SIS.
T – The cast was taken over the 30cm liner.
– We discussed with her about the blade option. I suggested using a blade and the specific knee for running leg even only for jogging as the blade foot makes a huge difference to reduce impact and energy consumption.
A – Pt is happy with the process. Pt is also pleased with the idea of having a blade leg with the specific knee for her long-distance challenge. Pt states she is ready to pay for the jogging leg if necessary.
P – I will order the new liner and contact her for fitting when the liner arrives.
|Consultation 2 (Socket fitting)
S – Pt attended for fitting her new socket.
O – Pt appears well and residuum in good condition.
T – New check socket was set on her existing knee.
– Bench alignment was set on PROSA jig.
– Static alignment was checked/adjusted on LASER posture.
– Dynamic alignment was adjusted by OGA.
A – The proximal part was a little small and the distal part was a little big so she felt slight movement distally.
– The proximal area was expanded.
– Overall comfort was good.
– She is happy with the fit.
P – The socket will be finished.
– The new check socket will be set on the running knee (3S80) and the blade (1E91) for the next visit.
|Consultation 3 (Fitting the running knee and blade)
S – Pt attended today to receive her finished resocket and fit her new running knee and blade.
O – Pt appears excited to try out the new running knee and blade.
T – The new socket was set on her existing C-leg limb.
– No issue with the socket fitting and alignment.
– In the morning session, the knee and blade were set with her check socket. Confirm the AP, ML alignment by various exercises.
The wooden block under the socket was then taken off, and the knee was attached to the socket directly.
– She tried with free knee mode in the afternoon.
A – The trial of the OB 3S80 and blade worked well.
– She builds her confidence with the running blade and can walk faster with it.
P – We will fabricate the socket and have her for the delivery and further gait training.
|Consultation 4 (Deliver the running prosthesis/running training)
S – Pt attended for delivery and training of the blade limb.
– The new socket for the main leg went well and no issues with
O – Pt appears well and residuum in good condition.
T – I checked the new fabricated socket fitting with OB 3S80 knee and 1E91 Runner blade.
– The static alignment checked on the LASER and the weight line went 60mm anterior to the knee centre, which is a safer set up than the standard 40mm.
– Our physiotherapist gave her training with the knee and blade.
A – As discussed with our physiotherapist, I leave this safer setting as it is because she needs to learn this
– Pt built her confidence throughout the training and managed to jog in the reception space.
– Pt is very happy with the blade limb.
P – She will come back in three weeks to see the progress.
S – Pt attended to have her running leg reviewed.
– No socket issue with both sockets.
– No rotation occurred even with some sweat. She found the new liner (OB Sealing liner) less slippy under sweaty conditions than her old one (Ossur Sealin X).
– She’s done 1.4k fast walk and 1k jog. Jogging is not particularly fast.
O – She walks and jogs very safe with the leg.
T – I moved the foot position posterior, so the LASER line goes 50mm anterior to the knee centre from 60mm. The instruction suggests 40mm, so I could go a little more if necessary.
– Pt see our physiotherapist for further running training.
A – She showed more propulsion when jogging.
– She found the leg still safe enough.
– Good improvement in jogging speed and posture.
P – She will attend 12k walk in Invercargill in two weeks, followed by 10k race in Christchurch.
Section 6: Critical Appraisal of Case Study
|What have you learned from this case?
With proper steps (patient assessment, socket fitting, setting up followed by the manufacture’s instruction), you can achieve a good result even with a specialised limb you have never tried before. Again, collaborating with a physiotherapist is crucial for the success of this type of high activity limbs.
|What could have been done better?
If we have a casting liner for this particular liner, the patient can reduce patient visits. However, keeping all size and kinds of liners isn’t practical.
|Does this study contribute to prosthetic/orthotic research/evidence?