Rehabilitation of an Individual with Transfemoral Amputation Combining Aquatic Ambulation With Prosthetic Socket Incorporating High-Fidelity Skeletal Capture

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IntroductionThe High-Fidelity skeletal capture socket has shown promise in improving outcomes for persons with transfemoral amputation. This case report looks at a synergistic benefit when incorporating aquatic therapy with successful skeletal capture subischial transfemoral socket fitting. Although previous studies have shown some transfemoral prosthetic sockets to be ineffective as preserving femoral adduction angle, knee disarticulation level and high-fidelity transfemoral level sockets were not assessed, both of which use skeletal capture.Case PresentationA 64-year-old, 290-lb male individual with amputation had been unsuccessfully fit with six ischial containment suction sockets without skeletal capture over a 3-year period. Multiple complications, including a 45° hip flexion contracture and 100-ft maximum ambulation range, limited his rehabilitation.Management and OutcomeAquatic ambulation increased in-therapy walking time from 5 to 45 minutes. Thirty-day results included prosthetic side hip flexion contracture reduction from 45° to 20° ambulation range increased from 100 to 400 ft. The 120–day results showed contracture reduced to 12° and ambulation range to greater than 500 ft. Additional 120-day outcomes included disability rating reduction from 78% to 48% and Tinetti fall score increase from 10 of 28 to 17 of 28.DiscussionInitial success with socket fit revealed limitations in certain approaches to rehabilitation of persons with amputation that were overcome in a reduced gravity environment. By combining both the additional reported stability benefit of the High-Fidelity Interface and the increased duration and confidence provided by the aquatic-based ambulation, the outcomes exceeded those anticipated with land-based ambulation alone.ConclusionBy considering skeletal capture, the case report challenges the assumption that socket design cannot secure the femur and provide better outcomes. By having success in a reduced-gravity environment, one concludes that a scrutiny of the goals of transfemoral amputation is warranted.

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