The American Prosthetics Institute recently reported that approximately one in 200 people in the U.S. are currently living with the loss of a limb, and approximately 500 amputations are done each day.
At age 4, Josh Green experienced a leg amputation.
“I was amputated in September of 1985, above the knee, and then by June of ‘86, I was already playing T-ball,” recalled Mr. Green of Elyria.
To enable independent and comfortable performance of daily activities such as walking, eating, and dressing, many people who experience a loss of limb turn to a prosthetic.
Now 42, Mr. Green credits his prosthesis as the reason for his full life.
“I was born without a knee joint. My femur, fibula and tibia were all fused at my kneecap. So, I had a leg, ankle and foot, just the knee didn't bend,” he said.
“And by the time I was 4, the Cleveland Clinic thought I would have a lot better life or be happier in life with a through-the-knee amputation ... which, then again, most kids that are amputees end up doing really well throughout life,” he said. “So, I'm glad my parents and the doctors made that decision.”
An artificial replacement body part, or prosthesis, is made for a part of the body that may have been missing at birth, lost in an accident or amputated as part of treatment for cancer, severe infection or vascular disease, particularly diabetes or peripheral arterial disease.
Site specific
There are four main types of prosthetics. A transradial prosthesis is an artificial arm that attaches below the elbow, while the transhumeral prosthesis connects to the body above the elbow but below the shoulder. A transtibial prosthesis is an artificial leg below the knee, while a transfemoral prosthesis replaces a missing leg above the knee, which is often the most challenging of the four main types.
For adults, the most common type of prosthetic limb is a below-the-knee prosthesis, accounting for approximately 70 percent of all prosthetic limbs, as reported by Pro Medical East, a leading provider of orthotic and prosthetic products.
Bryan Sculthorpe, a Certified Orthotist Prosthetist at Cole Leimkuehler Orthotic-Prosthetic Center in Toledo, works primarily with children. The practice develops prosthetic limbs on site. The specialists see about an even split of the need for upper and lower prosthetic limbs with kids.
“That's more common in children and it’s usually not an actual amputation, it's some sort of limb deficiency,” he observed. “The earlier you can get them fit, usually the better things will go.
“If it's for lower extremities, usually, even if they're crawling, they can still use the prosthesis for that because we want them to still hit those milestones, like where they get to the point where they're starting to stand up and use furniture to walk around,” Mr. Sculthorpe said.
An estimated 1.9 million people in the United States are living with limb loss, a number expected to double by 2050, mostly due to the rising prevalence of diabetes, as reported by the National Library of Medicine.
Dr. Seth A Phillips, an Orthopedic Trauma Surgery at Mercy Health in Toledo, works with patients that have experienced a limb injury typically due to an accident or medical emergency. He noted the importance of prosthetics in improving quality of life for amputees, despite the challenges.
“We talk to the patient and we look at ‘Are the injuries something that we can still reconstruct and put you back together and will give you a finished product that's worth saving?’ because there can be a lot of issues with the mangled limb versus something that is better,” Dr. Phillips said.
While going through an amputation is mentally and physically painful, in many cases, he said, ultimately, a prosthetic is something that gets patients back on the road to recovery, functioning better, quicker, restoring quality of life.
“Sometimes when people come in, it's a bad enough injury that there really is no decision making, and you just have to amputate the limb,” Dr. Phillips said.
Technological advances
Prostheses have advanced in recent decades. By using muscle signals for control, advancements such as osseointegration and myoelectric prosthetics offer patients a better quality of life.
“Essentially, they're able to pick up the electrical signal that goes to the muscles when your brain tells that muscle to move and contract. And when it picks up that signal, it's basically programmed to do a certain activity,” Dr. Phillips said.
For upper-limb amputees, myoelectric-controlled prostheses offer the combination of function and natural appearance as the units are designed to mimic human anatomy and motion.
“With osseointegration, you actually undergo a surgery where they implant a metal rod in your bone of your residual limb — so it either be your tibia or your femur, depending on your level of amputation – and that metal rod would actually stick out of the skin a couple inches,” he said.
“Instead of being a socket that slides over your leg, it actually directly hooks up and attaches to that metal rod that's sticking out of your leg,” Dr. Phillips said.
With this option, patients experience improved function and mobility without the usual socket prosthesis-related issues associated with traditional prosthetics like pinching, sweating, muscle weakness, and skin irritation.
“This is a pretty new thing, but in my eyes I think we'll look back in 30 years, and view that innovation as one of the biggest changes in orthopedics in modern times,” Dr. Phillips said. “I think it's really exciting.”
He and his partners almost exclusively utilize the services of Chris Perry at Perry Prosthetics, in Perrysburg, he said.
High-tech prosthetics can cost between $50,000 and $100,000, depending on the technology used, and the fitting process which is patient-specific can be as short as six weeks or as long as six months, the specialists said.
Most insurance plans cover a partial or the complete cost of prosthetics.
On average, most prosthetic limbs last about three years due to general wear and tear. Patients typically get refitted due to prosthetic warps or cracks, weight loss or gain or other physical body changes that alter the fit of the limb, or daily activity that has increased or declined.
“As a kid, you are getting a lot of legs,” Mr. Green said. “Through the summer of 7th and 8th grade, I grew almost a foot so I had two legs and probably four sockets in six months.”
While he knows the challenges of living with a prosthesis, Mr. Green’s passion for sports has propelled him to excel in golf and baseball, and he plays basketball for the Cleveland Wheelchair Cavaliers.
As a 6 '3, 230 pound, above-the-knee athlete, Mr. Green is considered rare in his community, he said, prompting two prosthetic manufacturers to ask him to serve as a product tester.
“I’ve had at least 50 legs or more – a lot more than a regular amputee,” he said. “And then if you’re just talking sockets – because you can reuse your knee and foot through multiple sockets – I’m probably over 500, for sure.”
Contact Sheila Howard at showard@theblade.com
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