A story like the story of Henry Mdluvu, is not just a success story, but a story of courage and determination!
In complex high level amputations, one is always faced with the difficult decision, whether to help or not, as it is very difficult to walk with such a prosthesis, it is expensive and many multiple prosthetic joint prosthesis, ends up in the cupboard.
Henry Mdlulu came to see me earlier this year. He suffered from Necrotising Fasciitis. It is a flesh eating disease that spreads rapidly through the body, once you have it. Henry was in and out of hospital for a period of 2 years, and to stop this disease from killing him, they had to amputate his leg through the hip. This is not a normal clean, well - shaped or formed through hip residual limb, because they had to cut several pieces out of his residual limb, to prevent the disease from spreading further. He has lots of scar tissue, sensitive areas and his sound hip has a 20˚ flexion contracture.
We had long discussions and explanations as well as realistic goals that he will or might achieve. For me, at the end of the day, the deciding factor in whether to help Henry or not, was his own spirit, determination, personality and will to live a better life!
The casting procedure was a 2 stage/appointment process. The first stage a non – weight bearing cast was taken, to get the volume of the lower body, the shape of the “stump” and to get proper definition of the Iliac Crest’s (hip). This cast was the modified, sensitives areas were relieved and proper Iliac Crest definition were achieved.
This positive mould was then moulded twice, first with a PTEG plastic to form a see - through weight bearing brim distally that was trimmed anterior to posterior as wide as what his stump is from medial groin to lateral distal area.
A second mould was done with a co – polymer plastic that was moulded over the iliac crest, and joined the first mould from the iliac crest downwards on the lateral side of his stump, to the distal end underneath the first mould. In essence, one has created a weight bearing brim to don onto the patient, so he can put full weight onto the brim over the groin area, and then pull the plastic mould in above the Iliac Crest with Velcro straps that is attached to the plastic.
The reason is that we want the Iliac Crest’s fully suspended under full weight, as once the amputee puts weight onto his prosthesis, he will move down into his socket, and if not casted under full weight with the correct height between the distal end of the stump and supra – Iliac Crest’s, there will be unnecessary up and down movement in the socket, that will make it even more difficult to control or walk with the prosthesis.
This “frame weight bearing” cast is then filled with plaster, modification are done, and the first mould was then done with a low density polyethylene plastic. A carbon frame was then laminated and the componentry was connected and bench – aligned according to the necessary rules and specification.
It is very important to keep in mind that a Through Hip amputee will and need to sit a lot, so sitting comfort is very important. This is very important to keep in mind when designing your socket and its trim lines. With this casting technique, it is possible to get rid of the very big body jacket that is usually associated with Through Hip sockets, and one can get a more streamline and smaller socket design that will increase sitting comfort and provide stability and proper suspension while walking.
Componentry also plays an important role, especially if one needs to consider the patient’s budget as well. Safety is very important, and there for we have chosen a knee with a weight activated lock, the 3R92, and the 7E9 hip joint from Otto Bock.
Once the patient starts to walk, or try to start to walk, one is absolutely confronted with the fact of how difficult it is to walk with a Through Hip prosthesis. In fact, it is frightening, no matter how much you have prepared yourselves or the patient. For this reason gait training with an experienced Physio is of extreme importance. 2 -3 sessions per week for 8 – 10 weeks is the minimum recommendation. The effort and energy level needed while walking is very high, and a patient needs to be strong, young and very committed.
Henry is working extremely hard. Some days are definitely more difficult than other days. I truly hope that my and his commitment to give him a better, more active life, pays diffidence one day!
I take my hat off to you Henry for your effort and you’re positive attitude towards life! You inspire us all!