The Prosthetics Service provides upper and lower limb prosthetic care to approximately 1500 patients from Lothian, Fife, the Borders, Forth Valley and some West of Scotland Health Boards. There is an average of 100 new patients and 3000 outpatient appointments per year. The department consists of six Prosthetists, including the Head of Prosthetics Services, and the equivalent of seven Technicians, including.
The service aims to provide a high level of care for amputees and others requiring prosthetic assistance (i.e. those with congenital absence or deformity). It provides prostheses, where appropriate, and life long care to the patient to ensure that their prosthesis is maintained and continues to meet their individual needs where possible.
We work as part of a multidisciplinary team (MDT), which includes the patient, Nursing staff, Occupational Therapists, Physiotherapists, Rehabilitation Consultant, and Orthopaedic Consultants. We are involved in weekly ward rounds for inpatients and three MDT clinics per month which involves assessing and reviewing new and existing outpatients. We also have a Young Person Clinic and Orthopaedic clinic. We are currently trialling a Prosthetist/Physiotherapist clinic and the ongoing requirements for this are being audited.
Patients are allocated a named Prosthetist on referral and may attend the clinics mentioned above as well as attending for review/assessment, casting, fitting, adjustment and repair appointments. Established patients can refer themselves for review, adjustment or repairs, or be referred by a carer, medic or Allied Health Professional.
What is a Prosthetist?
A Prosthetist designs artificial replacements, or prostheses, for limbs that have been amputated or are congenitally absent. They offer a vital service to people who lose or are born without a limb or who have particular conditions or injuries that affect their movement or body image.
To qualify, a Prosthetist must complete an Honours Degree course in Prosthetics and Orthotics. There are two universities in the UK that offer this degree – University of Strathclyde, Glasgow, and University of Salford, Manchester.
All of our Prosthetists are state registered with the Health Professions Council (HPC). The HPC is a regulator set up to protect the public. They keep a register of health professionals who meet particular standards for their training, professional skills, behaviour and health.
Prosthetics is one of 14 professions registered with the council. Only those who meet the council’s standards have the right to use the protected title of the profession and practise as a Prosthetist.
The majority of amputations of the lower limb are carried out by vascular and orthopaedic surgeons. Following amputation, most patients are transferred to the Astley Ainslie Hospital for their post-amputation care lead by a Consultant in Rehabilitation Medicine. Patients transferred here are mostly from the vascular unit at the Royal Infirmary of Edinburgh. If the multidisciplinary team (MDT) consider that limb fitting is appropriate, the patient will be referred to the Prosthetic Department in SMART. The patient will then be assessed by their Prosthetist and a plaster cast or digital image (TracerCAD) of their residual limb will be made. The Prosthetist will use this to design and manufacture a prosthetic limb, taking many factors into account including the patient’s general health, fitness level, clinical needs, life-style and personal requirements.
Approximately 1 week after casting or digital imaging, the prosthesis is ready for fitting. This involves the prosthesis being donned, the fit of the socket assessed and the prosthesis is aligned to provide an optimum gait pattern for the individual patient. Any components on the prosthesis e.g. knee joint, are also adjusted at this stage to suit the individual patient’s gait pattern. A check socket stage may take place before fitting. This is often used to assess the socket fit in detail before proceeding to the definitive fitting stage.
This stage allows for the components to be torqued and appropriate safety checks made. A cosmesis (enhancement of physicial appearance) is also added to the prosthesis which is shaped and finished with a cosmetic covering. The patient can choose for the prosthesis to be delivered without a cosmetic foam.
New patients to the service are provided with planned review appointments. Established patients may also be provided with planned reviews or can make their own. We aim to review every patient annually for maintenance checks. Review appointments can be made with the patients Prosthetist to essentially and continually review that the prosthesis remains comfortable, safe and fit for purpose. Review appointments are also available with the Multidisciplinary team to allow for changes to the individual patient’s clinical needs, e.g. physiotherapy input, changes to socket or components prescription, or changes to medication.
Repair appointments allow for any socket adjustment or repairs to components to be carried out.