For insurers, a case involving hip disarticulation surgery brings the difficult prospect of a costly claim that could well last for many years. Hip disarticulation surgery involves the amputation of the lower limb through the hip joint and is considered one of the most extreme and complex forms of lower limb amputation. Most commonly, it is performed following a major traumatic incident or spread of lower extremity infection, generally considered a form of life-saving surgery.

Applicants who undergo this form of amputation typically undergo intensive physiotherapy and rehabilitation after the amputation and before and after the fitting of prostheses. The dentures themselves can be problematic and impractical. The prosthesis is used as a replacement for the hip, knee and ankle joint, so walking is not only more inconvenient, but it leads to a greater risk of rejection of the prosthesis.

For insurers, these claims can be extremely costly. Fortunately, they are rare.

In the past, the quality of life of these amputees was considered low. However, technological advances in hip disarticulation prosthesis offer a better future for these people.

CONVENTIONAL PROSTHESIS

The traditional prosthesis was developed by Colin McLaurin in 1954 and refers to the ‘Canadian’ type prosthesis which uses a free hip, knee and ankle joint with a molded socket surrounding the ischial bone for the weight support with a wide integral belt gripping the pelvis.

Subsequently, the “bikini-like light hip grip”¹ was developed by Martin Bionics Prosthetics and Research which was considered a lighter design allowing patients to lean forward with little difficulty while wearing the prosthesis but also providing greater comfort. Fortunately, it weighed only a third of the weight of conventional bucket-type sockets.

In recent years we have seen the Helix 3D hip prosthesis² which uses 3D pelvic rotation to mimic the normal movement of the human body, providing a more natural gait and greater comfort. Hydraulics allow for greater hip flexion, making it easier to bend and participate in daily activities, as well as a stride length that can be tailored to each individual. The 3D prosthetic hip is fitted alongside a microprocessor controlled prosthetic knee and a separate Triton foot which reduces the risk of falling.

THE FUTURE AND ROBOTIC PROSTHESIS

The development of robotic prostheses for disarticulated hip patients is still at the prototype stage. The development of these prostheses is more difficult than the development of prostheses for other types of amputees, because these people have fewer muscles, less motor function, walking problems and require that the joints of the hip, knee and ankle work together to enable the individual to walk. Yuki Ueyama from the Department of Mechanical Engineering in Japan conducted a trial on robotic hip disarticulation prostheses. In his study, he states: “The robotic prosthesis is powered by two motors at the hip and knee joints”³ a battery and generates a walking motion to follow the non-prosthetic limb. The ankle joint is a non-powered foot. The battery pack is attached to a fanny pack carried by the individual. The prosthesis is then attached to the sleeve custom made for that individual which is tightened around the waist.

Although still experimental, the study found that the robotic prosthesis improved step length compared to an unpowered prosthesis and maintained leg symmetry, allowing the leg to swing forward and forward easily. rearward. In fact, the suggestion is that it could generate a gait similar to that of a healthy person, provide less physical burden of walking and require minimal training, thus improving quality of life. Additionally, the robotic prosthesis could eliminate the risk of rejection as well as reduce forward tilt, which was often the case with the traditional prosthesis.

While it may be game-changing for these amputees, the robotic prosthesis has proven to be much heavier than your standard prosthesis, weighing in at 25 lbs. That being said, with continued advancements in technology, the study found that there may be room for a lighter prosthesis in the future.


In the personal injury world, we are now beginning to see a wider variety of robotic prosthetics for amputees, including the robotic prosthetic leg and the development of the robotic prosthetic arm. Implementing a robotic prosthesis for disarticulated hip amputees is much more challenging given the nature of the amputation and, although the initial indication is that it will benefit the individual, there are concerns subsist. Its weight being one, as well as its complexity which can make it heavier to use. In some cases, we may find that older applicants prefer a simpler, lighter prosthesis. Also, there are a lot of unknowns ie will it have the necessary longevity, will there be higher maintenance costs? At this point, it remains to be seen whether the costs to insurers will outweigh the benefits.

Footnotes

1 https://martinbionics.com/hip-disarticulation-bikini-socket/

2 https://www.ottobock.co.uk/prosthetics/lower-limb-prosthetics/prosthetic-product-systems/helix_hip_system/

3 https://www.tandfonline.com/doi/full/10.1080/01691864.2019.1705908?scroll=top&needAccess=true

The content of this article is intended to provide a general guide on the subject. Specialist advice should be sought regarding your particular situation.

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