There are clear benefits for insurers in playing an active part in the developing prosthetics market, say Peter Walmsley of Clyde & Co and Toby Carlsson of Pace Rehabilitation
Amputation claims are changing rapidly, as prosthetic technology becomes more sophisticated with associated cost increases. Prosthetic devices are becoming more closely connected to the body they are fitted to and more intuitive to use. Clinicians already discuss concepts such as ‘intent control’—functionality facilitated by implanted sensors that detect the thoughts of the user and translate them into prosthetic action. While not available in regular clinical use just yet, it is definitely on the horizon.
These concepts are still unproven in terms of long-term outcomes, but it seems reasonable that if such developments are embraced rather than resisted, they have the potential to facilitate a level of function that will reduce costs in other areas, such as care and loss of earnings.
The backdrop to developments such as this is a combination of political interest in rehabilitation of amputees with service-related injuries following recent conflicts, combined with technological and medical possibilities now on offer. By way of example, microprocessor controlled prosthetic knees are now relatively common, and more recently, these have also started to be combined with microprocessor-controlled ankles. At times, the knee and ankle share the control system to make sure that their behaviour is optimised for users in any situation.
It all contributes to restoring an individual to their pre-accident status as far as possible, which is of course the end goal, but it comes at a cost. A transfemoral prosthesis can now cost above £100,000. Thankfully, the sophistication and versatility of these prostheses regularly negates the need for several different prostheses to accommodate different activities, so it is not all bad news.
The mechanism for connecting prosthetics to the body is also being enhanced to improve comfort for users. Osseointegration (the direct structural and functional connection between living bone and the surface of a load-bearing artificial implant) is gaining momentum in the UK.
This technology was first considered in the UK in the 1990s and has returned to favour, particularly with veterans and more active users who benefit from improved functionality. It makes it easier to use heavier and more robust technology without the socket related problems such as abrasions and pressure related discomfort. This year will see further growth for this treatment, which has the potential to give users improved functionality, while reducing long-term costs of care and loss of earnings.
For younger and medically appropriate claimants, osseointegration looks like a cost-efficient option. While there is an initial capital cost of the surgery and postoperative rehabilitation, prosthetic fitting and associated costs are reduced. The need for regular socket renewals is eliminated. Clinicians who believe in this concept also argue that advanced prostheses utilising osseointegration increase safety and improve the bio-mechanical loading pattern, which in turn reduces wear and tear to the rest of the body. Long-term monitoring has yet to prove or disprove this and there is presently little data available to demonstrate with certainty whether this new technology will continue to work over a claimant’s lifetime.
Furthermore, the long-term maintenance costs are not yet well understood and there are of course risks associated with the surgery and the long-term presence of an implant made through the skin (percutaneous). Historically, frequent changes to the design of the osseo-integration specific part of the prosthesis have been a problem, but the technology now appears to be sufficiently mature for this to no longer be an issue, creating new opportunities for more consistent treatment that will facilitate gathering of long-term data.