Delay in fitting upper limb prosthesis increases rejection risk

LAS VEGAS — Practitioners should fit patients with an upper limb amputation for a functional prosthesis as soon as medically possible, as it can decrease the likelihood the device will ultimately be rejected, according to a presenter here at the American Orthotic & Prosthetic Association World Congress.

Andreas Kannenberg, MD, PhD, executive medical director for Ottobock North America, said insurance companies should not delay early first fitting, within 30 days, or the definitive fitting, within 6 months, to prevent high rejection rates. He added that insurance companies should never “make the decision for the patient” regarding the type of prosthesis patients receive, as a lack of patient involvement also can lead to high rejection rates.

Andreas Kannenberg

“For children with congenital deformities or an absence of the limb, the first prosthesis should be fitted within the first 2 years after birth,” Kannenberg said. “For patients who require an amputation later in life, the definitive prosthesis should be fitted within the first 6 months after amputation.”

Failure to fit a prosthesis within 2 years, for congenital deformities, or 6 months, for patients with amputations later in life, can lead to a 15.9% increase in the likelihood of a prosthesis rejection, Kannenberg said.

In addition, if a patient is uninvolved in the process of choosing a prosthesis, they are 7.7 times more likely to ultimately reject the device, he added.

Age and proximal amputation level also factor into whether a patient will reject an upper limb prosthesis. According to Kannenberg, older patients are 6.8% more likely to reject an upper limb prosthesis, while patients with a more proximal the amputation level are 3.5% more likely to reject the prosthesis.

Although the data did not go into detail regarding why such a delay in prosthesis fitting leads to higher rejection rates, Kannenberg said he believes the longer wait time gives the patient the opportunity to grown more accustomed to life with one hand or arm.

“It is not specifically elucidated in the literature, but I believe that when a patient learns to manage their lives with one hand alone, they often are disappointed by the functionality of the device,” he said. “Also, the insurance company should not waste precious time arguing with the prosthetist about what type of prosthesis should be fitted because in doing so they shoot themselves in the foot.”


Kannenberg A. Factors that influence acceptance and rejection of an upper limb prosthesis. Presented at: American Orthotic & Prosthetic Association World Congress; Sept. 6-9, 2017; Las Vegas.

Disclosure: Kannenberg reports employment with Ottobock.


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