The industry standard attachment technology tends to be the "suction socket". The two biggest problems with suction sockets are that sweating can loosen the connection and that getting the socket
to attach consistently the same way every day is difficult. Based on the responses from other above knee amputees, the attachment technology that tends to provide the highest patient satisfaction is the silicone sleeve.
Silicone sleeves have some big benefits. First of all, they can be rolled on like a sock, and tend to hold onto the residual limb very well. The metal spike at the end of the sleeve plugs into the locking mechanism at the bottom of the socket. The silicone sleeve tends to contract on the residual limb and hold very well. Also, sweating tends to be minimized with a silicone sleeve. Generally with other attachment technologies, sweating can ruin the attachment. But not only do silicone sleeves reduce sweating, even if the amputee does sweat, the sleeves hold on great !!! In effect, with the silicone sleeve, the attachment to the residual limb is independent of the fit of the socket. In other words, even if the fit is not correct, your leg is not coming off! In this way, you can work on the fit with your prosthetist, without the aggravation of the fit preventing you leg from hanging on very well. Because silicone sleeves are prescribed more for below knee amputees, the sleeves are cylindrical up to the top. With an above knee amputee, the sleeve will tend to not fit exactly as it protrudes from the socket (an above knee amputee is not symmetrically at the hip). For this reason, there will be a "rolling" effect from the sleeve that can be minimized by cutting the sleeve down so that it does not protrude too far out of the socket. Also, an attempt can be made to cut the sleeve unevenly so that excess silicone that is in just on area can be removed. Ultimately AboveKneeAmputee.com™ hopes that silicone sleeve manufacturers will start do make silicone sleeves that are shaped at the top for above knee amputees.
There have been various "styles" of sockets over the years. Many of them have official sounding names. Instead of focusing on names, the best thing to do seems to be the following: Accept only a design that "captures" the tuberoscity (a pelvic bone) in the back of the socket. Also, make sure a casting is taken of the residual limb to create the socket (believe it or not, some prosthetists do not do this). A good prosthetist will "find" the tuberoscity with his hands during the casting period and create a "shelf" for the bone right then. After the casting, a "test socket will be made that will allow the amputee to try out the socket. Also, if your residual limb naturally extends out from your body (does not hang down), the socket should be made this way.
This is the point of no return for an above knee amputee. If the socket seems to fit o.k, there is a good chance that the final leg will be close to correct and any problems can be changed fairly easily. The test socket phase needs to be done with the test socket mounted onto a simple leg where the amputee can put weight on it (and hopefully, so the amputee can make a few steps with it). Of course this setup will not be aligned correctly, but being able to bear weight on the test socket without significant pain is a good sign. Find out ahead of time if the test socket phase is done this way or not. If it is not, you are at the wrong prosthetist, and need to leave !!! Now, this is important. If the test socket creates any undue pain when the amputee is weight bearing, it needs to be fixed on the spot, or the amputee should halt the process and demand a new casting. Remember, from this point on, you have "bought the leg", even if it is bad. So, don't go beyond the test socket phase unless you are pretty sure it was done correctly. The number one problem you cannot accept with a test socket is any kind of pain around the tuberosicty (tail bone), that does not allow you to put all of your weight on it. If, you have this pain, the socket is not right, and do not accept it!!!!
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