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Computerized leg a godsend to amputees

Two local men test high-tech prosthesis

Friday, May 17, 2002

By Anita Srikameswaran, Post-Gazette Staff Writer

Thanks to a high-tech prosthetic leg, some amputees no longer need to watch their steps.

Francis "Fran" Kozar of Munhall, for instance, now can walk on carpeted floors, uneven fields or grassy slopes without a second thought, just as he did before a workplace accident in November forced doctors to amputate his right leg above the knee.

Sensors and strain gauges in his computerized artificial limb, called C-Leg, take 50 readings every second, relaying them to microprocessors in the knee joint. Hydraulics rapidly respond by adjusting the bend of the knee so that the prosthesis moves much like a real leg.

With that computer-controlled agility and flexibility, the 51-year-old should be able to resume his active lifestyle and, perhaps, play basketball again.

"The leg is phenomenal, what you can do with it," Kozar said. "You can run with this leg after a while."

He returned home yesterday after spending two weeks in physical and occupational therapy at Mercy Hospital so that he could learn to walk on his C-Leg. He had been using a wheelchair while his C-Leg was being made.

A construction worker, Kozar was injured Nov. 21 while moving concrete Jersey barriers, a job he has done thousands of times without incident. But a tire on the machine carrying the heavy load caught part of his right foot and rolled over it.

It crunched the large bone of his lower leg, called the tibia, and destroyed the major blood vessels, nerves and tendons going through his calf to his foot.

"Basically the only thing that was holding his leg on was some skin and some muscle," said Dr. Jory D. Richman, Mercy's chief of orthopedic surgery. "Everything else was crushed."

Doctors amputated part of Kozar's right lower leg, hoping to save his knee joint. But within a few days, signs of gangrene appeared and it was clear that no blood was circulating in the lower leg. Kozar went back to the operating room and the surgeons amputated his leg above the knee.

Kozar said his immediate thought was: I could have been killed and I wasn't. So he accepted losing his leg.

"I figured, if I survived that [accident], apparently I can live with this," he explained.

The C-Leg is a Canadian invention that has become widely available only in the past year. Dr. Mary Ann Miknevich, head of rehabilitation at Mercy, had fitted the C-Leg for several of her patients and realized that it could be a good fit for Kozar after talking with him about his lifestyle. Her previous patients had used other prosthetic limbs and had to relearn how to walk with the C-Leg. Kozar would be starting with a clean slate.

"He put the leg on and walked in the parallel bars without holding on the first day," Miknevich said. "That is very unusual."

It often takes patients several weeks to walk with walkers or crutches using conventional artificial legs. Kozar uses only a cane now, and has set an initial goal of walking without any other assistance.

Already, he has successfully made a cup of tea in the rehabilitation center kitchen and, wielding a cane in his other hand, carried it down a hallway and sat down without spilling a drop. The microprocessors are programmed to coordinate with the person's gait and to bend the knee to smoothly sit down and rise from a chair.

Miknevich was shocked when she first saw videotape of someone using a C-Leg. And she, like Kozar, is impressed by patients who have returned to jogging regularly, rock climbing and even sky diving.

"What's been revolutionary with this C-Leg is the people who have it say they don't think about walking anymore," Miknevich said. Above knee amputees "have always had to think about walking, especially if it's an uneven surface. For people who really want to be more active, it's always been very difficult and frustrating."

A person wearing a conventional prosthesis has to go down stairs by placing both legs, first his own and then the prosthetic one, onto each step. With the C-Leg, the wearer can descend steps one after another, as able-bodied people do. Climbing, however, must still be done one step at a time, real leg first, because there aren't mechanics to raise the body up like muscle would.

Mike McGee, 32, of Hopwood, Fayette County, has had a C-Leg for three months. He lost his right leg above the knee and his left leg below the knee after an industrial accident 3 1/2 years ago. With a conventional above-knee prosthesis, McGee fell frequently and worried about stairs and slopes. Now, he feels stable and safe.

The C-Leg "is close to having my real leg back," he said. "I'm able to walk around in my yard without having that in my head: Am I going to fall?"

With a fully charged battery, the C-Leg will operate for at least 24 hours. A 15-minute boost provides several hours of power. Kozar even has an adapter to charge the C-Leg from the cigarette lighter in the car. But even if the battery runs down, the limb's hydraulics will still function mechanically so a user can't stall into immobility.

The C-Leg, manufactured by the German company Otto Bock Health Care, was approved by Medicare two months ago, so it's expected that many private insurers will follow suit to cover the $50,000 cost of the artificial limb. Workers' compensation paid for Kozar's care.

The C-limb is not for every above-knee amputee, Miknevich pointed out. People who are mostly sedentary can function very well with a conventional, and far less expensive, prosthetic limb.

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