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ReMotion Pro: a prosthetic knee specifically designed for young, active amputees in rural areas.

D-Rev aims to develop a better prosthetic knee to improve access to modern mobility for amputees in rural Africa and Asia.

Photo of Rob Weiss
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What problem does your idea solve?

A 2011 WHO reports suggest 30 million people in low-income regions require prosthetic and orthotic care, and more than 80% do not have access to modern devices. When low-income amputees in Asia and Africa are able to access to a prosthetic knee, the knee joint is usually a simplistic device that does not offer much functionality. Patients are frustrated by the lack of excellent prosthetic devices in their price range, and their clinicians are frustrated by the lack of options they can offer.

Explain your idea

In 2015, D-Rev released the ReMotion Knee, an $80 prosthetic knee designed to meet the basic requirements of low-income patients in an affordable package: simple maintenance, long-lasting build, adjustability, good cosmesis, and modern “polycentric” mobility. ReMotion is currently in 17 countries and we’re thrilled about continuing to expanding access to modern mobility and help clinicians remobilize patients. To scale impact even greater, the ReMotion project aims to design a knee specifically tailored to the needs of active, young rural patients: ReMotion "Pro." Without a great prosthetic limb, amputees are forced to use inappropriate, low-mobility devices such as crutches or staffs, leaving otherwise healthy persons disempowered and stigmatized. Lower-limb amputees living in rural areas need a prosthetic limb that can handle rugged, uneven terrain; they typically don’t have convenient access to transportation systems and are likely to be engaged in physical labor or agriculture. As a result, low-income amputees in fact require a higher level of functionality from their prosthetic limb. Our hypothesis a next generation knee called ReMotion Pro that integrates new features to increase patient confidence navigating rural terrain will fill an important gap and expanding access to mobility in an underserved population. With IDEO’s financial and design support we believe can efficiently design a ReMotion Knee Pro that serves these patients' unique needs.

Who benefits?

Our target user is a young (15-24 year old) transfemoral amputee: a patient who has lost their lower limb above the knee usually in a vehicle accident, but is otherwise healthy and active. These patients are typically of a critical age of entering the workforce, studying for higher education, or seeking a marriage partner. A great prosthetic knee can help reduce stigma by enabling normal-looking gait, make the prosthetic limb cosmetically appealing, and empower the patient to meet life goals.

How is your idea unique?

Currently, no other organization has succeeded in providing high-quality above-knee prostheses to low-income, rural amputees at scale. D-Rev has 6 years engaging on-the-ground with more than 50 prosthetic care organizations across 17+ countries. We have a deep understanding of the prosthetic sector, and are uniquely committed to serving low-income patients with excellent product design. User-obsessed design is in D-Rev’s DNA. D-Rev is uniquely focused on end-to-end design that endeavors to ensure the product gets to the people who can benefit from it. With the ReMotion project we’ve built the supply chains – relationships with manufacturing and logistics partners; a network of prosthetic clinic partners in 17 countries – to deliver at scale. D-Rev is a very small, nimble team. Despite our size, since 2009 D-Rev has brought 5 medical devices to market across two health areas in 50 countries. Our model relies on partnerships, such as is proposed with IDEO, to succeed.

Tell us more about you

D-Rev is a non-profit in San Francisco that exists to design affordable, high-quality medical devices to tackle health issues that disproportionately affect the poor. Our products scale via the market with direct sales and sales through distributors. The ReMotion Knee, an $80 modern prosthetic knee designed at D-Rev, launched in 2016 and has been sold in 17+ countries. D-Rev is a Tech Awards Laureate, and has been recognized by the World Economic Forum as a Technology Pioneer.

What are some of your unanswered questions about the idea?

The technical risk involved in adding new features keeps us up at night, which is one reason we would hugely benefit from working with IDEO designers. The question of how much redesign is involved in adding priority features, and what technical trade-offs may be required, is an unknown. Frequently, changing the design to improve one feature can impact another feature; for example, increasing extension assist force to help amputees feel more stable can also increase the amount of unwanted noise heard upon extension. Leveraging IDEO’s extensive experience across the design process will result in a better knee reaching high-need amputees faster, as well as learnings that we can integrate into other product development across D-Rev.

Where will your idea be implemented?

  • Bangladesh
  • Burma
  • Kenya
  • Nepal
  • Rwanda
  • South Africa

Experience in Implementation Country(ies)

  • Yes, for more than one year.

Expertise in Sector

  • I've worked in a sector related to my idea for more than a year.

Organizational Status

  • We are a registered non-profit, charity, NGO, or community-based organization.

Idea Maturity

  • Prototyping: I have done some small tests with prospective users to continue developing my idea.

How has your idea changed based on feedback?

An OpenIDEO community member posted about Bespoke Innovations, a company empowering patients to custom design their own cosmetic coverings for their prostheses - resulting in intricate designs reflecting their unique personalities and goals. Although at D-Rev we design our products based on feedback from users, because medical devices are regulated, we sometimes feel it's hard to give too much "creative control" to the end-users. Yet, here was a company that put the end-user customizations radically at the center of its model. How could an analogous concept work for ReMotion Pro – could we give the user more choice? One possibility is making the knee's features modular, allowing the customer to customer order a knee with the features they want, like a locking mechanism, and subtract the ones they don’t. That would also give us excellent data on what features are important to clinicians and patients that we could use to further optimize the product.

Who will implement this idea?

Two San Francisco-based staff would be devoted to this idea, a product manager and an R&D engineer. The role of the product manager is to participate in need-finding, manage the design process, and liaise with partners. The R&D engineer's role is to participate in need-finding, feature selection, and concept generation. The D-Rev team would aim to hire a person in one key market in order to maintain close relationships with end-users and allow us to rapidly obtain feedback on prototypes.

Using a human-centered design approach, you may uncover insights that lead to small or foundational changes to your organization’s existing strategy or processes in order to unlock the potential of your idea. How would your organization go about making such changes?

D-Rev is an unusually horizontal organization; seeking new ways of thinking is built into our DNA (one core value is "improve"). D-Rev staff regularly give presentations on new ideas; team members at every level of seniority are encouraged to implement new processes and strategies with input and support from their colleagues. In my 4 years at D-Rev, I've had the opportunity to introduce new strategies around how we release products to market; other colleagues have taken initiative to revamp our onboarding process; introduce project planning tools, and co-develop and implement our rigorous quality system. This is one of the reasons we're excited about Amplify - what the Mobility team learns about HCD will be shared with intellectually curious, eager-to-learn, folks across D-Rev!

What is it that most attracted you to Amplify instead of a more traditional funding model?

Amplify was attractive for two primary reasons. This challenge offered a source of funding uniquely aligned with our goal of empowering persons with physical disabilities using innovative technology. Just as importantly, Amplify offered an opportunity to partner with IDEO as a "force multiplier" to help us make a more impactful product, and to bring the HCD methodology more deeply into our culture. We are excited to work side-by-side with IDEO designers and effect long-term change at D-Rev.

What challenges do your end-users face? (1) What is the biggest challenge that your end-users face on a day-to-day, individual level? (2) What is the biggest systems-level challenge that affects your end-users?

On an individual level, our end-users (young, active amputees) report facing difficulties getting back to normal life. This means that schooling is disrupted; they have trouble convincing employers of their abilities; feel like it's harder to attract a partner in marriage, and even just simple things we take for granted like riding a bike or dancing. At a systems level, there's a difficulty in accessing great prosthetic care - meaning the prosthetic limb itself, and the accompanying rehabilitation support - that's nearby and affordable. Far too frequently we hear from patients that they've journeyed tens or even hundreds of kilometers to find prosthetic care in their price range; even then, their options are more limited than they would like.

Tell us about your vision for this project: (1) share one sentence about the impact you would like to see from this project in five years and (2) what is the biggest question you need to answer to get there?

I: By 2019, we aim for more than 5,000 amputees to be remobilized with ReMotion Knee. By 2020, we aim to release ReMotion Pro device that helps improve the patient's experience. Q: How do we take a quantitative goal (# of amputee patients remobilized) and deepen it to reflect the quality of that mobility achieved? How might we measure impact both by with quantitative methodologies like Amputee Mobility Predictor (AMP) and quality-of-life indicators to reflect changes in health and well-being

How long have you and your colleagues been working on this idea together?

  • More than 2 years

How many of your team’s paid, full-time staff are currently based in the location where the beneficiaries of your proposed idea live?

  • No paid, full-time staff

Is your organization registered in the country you intend to implement your idea in?

  • We are a registered entity, but not in the country in which we plan to implement our idea.

My organization's operational budget for 2016 was:

  • Above $1,000,000 USD

If your team/idea/organization has a website, please share the URL below.

www.d-rev.org/projects/mobility

26 comments

Join the conversation:

Comment
Photo of Shihao Song
Team

Hi Rob, Very happy to see your contribution. i hope your project can be perfected. disable people can run and think with us, it's a good aim!

Photo of Carmen
Team

Hi Rob Weiss 
I am very impressed by your idea and I wish you all the best for the execution. You will dramatically improve the lives of so many people, they will have a completely different living standard due to your help - you can be very proud of yourself and what you and your team created and achieved so far. Good luck for the future, this entrepreneurial story really inspired me!

Photo of Jit
Team

Fabulous achievement well done and good luck with the implementation phase.
Regards,

Jit.

Photo of Merel Rumping
Team

Congratulations Rob Weiss & team!!
Happy to see you among the winning ideas and good luck with the execution!
Warm regards,
Merel

Photo of Rob Weiss
Team

Thanks Merel Rumping appreciate the support and look forward to staying in touch! Hope we can find ways to collaborate. Best regards,
Rob

Photo of Umuraza Mathilde
Team

Congratulation?
UNABU is happy to see your idea among the winning ideas . Welcome to Rwanda. We would like to be in touch with you as Rwanda is part of your coverage zone. For sure Rwandan women with disabilities will benefit a lot from the implementation of your idea

Photo of Rob Weiss
Team

Thank you Umuraza Mathilde . Do you work with lower-limb amputees in Rwanda? We would love to be connected with people currently using a prosthetic knee joint for their feedback and insight. You can please reach me at remotion@d-rev.org if willing to talk via email. Kind regards

Photo of UMURAZA Mathilde
Team

Dear Rob, you are most welcome. Of Course UNABU works with Women/girls with disabilities of UNABU. Hence we have a got a number of them who use Prosthetic knee joint though they are not many because the assistive devices are expensive in Rwanda and hardy covered by the universal health insurance. On the other hand we are also member of the umbrella organisation of Persons with disabilities in Rwanda, allowing us to stay in contact with other Disabled organisations of Rwanda hence we can link with you with the Umbrella organisation as well as other individuals with disabiltiies who might be of your interest. Being member of the Amplify impact may open for more partnership in the future. We keep in touch. Mathilde Umuraza

Photo of Chelsea Takamine
Team

Rob Weiss and Team - Congratulations again! Check out this blog post highlighting the winners of this Challenge: https://challenges.openideo.com/blog/disability-and-inclusion-challenge-winning-ideas-announced

Photo of Asad
Team

Hi Rob!
Nice product you and your team have come across.
However i would like to know how does it functions? Since it is for above knee amputees, does it function voluntarily on the basis of weight to move the knee or some other function it has?
What is the lifecycle of this product?
How are you planning to promote it in developing countries since it requires strong partnerships and legislation?

Photo of OpenIDEO
Team

Hi Rob Weiss and D-Rev Team! We’re excited to share with you feedback and questions from the Amplify team and an external set of experts. We encourage you to think about this feedback as you continue to improve and refine your idea. You are welcome to respond in the comments section and/or to incorporate feedback into the text of your idea. Your idea and all associated comments will all be reviewed during the final review process.

- We love that you are building upon an existing approach of providing affordable, high-quality prosthetic devices and implementing in this context. Great job!!!
- The core component of human-centered design is to start with desirability. What is your mode for engagement and outreach? What are the potential barriers facing your user? For example: will the new specifications make the product so expensive that the target group is not willing to pay it? Are there competitive products in the existing market?
- Tell us more about how you integrate your target user group into the design and development of your idea. Are there trainings or capacity building services offered to your target user group?
- We want know more about your vision for bringing your product to the market. Do you have specific hypotheses you want to test as you expand your model? What are your measures for quality control? Are you manufacturing in the regions you distribute to or is it centralized ? If so, does freight add significantly to cost of your products?

In case you missed it, check out this Storytelling Toolkit for inspiration for crafting strong and compelling stories: http://ideo.to/DXld5g Storytelling is an incredibly useful tool to articulate an idea and make it come to life for those reading it. Don’t forget - June 4 at 11:59PM PST is your last day to make changes to your idea on the OpenIDEO platform.

Have questions? Email us at amplify@ideo.org

Looking forward to reading more!

Photo of Rob Weiss
Team

Hi IDEO team - thanks for some great Qs!
1. "What is your mode for engagement and outreach? "
One of the trickiest parts of our work is that our team is small and San Francisco-based: we don't yet have teammates permanently based in our target markets. We do a couple things to overcome this. Firstly, we work through great partners. Clinical partners in India, Guatemala, Ecuador, Indonesia, Cambodia, and elsewhere have given us excellent feedback on the ReMotion knee as it's undergone multiple iterations, including 4+ rounds of patient trials (including one completed just last month). Through the help of these professional prosthetic clinicians and staff, we've made improvements to the design, functionality, and manufacturability of the current iteration of the knee. Another tactic we use to compensate for not having staff "on the ground" is that we travel to our users. A lot. As an example, I spent 9 months of my first year at D-Rev in the Philippines, Kenya, Ethiopia, Indonesia, Cambodia visiting clinical sites. We've been to all of the partner clinics previously mentioned for multiple, lengthy stays. Finally, we hope this grant will empower us with the financing to spent more time overseas and potentially expand our on-the-ground presence in one or two target markets for ReMotion Pro. One area I'd like us to improve is by connecting more with patients and patient advocacy groups out side the clinic; we've spent a lot of time with clinicians and individuals while they are in the clinic, but being within earshot of the care provider can of course bias their reported satisfaction with the limb they're getting!

2. The biggest anticipated barrier to reaching our targeted users is the disconnect between early adopters of a new technology - internationally-oriented, highly computer-literate, typically relatively well-off -- and the people we believe are least served. The distribution challenge of reaching low-income rural users is one we will have to iterate on just as much as the design. There are some organizations - including Exceed Worldwide, BMVSS, Mobility India, Puspadi Bali, Range of Motion Project - that have in their mission to expand prosthetic care access. Yet, much of the population remains served by low-resource government efforts that have limited effectiveness, or are ignored by private prosthetic facilities that need to offer higher-end components to make a profit.

3. "Will the new specifications make the product so expensive that the target group is not willing to pay it?"
Fair question. While cost can be a huge barrier, I actually don't anticipate the Cost of Goods Sold (COGS) to increase dramatically due to design changes. As a non-profit, D-Rev's model is for our products to be financially sustainable after they hit the market. One benefit is that the initial investment / R&D costs don't need to be recouped on the market, so the relative expense of the engineering work we do to modify the design or add in new features isn't reflected in the end-user price. What would be reflected in the price is any additional materials costs, i.e. the variable cost of making a knee. These costs usually aren't too high (I could see an increase of maybe 25%), and could be paired with concurrent component cost reductions in other areas.

4. "Are there competitive products in the existing market?"
Yes. The International Committee on the Red Cross (ICRC) makes a knee joint that is fairly common in rural areas. We built the ReMotion knee in part on the belief that customers were poorly served by only having access to that one type of knee - as a single-axis locking knee, it's not what would be prescribed in a high-income country for a young-active patient. There are also "caliper style" exoskeletal knee joints, which cost dollars to produce but are an antiquated technology that is even more clearly inappropriate and disempowering for young, active patients.

Photo of Rob Weiss
Team

5. "Tell us more about how you integrate your target user group into the design and development of your idea. Are there trainings or capacity building services offered to your target user group?"

Training is a critical factor in success of this product, although to be very clear, D-Rev is not interested in teaching prosthetics. It's not our skill-set, and there are excellent organizations (ISPO, Exceed) that ably and actively fulfill this role by supporting modern, high-quality standards of prosthetic training all around the globe. What we do believe in is supporting our customers, who are highly trained and typically ISPO-certified prosthetists, with the information they need to use our knee with max efficacy. For the ReMotion Knee, we've put together a series of training videos showing fabrication with different socket types commonly used in our target markets, and demonstrating proper alignment and tips for gait training. We're also partnering with practitioners to launch an inaugural day-long credit course in India in July. Each ReMotion Knee also comes with our Instructions for Use: a clearly-worded and highly visual guidebook that indicates proper use, patient selection, and alignment tips. All three of these resources -- the IFU, 1-day course, and video series - were developed with iterations based on multiple rounds of feedback from users.

6. We want know more about your vision for bringing your product to the market. Do you have specific hypotheses you want to test as you expand your model? What are your measures for quality control? Are you manufacturing in the regions you distribute to or is it centralized ? If so, does freight add significantly to cost of your products?

Currently, we manufacture and hold inventory centrally and distribute globally (hub-and-spokes model). We have an excellent and synergistic working relationship with our manufacturing partner, and manufacture in an ISO 13485 (medical grade) facility, having passed ISO 10328 (structural testing for lower-limb prosthetics). As a result ReMotion was able to receive CE mark and is registered with the FDA, standards we would hold ReMotion Pro to as well. With the $80 ReMotion Knee we demonstrated this level of quality could be achieved with an affordable end-user price. Internally at D-Rev we follow professional quality control procedures and recently passed a routine FDA audit.

Freight does add to the cost of the product, but we've been fortunate to have an excellent partnership with DHL which allowed us into their NGO program and offers door-to-door global shipping (destinations outside the USA) at a fraction of their typical rates. We've gotten rates down to approximately $5-10 / knee for most countries for a typical small order, and less for higher volumes. We've shipped successfully to customers in 20 countries, including arranging complex pick-ups from individual patients and returns management. This is an area we think we can add value by offering smooth and cost-effective service to customers used to difficult logistics and long lead times, and continue to improve in coming years.

Photo of Lesa R. Walker MD, MPH
Team

Rob Weiss This is an exciting project! Such a prosthetic could make such a difference in the lives of people who have above the knee amputations. Do you already work with key partner organizations in the countries that you will be serving with your idea? Since 2 countries you will be serving are Kenya and South Africa, you might consider sharing your idea with the OpenIDEO Nairobi Chapter (https://beta.openideo.com/chapters/28) and the OpenIDEO Johannesburg Chapter (https://beta.openideo.com/chapters/22) to gain feedback and perhaps develop connections and relationships.

Photo of Rob Weiss
Team

Thanks Lesa R. Walker MD, MPH ! We have key partners in some regions, particularly Central America (ROMP is one), and Southeast Asia (Exceed is another), and East Africa (through our other, non-prosthetic medical devices). Great idea to share with the Nairobi and Joberg chapters - our team just returned from South Africa where we see an excellent market for a high-quality prosthetic knee geared for low-income users, and I visited prosthetic facilities in Nairobi in 2014 (nearby Tanzania has a center of excellence as well).

Photo of Lesa R. Walker MD, MPH
Team

Rob Weiss  Wonderful! I've visited Nairobi. I know a physician there. I also visited Maai-Mahiu several years ago and participated in the "Ubuntu" project (also participating in this Challenge). Maai-Mahiu is about 1.5 hrs SW of Nairobi. There may be some connections for you.

Photo of Stephan Hitchins
Team

More than five years after crashing in an Iraqi desert, crushing his spine on impact, retired US Army pilot Gary Linfoot will walk again on Veterans Day thanks to INDEX: Award 2013 Finalist EksoTM.

http://designtoimprovelife.dk/paralyzed-army-veteran-to-walk-again-using-index-award-winning-exoskeleton/

Using the INDEX: Award 2013 Finalist EksoTM exoskeleton that straps onto his waist and legs, Gary Linfoot will make the historic steps twice on Monday: once on NBC’s “Today” show and later in the afternoon at the Statue of Liberty. The retired U.S. Army Chief Warrant Officer and former pilot with the “Night Stalkers” of the 160th Special Operations Aviation Regiment (SOAR) told The Leaf-Chronicle the $125,000 unit will allow him to someday walk his daughter down the aisle, an unthinkable task just a few years ago.

http://designtoimprovelife.dk/

Photo of Rob Weiss
Team

Amazing stuff, Stephan. I've had the fortune to see one of these exoskeletons in real life and it truly is unbelievable what it can allow people to do.

You mentioned Bespoke Fairings in an earlier posting. While obviously $4K-6K is out of range for the people D-Rev aims to reach -- and in fact, these really cool "stand-out" prostheses are generally not culturally acceptable in some of the regions we reach - I think the principle remains the same. That people everywhere deserve good design, design that empowers them to meet their goals both functional and cosmetic, and puts the patients' goals, not the designer's, at the center of the experience.

Photo of Merel Rumping
Team

Keep up the good work Rob Weiss and other D-rev team members! :-)

Photo of Rob Weiss
Team

Thanks Merel Rumping  back atchya!

Photo of Stephan Hitchins
Team

So many individuals need help with prosthetics and here is another organisation working along the same lines. All of you should be applauded and supported.

http://designtoimprovelife.dk/mobility-trends-exoskeletons/

In 1969 Neil Armstrong walked onto the moon. In 2012 Claire Lomas – a paraplegic former event horse rider – finished the London Marathon on her own two feet. From science-fiction fantasy to commercial reality, a handful of our nominees belong to a new breed of wearable robotics called exoskeletons that enable man to walk again after disabling spinal cord injury.
Akin to animal exoskeletons, powered exoskeletons are worn like a suit. Though the first exoskeleton was developed as early as 1890, the technology could not keep up with the ambition. The second generation – aptly named Hardiman – was developed by General Electrics in collaboration with the United States military in 1960. Hardiman was designed to amplify the wearer’s strength by a factor of 25 – making loads of 110kg seem like 4.5kg. However, it was too clunky, jittery, and above all heavy to put to use.

These early generations of powered exoskeletons were geared towards making man superhuman by amplifying strength and endurance for military use, as well as creating protective layers for firefighters and rescue services operating in dangerous environments. But a new breed of exoskeletons aims to do the impossible: allowing paraplegics to walk, and giving amputees their hands back!

Photo of Stephan Hitchins
Team

So many individuals need help with prosthetics and here is another organisation working along the same lines. All of you should be applauded and supported.

http://designtoimprovelife.dk/mobility-trends-exoskeletons/

In 1969 Neil Armstrong walked onto the moon. In 2012 Claire Lomas – a paraplegic former event horse rider – finished the London Marathon on her own two feet. From science-fiction fantasy to commercial reality, a handful of our nominees belong to a new breed of wearable robotics called exoskeletons that enable man to walk again after disabling spinal cord injury.
Akin to animal exoskeletons, powered exoskeletons are worn like a suit. Though the first exoskeleton was developed as early as 1890, the technology could not keep up with the ambition. The second generation – aptly named Hardiman – was developed by General Electrics in collaboration with the United States military in 1960. Hardiman was designed to amplify the wearer’s strength by a factor of 25 – making loads of 110kg seem like 4.5kg. However, it was too clunky, jittery, and above all heavy to put to use.

These early generations of powered exoskeletons were geared towards making man superhuman by amplifying strength and endurance for military use, as well as creating protective layers for firefighters and rescue services operating in dangerous environments. But a new breed of exoskeletons aims to do the impossible: allowing paraplegics to walk, and giving amputees their hands back!

Photo of Stephan Hitchins
Team

Maybe this is something or a potential link / networking opportunity?

http://designtoimprovelife.dk/bespoke-fairings/

25,000 people are injured by landmines every year due to war, disease and traffic accidents, etc. and all these people are in need of functional prosthetics – prosthetics that until now have been a one-size-fits-all solution. By carefully measuring body movements and their angles, designer Scott Summit is thus able to develop amazingly cool custom limbs. They are called ‘Bespoke Fairings’ and bring a whole new dimension to prostheses – and more importantly, to the people needing them.

Photo of Stephan Hitchins
Team

Great work. I came across this link and thought it may be relevant. Not sure if you have seen it.
"Often overcoming the physical barrier is only half the battle when we’re faced with life-changing health issues. The only way forward is through holistic solutions that also address the emotional and social aspects of a challenge, allowing us to recover faster and live long and productive lives. One incredible example is 2015 INDEX: Award Finalist, IKO, a children’s prosthetic system that turns a challenge into a truly creative opportunity".
http://designtoimprovelife.dk/2015-finalist-carlos-arturo-torres-tovar-iko/

Photo of Rob Weiss
Team

Hi Aaron Huffman ,
Thanks for your questions. To add some context that might be helpful: the typical above-knee prosthetic limb consists of a socket (where the residual limb interfaces with the prosthetic), some sort of socket liner (or a simple sock in low-income areas), a socket-knee adapter, the knee, the pylon/shank, a pylon-foot adapter, and a foot. Often there will be a cosmesis cover that goes around the prosthesis as well. The socket is custom-made for each patient (as is the cosmesis), and the rest of the components are off the shelf: selected, adjusted and fit by the prosthetist.

To answer your questions:
In clinics we visit, the knee joint usually makes up about half the cost of building the overall limb (which is one reason we work on the knee joints, because it is typically the costliest component).
Labor is a huge factor in the USA - a skilled prosthetist can take years to become excellent at making an accurate, comfortable sockets. In very low-income countries the same applies except that, unfortunately for the profession, salaries / wages are quite low -- by our standards, but also often even in comparison to other medical professionals like doctors in those countries.
The clinic determines the materials used for the limb: they will select the components like the knee, and the raw materials used to make the definitive socket (often carbon fiber in the USA, but a thermoplastic or laminated resin in the places we work).

Photo of Aaron Huffman
Team

Rob,
Great job!  I am very impressed by the amazing accomplishments your team has accomplished.  I can't even imaging the positive impact you have had on creating a better quality of life for those you have helped. 

I have a few questions about the design and how it incorporates into the completed prosthetic.  I am sure each patient has  a very different situation which may make some of my questions hard to answer accurately.  What percentage of the total cost of the prosthetic is the knee joint?  Furthermore, how much of a factor is labor in the total cost?  Is it up to the clinic to determine the materials used for the limbs? 

Thanks for the contribution.

Sincerely,

Aaron