New Amputations SIG Lead, Rebecca Williams, details the latest Genium knee prosthetic and analyses its impact on complex injury claims, in consultation with Abdo Haidar, Consultant Prosthetist at the London Prosthetic Centre.
On 11 September 2024, Ottobock released the Genium X4, which they have branded as, “a truly next-gen microprocessor knee,” with “groundbreaking design, unrivalled durability, and pioneering technology.” Descriptions aside, what have we learnt so far in the context of future prosthetic claims for ampute
The X4 is a non-powered knee joint, which has similar technology to previous models, but with improved function. It has replaced the X3 and Genium models as of September 2024, which means that the older versions have now been discontinued. For current Genium and Genium X3 users, however, warranties will remain valid, which means that repairs and servicing for those devices will still be available until the end of their serviceable lifetime (six years).
Price
The X4 is undoubtedly more expensive than the X3, but arguably the increase is a small price to pay for what Ottobock promise will result in significant functional improvements. The difference in costings has been summarised as follows by Abdo:
Note, the prices above are for the knee joint only with a six-year warranty.
Performance
The X4 moves closer towards a smooth and natural gait, making it easier to move in crowded spaces, due to real-time control and support for taking small steps in tight spaces (smaller hydraulic cylinder). The microprocessor calculation is faster and therefore the knee adapts quicker to different walking patterns (safer in stance and more natural in swing). There is also enhanced support for dynamic backward movement.
Key feature
One of the key features is the transition to the new Connectgo.pro app instead of computer software, which supports expert configuration and customisation. During fitting, prosthetists can use the app to fine-tune a range of parameters to fit that specific user’s gait.
Use in rehab
It is anticipated that prosthetic limb users will be able to use the X4 earlier in their rehabilitation journey than the X3. The Genium X4 is recommended for Mobility grade/K level 2-4 while the X3 is recommended for Mobility grade/K level 3-4.
Reduction of future MSK issues
The more natural movement pattern of the prosthetic knee joint is likely to lead to reduced compensatory movements of the pelvis and upper body, therefore reducing the likelihood of future MSK issues.
Weight
The X4 is lighter than the X3, weighing 1.6 kg to the X3’s 1.71kg. It has a smaller hydraulic unit and therefore feels lighter when the knee flexes and extends in space.
Battery life
The new prosthetic has a long battery life of up to five days (depending on level of use), similar to the Genium X3, with quick-charge capability. There is Bluetooth connection and a magnetic charging socket, which provides secure charger connection to the knee joint with USB options for the power supply.
Customisable covers
There are a range of optional customisable covers, to include those which are functional, protective or cosmetic. These covers can be chosen to suit an individual’s daily activities and/or personality. They can, for example, be decorated with spray paint or stickers.
Bilateral users
It is anticipated that the new features on the X4 will provide remarkable benefits to bilateral users, although there will be clear benefits to unilateral users also.
Waterproof
The X4 is IP68 rated, remains fully waterproof against all water types (fresh, salt and chlorinated) and is corrosion resistant. It is the only MPK on the market with these capabilities.
Maximum body weight
The weight remains the same as the X3, at 150kg.
Mandatory service schedule
This differs from the X3, and is now either every two years, or, when the knee joint reaches a 2.8 million step count; whichever event happens first.
Note that Abdo suggests the socket fitting remains the most important element of the prosthesis and is the main determinant for good mobility and outcome.
According to an upcoming publication produced by Ottobock relating to Genium X4 users in Germany, feedback over a period of 14 weeks included the following:
As with any other prosthetic limb, a claimant wanting to purchase the Genium X4 will need to undertake a closely monitored trial and we need to see clear, objective outcome measures, gait analysis and energy consumption tests etc. to be interpreted and commented upon by Part 35 experts in prosthetics.
Trials of the X4 are already taking place and we have seen reports of users feeling more confident walking than they had ever felt before with the new device. There have been reports of feeling that the limb is lighter, resulting in one user feeling more confident to access restaurants and public places than they had previously. The same user was able to walk 30 metres further on the 2 Minute Walk Test and managed the 6 Minute Walk Test with no problems on the X4, despite being unable to complete that previously with the Genium.
Such improvements are likely to result in a more positive psychological outcome for prosthetic limb users and an increase in confidence to access the workplace, for example. Obviously this, in turn, should have a positive impact for insurers in terms of any claim for loss of earnings. The hope therefore is that the increased costs associated with the more expensive X4 limb will improve function to the extent that other heads of loss, to include care and earnings, are reduced substantially.
However, one issue that we have already seen being raised is whether it is reasonable for there to be provision of two limbs, such as the Genium X4, for everyday use in a unilateral amputee. We have already seen reports from claimant’s experts costing for two X4 devices, effectively suggesting that one is used as a spare. This again will be a question for a Part 35 expert in prosthetics, as to whether there is a clinical need for a second X4 to be used as a spare in the event that a mechanical issue were to occur to a user’s day-to-day prosthetic. It is likely to be argued by defendants that there is no reasonable need for two prostheses equipped with the most advanced knee joints on the market.
Prosthetic experts should be asked to comment within their reports on what they would recommend in the unlikely event that a mechanical problem presents with the claimant’s X4. Our understanding, however, is that at any time within the warranty period of six years, the claimant’s private clinic will request an identical loaner joint, which is usually delivered within two days. It is therefore likely to be argued in Counter Schedules of Loss that it is disproportionate for provision of two limbs, such as the Genium X4, to be provided. The waterproof and durability features of the X4 should also mean that there will be strong arguments against a separate water activity prosthesis being prescribed.
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