Expert voice: meeting with Kilian, ortho-prosthetist.

Hello Kilian, how and when did you discover U-exist?

I worked for two large orthopedic groups and discovered U-exist through that. My job is to buy the overlays and install them on the patients' prostheses. 

Why did you want to testify?

To me, it is obvious that the aesthetics of a prosthesis is not just about camouflage. We are fortunate today to have much more acceptance of disability, patients who want to show more and more that they have a prosthesis and I think that is a very good thing. 

When I saw your call for witnesses I thought of my last patient. A lady of about 70 years old, very dapper, full of life, always dressed in pink... the first time I saw her two years ago, I had the reflex to suggest a basic prosthesis, because that's what she had always worn. But the next time I saw her pink anti-covid mask with flowers, I thought "but why not offer her a U-exist prosthesis?" 

We looked together on the website, I filtered "pink" (laughs), and she was super happy. She's been wearing them for 40 years, and she told me she's never had a prosthesis that looks this good. That's what I think is great, because it's for all ages. Before this patient, I had the bad habit of only offering U-exist designs to patients under the age of 30. Now I routinely offer them. 

In general, do you have the impression that the customization of prosthesis is more and more requested or on the contrary, that we still remain on this will to camouflage?

I don't know if it's because of the connection I have with my patients and the way I offer them or if it's more personal, but every time I offer customization, they do it. 

It is much more accepted today. To give an example, before I met you, I used to offer children and their parents a t-shirt with a design on it, which I would cut out and fit to the prosthesis. Since I have known U-exist, I find it nice to have another shape to give to the whole. 

Do you think that the acceptance time can be longer or shorter before you really take on your prosthesis?

The main thing I think is that not enough patients are offered the opportunity to have a custom prosthesis. In reality, it depends a lot on how the professional brings up the subject with them. If you take a patient who has just come out of rehabilitation, depending on how you talk to him about his prosthesis, he will not consider it in the same way. Some will have a purely technical and medical discourse, others will bring in the identity side: "here is your prosthesis, it is you, it is your life, what do you want to do with it?" 

Unfortunately most of the time I feel that they are offered the basic camouflaged trial prosthesis scheme, and only later in the process will they be offered something different. 

You mean it hasn't become a reflex among the pros to offer customization?

Clearly not. For me the defect today comes almost more from us, professionals. For example, I systematically propose to the young people to do the customization, but for the not so young people it is them who ask me. I really think it's more a fault of ours, we should have the same reflex for all ages. There is also the financial aspect which can slow down, whereas customization is the same, or even less expensive than an aesthetic foam.

Why do you think this is?

On the whole, these are old reflexes and we must hope that habits will gradually change. For example, at ISPO, almost all the prostheses presented to the public are customized and I think that any prosthetist knows U-exist. So at the same time we want to show this image and yet in reality we don't apply it systematically. 

It also depends on the type of prosthesis. Out of habit, a corset is never offered without patterns or colors. But it's just out of habit, there's no particular reason. For me, it's part of the old reflexes that we all have in life that don't really have any logic. Of course, it depends on the patient, some are not particularly open to it either. 

A project with U-exist that you would like to tell us about?

I once had a 62-year-old man with a femoral prosthesis. He was a very active person who liked to move, quite young in his mind. He had a foam liner but wanted a socket with the fractal black carbon effect. It's funny because there is not a big difference with the raw carbon color, but for him it still had this little extra cachet, it was a way of saying "it's my prosthesis, it's my life".It's my prosthesis, it's my fabric and I choose."

Do you think that the view of disability has changed?

Yes, since I started practicing in 2009 I think that mentalities have changed a lot, in a good way. Before 2015-2016, it was still rare to come across someone with a simple prosthesis, because the reflex was to hide it. Today, I can easily see people wearing shorts or a skirt with a prosthesis. Before, it was simply inconceivable for my patients. It is still a source of pride today when I pass these people on the street, I always want to go up to them and congratulate them, to tell them to be proud of themselves. 

How do you view the various innovations in the orthopedic field?

It's mostly from an aesthetic point of view in my opinion, even if it's already very good. Now we need to develop the ecological side, if someone could find a durable resin and fabric, it would be perfect. It doesn't exist today, it's always the same materials since I started working. I think there are really things to do... not to mention some aberrations that persist, for example the corset is very well recycled thanks to its polyethylene material, except that it costs too much so nobody does it. 

Many patients are wondering how to upcycle their prostheses. Any ideas?

Yes, many patients ask me if they can be recycled. Metals can be recycled, but unfortunately today the sockets cannot be recycled. This is a subject that deserves to be explored, can we give a second life to our prostheses?