Restoring Limb – and Lives

Led by John Horne, an amputee himself, the team at Independence Prosthetics treats patients with skill and sensitivity

As a freshman at St. Mark’s High School in 1989, John Horne faced up to an unexpected challenge and took the first steps toward what would become his career.

Just before that first year of high school, he began experiencing swelling in his right ankle. The problem went on for six months, never getting better. Then, over the Christmas holiday break, doctors at the Alfred I. du Pont Children’s Hospital rendered a diagnosis: bone cancer.

At 15, Horne became an amputee, losing his right leg just below the knee. Before the winter was over he was at a therapy camp in the Poconos, learning how to ski on one leg and getting ideas for the type of prosthetic he would like to have for himself.

By his senior year at St. Mark’s, he was still skiing—until his prosthetic broke in half when he took a fall on a downhill run. “Here I was, getting a cast for a new prosthetic,” Horne recalls, “and I looked around and thought, ‘I can do this.’”

At that moment, the idea for Independence Prosthetics and Orthotics was born. The delivery didn’t occur until 15 years later—2007—as Horne earned his college degree, then worked at a series of hospital management jobs, learning more about prosthetics every step of the way.

Today Independence has 30 employees at five locations, the newest having opened in mid-September on the University of Delaware’s STAR Campus, the former Chrysler assembly plant site.

Independence doesn’t make the actual artificial legs, knees and hands that amputees use to restore as much normalcy as possible to their lives. Rather, Independence’s role is to help the patient choose the appropriate device and then manufacture the “socket” that attaches to the device and fits over the stump of the amputee’s leg or arm. Independence’s professional staff custom fits the socket, adjusts the prosthetic device, trains the patient in how to use and care for the artificial limb, and provides follow-up services when needed.

That includes making sure the microprocessors and all the high-tech electronics and mechanics that make up each device are working properly.

Customers credit the success of the business to Horne’s sensitivity and to the caring attitude of his staff.

“He’s an amputee himself, so he’s very sympathetic to our needs and understands the equipment that we will be using,” says Rick Hofmann, 70, of Newport, who lost a leg in a motorcycle accident 21 years ago and turned to Horne shortly after Independence opened because he was dissatisfied with other prosthetics specialists he had used.

Jocelyn Wong, clinical director, modifies a below knee mold at the Independence Prosthetics Orthotics new office at the UD STAR campus, Monday, Sept. 21, 2015. Photo by Tim Hawk
Jocelyn Wong, clinical director, modifies a below knee mold at the Independence Prosthetics Orthotics new office at the UD STAR campus, Monday, Sept. 21, 2015. (Photo by Tim Hawk)

“I didn’t want to be there,” says Benita Beckham, 51, of Dover, recalling her first visit to Independence in March 2013, three months after her leg was amputated below the knee due to complications from diabetes. “The fact that my leg was gone was bothering me. I was mad at everybody.”

And then her prosthetist, Pete Seaman, said, “I want to help you. You’ve got to meet me halfway.” A day later, she was walking on her new leg. “Independence has helped me reestablish myself,” she says.

Cost and Coverage

About 60 percent of the patients Independence treats need prosthetics because of diabetes and vascular issues, Horne says. Other common causes of amputations are traumatic injuries, electrocutions, auto accidents, certain cancers and congenital birth defects.

Prosthetics for below-the-knee amputees can cost from $3,000 to $10,000, depending on the patient’s needs; prosthetics for above-the-knee amputees cost from $12,000 to $50,000, and prosthetic hands run about $25,000, Horne says. A Delaware law, passed in 2012, requires private insurers to provide coverage equal to federal Medicare guidelines, which treat prosthetics as durable medical equipment, covered at 80 percent of cost, leaving the patient or a secondary insurance plan to pick up the remaining 20 percent.

Making the sockets is a complex task, starting with taking detailed measurements of the patient’s limb, making a plaster cast and making multiple adjustments to relieve high pressure on bony areas of limb.

“We’re customizing the interface to the body,” Horne says.

The socket usually consists of a carbon fiber outer shell that provides the strength and a plastic inner shell molded to the contours of the patient’s limb. The manufactured leg or arm is attached to the lower end of the socket. The amputee wears a special sock or sleeve over the limb; at the end of the sock is a pin, lanyard or other connecting device that slips through the bottom of the socket and firmly attaches to the manufactured leg or arm.

Appearance is Important

Independence fabricates the sockets at its Meadowood site, off Kirkwood Highway east of Newark. Two technicians who work in the fabrication lab, Steve Fine and Steve Sims, are themselves amputees. Their work can include creating outer shells for the artificial devices to give the patient’s new limb a natural appearance.

“Some people prefer to have [their prosthetics] exposed, more so with men,” Horne says. “But if a different look will make you wear it, as opposed to putting it in a closet, that’s what we want. I had one patient, a bilateral amputee, who wanted to be sure her leg looked good when she went to church. We’ve done camouflage, all sorts of things” to give limbs the appearance their users desire.

Once the socket is connected to the artificial leg or arm, prosthetists make final adjustments, things like tweaking the length of the leg or the angle where the ankle and foot are joined.

Children, because of growth spurts, may outgrow a prosthetic in a year, while an adult can expect one to last for three to five years. “I had a foot that lasted for seven years,” says Horne. “Then it snapped while I was moving a piece of equipment. I thought that was pretty good.”

Louis Freeman of Claymont lost his leg in an automobile accident when he was 17. Now 60, Freeman estimates that he has had at least 40 artificial limbs, but the best service he has received has been from Independence. “The others, they fit you with a prosthetic and you’re on your way,” he says.

Freeman, who calls himself “a pretty particular person,” says Jocelyn Wong, his Independence prosthetist, “understood what I wanted and was willing to work with me—how I wanted to be fitted, how I wanted to walk, what I wanted to do with my life.”
“Jocelyn has a way with amputees. She knew exactly what to do to adapt [my prosthetic] to the shape of my limb,” says Matt Eichler, 24, of Brookhaven, Pa., who lost a leg above the knee in an industrial accident in 2008 and turned to Independence after becoming unhappy with his previous provider. “It’s way better now than it was before.”

Steve Fine, prosthetics technician assembles a below knee socket at the Prosthetics Orthotics new office at the  Independence Prosthetics Orthotics new office at the UD STAR campus, Monday, Sept. 21, 2015. Photo by Tim Hawk
Steve Fine, prosthetics technician assembles a below knee socket at the Prosthetics Orthotics new office at the Independence Prosthetics Orthotics new office at the UD STAR campus, Monday, Sept. 21, 2015. Photo by Tim Hawk

Growth Industry?

“The reason we’ve grown is the way we treat our patients individually,” Horne says. “They go back to their physicians and to their therapists, and they tell everyone they know about their experience.”

While Independence continues to grow, Horne says he isn’t sure providing prosthetics can be considered a growth industry. “The population is aging and diabetes is prevalent. With that being the number one cause [of amputations], there’s reason to think it’s growing,” he says. “At the same time, there have been improvements in vascular surgery and salvage techniques, so from the medical side, surgical procedures are able to do a lot to restore and maintain the health of a person’s limb.”

Given that uncertainty, Independence’s expansion onto UD’s STAR campus—its other sites are in Dover, Philadelphia and Brookhaven—offers advantages that position the company for continuing growth.

“It will be a destination-type location,” Horne predicts, because its location is practically down the hall from three UD facilities with which it has informal partnerships—the Physical Therapy Clinic, the Delaware Rehabilitation Institute, and the BADER Consortium.

Horne, who lives in Wilmington with his wife, Joanna, and sons Joshua, 21, and Jonathan, 18, says that, taken together, “Delaware has the most comprehensive amputee clinic in the country.”

Physical therapy is often required as amputees adjust to their prosthetics, and the institute offers opportunities for collaborative research and BADER provides services to help military personnel and veterans with traumatic orthopedic injuries reach their highest level of function. “As BADER interacts and cares for their patients, we’ll see how their advances translate over to the general population,” Horne says.

“Not many services like ours have a relationship with a university,” he says. “We’re unique in the Mid-Atlantic region.”

Independence has built its reputation by providing exceptional patient care, Horne says, and access to the university’s facilities should make that care even better.