20A: Transfemoral Amputation | O&P Virtual Library
Energy cost of walking in transfemoral amputees: Comparison between Marlo Anatomical Socket and Ischial Containment Socket
Custom Prosthesis Abroad, Above & Below Knee …
The friction-brake stance control (safety) knee is probably the second most frequently utilized component. Because there is very little increase in cost or weight and reliability has been good, many clinicians feel that the enhanced knee stability justifies this approach, particularly for the novice amputee. Missteps causing up to 15 degrees of knee flexion will not result in knee buckle, which makes gait training less difficult for the patient and therapist. The major drawback to this knee is that the limb must be non-weight bearing for knee flexion to occur. Although this generally presents no problem during swing phase, some patients have difficulty in mastering the weight shift necessary for sitting. It should be noted that use of such knee mechanisms bilaterally must be avoided. Since it is impossible for the amputee to simultaneously unload both artificial limbs, sitting with two stance control knees becomes nearly impossible.
Other than the exception discussed above, knee mechanisms are selected by the same criteria as for transfemoral (above-knee) amputees. The single-axis (constant-friction) knee remains the most widely utilized due to its light weight, low cost, and excellent durability. Friction resistance is often eliminated to ensure that the knee reaches full extension as quickly as possible. A strong knee extension bias enhances this goal and offers the patient the most stable biomechanics possible with this mechanism. Although the single-axis type was proposed as the knee of choice for the Canadian hip disarticulation design, more sophisticated mechanisms have proved their value and are gradually becoming more common.
Hip Disarticulation Prosthesis at Award Prosthetics
Although wearing a transpelvic or hip disarticulation prosthesis may be cumbersome, when fitted within a few weeks of amputation, the initial acceptance rate appears to be similar to that for transfemoral amputation. Immediate postoperative fitting is technically feasible but rarely performed today. Long-term wearing rates increase significantly when sockets are comfortable, flexible, and carefully aligned. In view of the magnitude of loss at this level, application of newer, sophisticated joint and foot mechanisms is often helpful. Every case requires review on its own merits; careful attention to socket design, components, and alignment ultimately determines the effectiveness of the prosthesis.
The most important part of any prosthesis is the socket, which provides the man-machine interface. During the initial assessment of the amputee, examination of postoperative radiographs and careful palpation of the pelvis are recommended. Some amputees present as "hip disarticulation" when they have a short femoral segment remaining or as "transpelvic" when part of the ilium, sacrum, or ischium remains. Unanticipated bony remnants can become a puzzling source of discomfort. On the other hand, they may sometimes be utilized to assist suspension or rotary control or to provide partial weight-bearing surfaces. Due to the success of ischial containment transfemoral sockets, the importance of precise contours at the ischium and ascending ramus is now more widely recognized. The same principles can readily be applied to hip disarticulation sockets to increase both comfort and control (Fig 21B-11.).
Lower Extremity Prosthetics - The London Prosthetic Centre
MSAC - Medical Services Advisory Committee
POA - Prosthetic & Orthotic Associates
Prosthesis - Wikipedia
Amputations - Trauma - Orthobullets
Scott Sabolich Prosthetics & Research » About Us
A person's prosthesis should be designed and assembled according to the patient's appearance and functional needs
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