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Prostheses

The principal lower limb prostheses are


Partial foot prostheses
Symes prosthesis
Transtibial prostheses
Transfemoral prostheses
Knee disarticulation
Hip disarticulation
Partial Foot Prostheses
Purpose
1. Restore foot function particularly in walking
2. Simulate the shape of the missing foot
segment
. Indications
1. Loss of one or more toes
2. Transmetatarsal amputation
3. Amputation or disarticulation through
tarsals
Partial Foot Prostheses
Loss of one or more toes
Pad the toe section to improve appearance of the
upper section of the shoe
Arch support to maintain alignment of amputated foot.
Transmetatarsal amputation
Plastic socket to protect amputated ends of the
metatarsals
Rigid plate restores the foot length
Toe filler
Rocker bar at the bottom of the prosthesis to aid late
stance.
Partial foot prostheses
Amputation or disarticulation through
tarsals
Prostheses used in transmetatarsal
amputation augmented with a plastic
calf shell which is strapped around
the leg.
Trans-tibial Prostheses
Trans-tibial level refers to -
Amputation in which tibia and fibula
are transected
Retention of anatomical knee joint
Intact motor and sensory functions.
Indicated in vascular diseases.
Parts of Trans-tibial
Prostheses
1. Foot-ankle assembly
2. Socket
3. Shank
4. Suspension component
Foot-ankle assembly
Uses
Restores contour of the foot
Absorbs shock at heel contact
Plantarflexes in early stance
Simulates metatarsophalangeal
hyperextension in late stance phase
In neutral position during swing
phase
Foot-ankle assembly
Types
Non-articulated feet
1. SACH foot (solid ankle cushion heel)
2. SAFE foot (stationary attachment
flexible endoskeleton)
. Articulated feet
1. Single-Axis feet
2. Multiple-Axis feet
SACH FOOT (Solid ankle Cushion Heel)
SAFE FOOT ( Solid Ankle Flexible
Endoskeleton)
Shank
Substitute for human leg
Restores length and shape
Located above foot-ankle assembly
and below socket in transtibial
prostheses
Types
Exoskeleton shank
Endoskeleton shank
ENDOSKELETON EXOSKELETON
Socket
Uses
Maximum distribution of load
Assist in venous blood circulation
Provide tactile feedback
Patellar tendon bearing (PTB) socket
has a prominent indentation over
patella tendon.
Socket has reliefs and build-ups
Structure of Socket
Reliefs-concavities in the socket over areas
contacting sensitive structures such as
bony prominences.
Located over
i. fibular head,
ii. tibial crest,
iii. tibial condyles and
iv. anterior-distal tibia.
. Posterior brim is trimmed to provide room
for hamstring tendons
Structure of Socket
Build-ups- convexities n the socket
over areas contacting pressure-
tolerant tissues.
Located over
i. belly of gastrocnemius,
ii. patellar tendon,
iii. proximomedial tibia (pes anserinus)
and
iv. tibial and fibular shafts.
Alignment of Socket
On the shank in slight flexion and in slight
lateral tilt.
Flexion
i. enhances loading on patellar tendon,
ii. prevent genu recurvatum,
iii. resist tendency of amputated limb to
slide too deeply into socket,
iv. facilitates contraction of quadriceps
muscle
. Lateral tilt reduces loading on fibular head
Types of socket
Lined socket
i. Made of polyethylene foam liner, silicone
ii. Liner adds or reduces volume of the socket
iii. Adds to the bulk of the prosthesis
iv. Heat insulator
v. Reduces risk of abrasion between socket and skin
. Unlined socket
i. Made of thermoplastic material
ii. Usually given when stump has stabilized in volume
iii. Easier to clean
iv. Difficult to alter the shape of the socket.
Suspension
Prosthesis requires some from
suspension to hold it in place while
walking or climbing stairs or jumping.
Types of suspension
i. Cuff variants
ii. Distal attachment
iii. Brim variants
iv. Thigh corset
v. Vacuum-assisted socket system
Transtibial PTB
PTB SC/SP
prosthesis
Trans-femoral prosthesis
Components
Foot-ankle assembly
Shank
Knee unit
Socket
Suspension device
Knee Unit
Knee units have four features:
Axis
Friction mechanism
Extension aid
Mechanical stabilizer
Knee Unit: AXIS SYSYTEM
Two types of knee units
i. Single axis
ii. Polycentric linkage
a) 4 or more pivoting bars
b) Provide greater stability
c) center of knee rotation in posterior
to weight bearing line
Knee Unit: FRICTION
MECHANISMS
Change the knee swing by modifying
speed of knee motion during swing
phase
Affect knee swing according to
walking speed.
Two factors affecting friction
mechanism are
i. Time during swing phase when
friction affects knee joint
ii. medium through which mechanism
Knee unit:FRICTION
MECHANISMS
Constant friction
i. Clamp grasping knee joint
ii. Amount of friction is unvarying in swing phase
iii. Manually adjusted to loosen or tighten
. Variable friction
i. Amount of friction is variable in swing phase
ii. Early swing high friction
iii. Mid-swing friction diminishes
iv. Late swing -friction increases
Knee Unit: FRICTION MECHANISM

Medium
Sliding friction
Fluid friction
- hydraulic friction
- pneumatic friction
Microprocessor controls
Knee Unit: EXTENSION AID
A mechanism to assist knee
extension during latter part of swing
phase
Types-
i. Elastic webbing
ii. Internal extension aid
Knee Unit:STABILIZERS
To increase stability of knee unit
Hip motion controls knee action, aided by
alignment of knee in relation to other
components of prosthesis
Knee joint is aligned posterior to line
extending from trochanter to ankle (TKA
line)
Types
i. Manual lock
ii. Friction brakes
SOCKET
Pressure tolerant
areas
Gluteal
musculature Pressure sensitive
Sides of the thigh areas
And distal end of Pubic symphysis
amputated limb Perineum
Types of socket
Ischial Containment
Quadrilateral socket socket
i. Post wall-ischial tuberosity i. Contoured adducted
+ gluteal muscles trochanter-controlled
ii. Ant wall- applies post alignment method.
directed pressure ii. Covers ischial tuberosity
iii. Lat wall- aid in medio- and part of ischiopubic
lateral stabilization ramus to increase
iv. Med wall stability.
Reliefs iii. To increase frontal
v. Antero-medial stability medial-lateral
vi. Postero-medial width is narrow.
vii. Antero-lateral iv. Lateral wall covers
viii. Postero-lateral greater trochanter.
Suspension
Suction suspension
i. Refers to pressure differences inside and outside the
socket.
ii. In suction suspension,(int socket press) < (ext
pressure), therefore atm press. causes the socket to
remain on the thigh
iii. One-way air-release valve enables residual air to be
expelled
iv. Types of suspension are
a) total suction,
b) partial suction and
c) no suction
Suspension in Transfemoral
Prosthesis
FIT AND ALIGNMENT
FIT
i. Snug fitting to minimize chaffing
and maximize control
. ALIGNMENT slight socket flexion
i. Facilitates contraction of hip
extensors
ii. Reduce lumbar lordosis
iii. Allows equal step length
DIFFERENT TYPES OF LOWER LIMB
PROSTHESIS
KNEE DISARTICULATION
PROSTHESIS
Excellent prosthetic
control because
i. Thigh leverage is
maximum
ii. Body weight can be
borne through distal
end of femur
iii.Epicondyles provide
rotational stability
HIP DISARTICULATION
PROSTHESIS
Indications
i. Amputation above greater
trochanter (short transfemoral)
ii. Removal of the femoral head from
acetabulum (hip disarticulation)
iii. Removal of femur and portion of
pelvis (transpelvic amputation)
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