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Transfemoral Pros.

Transfemoral Prosthetics Presentation

QuestionAnswer
Prosthetic Knees Used on 90% pts
Patient Requirements- Physical Knee disarticulation; Transfemoral; Hip disarticulation; Hemi-pelvectomy; Bilateral; Pediatric; Adult; Geriatric
Knee Selection Criteria Functional- stability, maintenance, durability; Pt Priorities- function, durability, cosmetics, comfort
Knee Failure- Alignment Socket & components not set in appropriate alignment; Forces improperly interacting with components & causing premature wear; Pt has changed heel height adding stress to knee
Knee Failure- Inappropriate Use Knee used and stressed in conditions that system isn't designed for
Knee Failure- Proper Adjustment Knee adjusted incorrectly; Excessive friction & strong extension assist; stance screw too tight & swing screw too loose; Installed with non-compatible components (foot, pylon connectors)
Single Axis Advantages & Disadvantages A: Less moving parts & simple design; Lower fabrication costs D: Less stable at heel strike; One axis to absorb gait stress
Polycentric Advantages & Disadvantages A: Inherent stability at heel strike; Easy to initiate swing phase D: Tend to be heavier; Increased maintenance
Manual Lock Advantages & Disadvantages Fxnal level 1-2 A: xfer prosthesis or limited walking on level surfaces; simple design, non-flexing knee w/ standing/ambulation D: Pt must unlock knee manually to sit; If pt falls, knee doesn't collapse under them
Friction Knee Advantages & Disadvantages Fxnal level 1-2 A: Xfer prosthesis/limited walking on level surface; Simple design, fxnally acts like door hinge D: Friction setting allows only 1 walking speed; Friction plates wear, require regular maintenance/replacement
Stance Control Knee Advantages & Disadvantages Fxnal level 1,2,3 A: Added stability during misstep/uneven surfaces; Breaking mechanism locks knee during stance; Most popular in US; Lightweight D: Break will wear, knee will fail w/o proper adjustment/maintenance
Hydraulic Swing Phase Knee Advantages & Disadvantages Fxnal level 3-4 A: Hydraulic mech provides resistance to flex/ext during swing; Provides variable cadence (change walking speed w/o hesitation) D: Heavier b/c of hydraulic fluids in cylinder; Require regular maintenance
Hydraulic Swing & Stance Knee Advantages & Disadvantages Fxnal level 3-4 A: Hydraulic mech provides resistance to flex/ext during swing & stance; Provides stumble recovery & ability to walk down stairs/ramps D: Heavier b/c of hydraulic fluids; Require regular maintenance
Microprocessor Swing Advantages Fxnal level 3-4; Resistance to flex/ext during swing; Variable cadence (change speeds w/o hesitation); On board microprocessor analyzes gait, selects appropriate resistance for smooth swing
Microprocessor Swing Disadvantages Added expense due to computer technology; Maintenance is essential
How does microprocessor swing work? On board computer analyzes gait 50x/sec; Calculates knee angle & ankle strain in relation to gait cycle; System performs continuous hydraulic adjustments to ensure stability, security & efficiency in swing & stance
How does microprocessor swing work? Microprocessor hydraulic controlled stance & swing phase fxn; Dynamic valve control & multiple inputs, stance stability engaged & disengaged PRN; Less need to concentrate on prosthesis; Provides max cadence response over wide range of fxnal applicatio
How does microprocessor swing work? Stance flexion feature, adjustable; Hydraulic stance extension, dampening- reduces impact to skeletal structure at heel strike; initiates a natural & smoother transition to mid-stance; mimics natural gait dynamics; beneficial for descending ramps/stairs
Microprocessor Swing Lithium Ion Battery Recharger Necessary to power microprocessor; Solar adapter in testing stages; Standardized item for UE prosthetics
Socket Design Criteria Improve balance; Improved comfort (standing, walking, sitting); Improved control; Improved fxn; Better stability
Socket Design Criteria Natural shaping conforms to mm, tendons, arteries, nerves; Socket flexibility allows mm mvmt & comfort; Maximizes socket control, contouring, contact, comfort; Level of ischial containment will determine level of socket/prosthetic control
What are the 4 T's of socket design/comfort? Total Contact; Total Contouring; Total Control; Total Comfort
Structural Goals Replace structural support to skeletal system; Xfer support forces thru residual soft tissue to femur; Stabilize femur into hip in natural position for posture & force
Hip Geometry- Anterior Acetabulum is functional center of rotation of hip joint; Ischial tub & greater trochanter are relatively equidistant from center of femoral head
Hip Geometry- Lateral Acetabulum is fxnal center of rotation of hip joint
Socket Geometry- Soft Tissue Containment Controls mm tissue; Provides counter support to contain ischium in place; Must be flexible to allow for mvmt & seating comfort
Socket Geometry- Bony Lock Medial lock contains & supports ischial tuberosity; Lateral lock supports sub-trochanter & maintains femoral control
Plug Fit Provides limited concentration of forces on acetabulum; Lacks rotational control; No bony lock
Quadrilateral Socket Controls rotation by restricting mm & tendon mvmt; Excessive soft tissue containment; No bony lock
Quad Socket- Medial Contain tissue; Counter pressure to lateral wall; Same height as posterior wall to prevent adductor roll; Proximal brim horizontal & parallel to floor
Quad Socket- Lateral Adequate lateral support to femur at mid-stance; Socket adducted (prevent abd & stabilize pelvis; provide stretch to glut med); 2.5" above ischial shelf; Stabilize greater trochanter
Quad Socket- Anterior Blocks fwd motion of residual limb; Ant/Med channel- relief for adductor longus & gracilis; Scarpa's triangle modification; 2.5" above ischial seat- too high impinges ASIS
Quad Socket- Posterior WB surface for ischial tub; Ischial tub 1" medial from medial wall & .5" posterior; Wall slopes 5-7 deg medially (easier access to ischial tub; places hip extensors on stretch)
Problems with Quad Socket Femur abd due to loss of adductor strength- compensated Trendelenburg; Uncomfortable due to excess pressure over ischial tub; Short limbs- harder to distribute pressure= worse fit
Ischial Containment Socket Wider AP, Narrow ML; Controls femoral adduction; Contains ischial tuberosity & pubic ramus; More optimal distribution forces along femoral shaft
Ischial Containment Socket More containment of residual limb = larger volume = better distribution of forces/pressure; Post. brim- prox & post to ischium; Ischial tub contained in socket = bony lock; Provides ML & rotational control
Anatomical Socket Focused bony lock to stabilize ischium; Femur supported in fxnal position; Uniform soft tissue compression maintains support, comfort, containment; Balanced geometry
Anatomical Socket- Lateral View Control of the femur; Stabilize the hip
Anatomical Socket- Medial View Contain ischium; Stabilize medial mm group; Provide counterforce for femur; Allow mm mvmt
Anatomical Socket- Anterior View Flexible at proximal aspect to provide walking/sitting comfort; Allow for blood flow; Provide relief for mm mvmt
Anatomical Socket- Posterior View Flexible at proximal aspect to provide walking & sitting comfort; Support gluteal mm; Provide relief for mm mvmt
Anatomically Contoured Socket Custom designed to individual residual limb shape; Mm & bone contoured; Flexible interface works with mm to enhance fxn; Enhanced comfort for specific lifestyle
Suction Suspension Pts who have stable volume residual limb; Wet-fit; Tradition fit; Advantages- cosmetic, intimate fit; Disadvantages- scarring, volume fluctuation
Lanyard Suspension String attached to end; Pulled down into socket; Advantages- cosmetic, intimate fit; Disadvantages- need good hand dexterity
Locking Linear Gel liner with locking mechanism; Pin attached to bottom; Slide into socket- locks; press button to release Advantages: comfort, ease of donning; Disadvantages: less durable, perspiration, limited on length
Waist Belt Total Elastic Suspension (TES); Silesian bandage; Advantages: add'l suspension, controls rotation; Disadvantages: not cosmetic, uncomfortable around waist
Pelvic Belt Includes metal hip joint; Goes around waist for suspension; Advantages: controls hip, looser fit; Disadvantages: increased weight, not cosmetic, restricts hip
Check-Out: Standing Exam Foot flat on floor (with shoe); Correct height; No leaning pylon; Stable knee; Ischial tuberosity contained
Check-Out: Sitting Exam Remain on limb; Knees aligned (as close as possible)
Check-Out: Walking Exam Note gait deviations; Pistoning minimal; No leaning pylon
Created by: 1190550002