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Transfemoral Pros.
Transfemoral Prosthetics Presentation
| Question | Answer |
|---|---|
| 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 |
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1190550002
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