LOWER-EXTREMITY

PROSTHESES

lec4
Prescription of a prosthetic
• Prescription of a prosthetic is multidisciplinary process
that includes at least the user, prosthetist and
physiotherapist.
• During the prescription process, the team decides on the
type of device that should be fabricated also the socket
design, the various types of components and the choice
of suspension. All these decisions are very important for
the rehabilitation process that will happen later.
Lower Extremity Amputation
• Main Causes of Lower Extremity Amputation
• 1. Disease
• 2. Trauma
• 3. Cancer
• 4. Congenital
Cause of Amputations Disease
• Disease Diabetes Mellitus (DM)
• Peripheral Vascular Disease (PVD)
• Chronic Venous Insufficiency (CVI)
Amputation level

• Amputation can be at any level, but the most common

are:
• a single toe
• through part of the foot
• below the knee
• through the knee
• above the knee
• through the hip joint.
items to be covered
• Lower Limb Prostheses (LLPs) replace the functionality
of a missing limb to as great a degree as possible.
healthcare covers custom fabricated LLPs in accordance
with the Local Coverage Determination (LCD) for
Lower Limb Prostheses. As for all items to be covered :
• 1) be eligible for a defined benefit category,
• 2) be reasonable and necessary to improve the
functioning of a malformed body member.
• 3) meet all other applicable statutory and regulatory
requirements.
fabrication of the prescribed
• The fabrication of the prescribed prosthesis also goes through
various stages that could influence considerably the
rehabilitation and the physiotherapy program planned after the
first fitting. These fabrication steps are:
• Casting
• Positive mould
• Rectification
• Assembling
• Alignments
• Cosmetic
International Organization for
Standardization
ISO Standard determined for the Lower Limb
• Ankle (Syme) Disarticulation
• Transtibial Amputation
• Knee Disarticulation
• Transfemoral Amputation
• Hip Disarticulation
Terminology
• Disarticulation:
When the amputation is between long bones,
anatomically is through the center of a joint
• Partial:
Amputations of the foot distal to the ankle joint
• Residual Limb
The extremity of a limb left after amputation, “Stump
• Transfemoral
Above Knee Amputation
• Transtibial
Below Knee Amputation
Prosthetic Components
• Replacing the movements of the human body with
prosthetic components is a very complex and
complicated task. Prosthetic components can imitate,
with different level of complexity, these movements
but never replace them. Obviously, the higher level of
imitation, its complexity and price.
• With the loss of sensory and proper inception,
sensory capabilities of his stump and body, However,
modern prosthetic technologies offer a wide range of
components, especially in lower limb prosthesis,
which manages to replace the major movements and
enable users to perform the gait..
prosthetic leg include knee
Main part
• The internal frame, of a prosthetic limb is
called the pylon. ...
• Socket- Forms- the connection between
the residual limb and the prosthesis….
• Sleeve- Provides suction suspension for
prosthesis. …
• Shank (pylon)- Transfers weight from
socket to the foot-ankle.
• Foot-ankle- Absorbs shock ,impact and
provides stability.
Suspension

• Suspension is a very important part,

which keeps the prosthesis attached to
the residual stump during function and
allows for comfortable sitting.
parts of a prosthetic leg
prosthetic socket
• The prosthetic socket is the device that joins
residual limb (stump) to the prosthesis. Every
prosthetic leg starts with the design of a socket best
suited to the anatomy of the individual: if the socket
does not provide a good, comfortable fit, if the
suspension that links the socket to the body doesn’t
perform well and if all the components are not
correctly aligned, even the most expensive prosthetic
components will underperform and probably be
inadequate.”
residual limb
• Most modern artificial limbs are
attached to the residual limb (stump) of
the amputee by belts and cuffs or by
suction. The residual limb either directly
fits into a socket on the prosthetic, or—
more commonly today—a liner is fixed to
the socket either by vacuum (suction
sockets) or a pin lock.
Components of a prosthetic leg
liner
• The liner plays a key role in suspending the socket
from the residual limb and as a protective barrier
between your skin and the socket. There are three main
ways to attach the liner to the socket; namely
1- (locking liner) with a locking pin at the end furthest
from the residual limb.
2- (cushion liner) with an extra sleeve applied over the
liner and socket.
3- (seal-in liner) by creating a vacuum with a seal.
Lately, the effectiveness of seal-in liners, essentially
a passive vacuum system, has been improved with
the incorporation of a pump that sucks air out of the
socket, creating an even stronger attachment.
three main ways
Cushion seal-in liner
Locking Liner

Considering how fundamental the socket and suspension are to the

effective functioning of a prosthetic leg, it’s impossible to overstate the
importance of selecting the right liner.
Prosthetic knee
• aims to sample function of a natural knee by providing
safety, symmetry and smooth movement when
walking, stability when standing and a range of motion
that makes sitting and kneeling possible. The knee is
one of the most complicated joints in the human body,
so designing a prosthesis that functions like a real knee
is quite a challenge. If the design is poor and forces the
user to walk in an unnatural way, back and hip pain
may result, and if the knee doesn’t suit the user’s
physical requirements, it may even cause the user to
fall
knee prosthesis
• There are many type of knee system, to provide
better control of the above-knee prosthesis
during standing and the sewing.
• knee prosthesis can be divided into two major
classifications: mechanical and computerized.
Mechanical knees
Mechanical knees can be further separated into two
groups: single-axis knees and polycentric knee. :
1- Single axis knee (Monocentric)
• These types of prosthetics is essentially a simple hinge,
use a simple one speed, which makes them relatively
inexpensive and very reliable.
• The drawback of single axis knee is don't have stance
control which mean amputees must use their own
power to keep them stable while standing.
 Polycentric knees
2- Polycentric knees (Multiple axis)
• Polycentric knees are more complex in design,
with multiple axes of rotation.
• Their biomechanical flexibility is the primary
reason for their popularity.
• Polycentric knees used in prostheses for higher
levels, especially when stability at heel strikes
is desirable.
• Many polycentric knees incorporate fluid
(Hydraulic systems use a liquid medium instead
of air to respond to a wide range of walking
 Total Knee Mauch

Example of single axis knee is the Total Knee

That combined with the extension promoter Mauch
which assists in limiting heel rise and Mode selector switch
moving the knee into a fully extended allows manual locking
and free swing functions
Computerized knee
• Microprocessor-controlled prosthetic knees are
equipped with sensors that continuously detect the
position of the knee throughout the stance and swing
phases of gait. These sensors provide input to the
prosthetic knee so that the knee “knows” which gait
phase it’s in.
• Next, the software interprets this information to
anticipate (expect )the walker's needs at that instant in
the walking cycle.
• Finally, the computer changes the settings of hardware
of the knee to affect its mechanical resistance to
motion.
Examples for microprocessor knee C-leg
microprocessor-controlled hydraulic unit.
Prosthetic foot

• should ideally imitate the function of a real foot as

closely as possible by providing a safe platform,
handling differences in terrain and allowing the user to
walk in a natural, symmetrical way. It’s the main
prosthetic component responsible for absorbing the
shock generated by impact on the ground due to the
absence of muscles from the amputated limb, and it
should also help the user walk more easily by returning
the energy generated by the impact of walking.
Single-axis Foot
• The feet are designed to help patients quickly and securely
reach foot-flat, good for amputees with short stump and weak
muscles.
• Requires periodic servicing, and is slightly more expensive,
most appropriate for individuals whose major concern is
stability.
Multiaxial Foot

• allows eversion /inversion to cope with uneven terrain, more

expensive and used for people who work in countryside, very
active amputees, golfers, dancers.
consideration
• Lower limb prostheses can be Exoskeletal systems
(prosthesis with the peripheral weight-bearing capacity,
the use of which facilitates the transfer of a patient’s
weight to the ground along the device’s circumference) .
• or currently most frequently used endoskeletal – modular
(prosthesis with the central weight-bearing capacity, the
use of which facilitates the transfer of a patient’s weight to
the ground a tubular structure in the prosthesis centre
• Health condition assessment and assignment to a
functional regime is carried out considering the following
Health condition assessment
• 1. assessment of cardiovascular apparatus efficiency,
especially in terms of load tolerance,
• 2. muscular power of a person insured, muscle tone, and
loco motor finding,
• 3. self-sufficiency when applying an orthopedic prosthetic
device,
• 4. mobility of a person insured with an orthopedic
prosthetic device,
• 5. local finding on a residual limb and a residual limb’s
bearing capacity,
• 6. psychological preconditions for the use of prosthesis
QUIZE
• type And design of lower limb orthotics