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64 Cards in this Set

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Transfemoral Considerations

Cause of Amputation
Chronology
Biomechanics: Length/ROM
Patient Issues
Funding Issues
Geographic Location
ok
Transfemoral Considerations

Cause of Amputation:
1. Peripheral Vascular Disease
-Diabetes
-Infection
-Gangrene

2. Trauma

3. Congenital

4. Tumor
ok
Transfemoral Considerations

Chronology:
Date of amputation
RL Condition
Post Op?
Intermediate 3-6 mos
___ ~6mos
Definitive
Transfemoral Considerations

Biomechanics:
ROM
Length
Surface Area
___ Condition/Surgical techniques
residual limb
Transfemoral Considerations

Patient Issues:
General ___
Desire, Ability
Activities
Physical Condition
Medicare K-levels

___- Does not have ability or potential to ambulate safely with or without assistance and a prosthesis does not enhance their quality of life or mobility.
K0
Medicare K-levels

___- Has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. Typical of the limited and unlimited household ambulator.
K1
Medicare K-levels

___- Has the ability or potential for ambulation with the ability to traverse low level environmental barriers such as curbs, stair or uneven surfaces. Typical of limited community ambulator.
K2
Medicare K-levels

___- Has the ability or potential to ambulate with variable cadence. Typical of the community ambulator who has the ability to traverse most environmental barriers and may have vocational, therapeutic, or exercise activities that demands prosthetic utilization beyond simple locomotion.
K3
Medicare K-levels

___- Has the ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress or energy levels. Typical of the prosthetic demands of the child, active adult, or athlete.
K4
Prescription Factors

___ mediates knee and foot componentry
Knee Selection
Foot Selection
K-Level
Prescription Factors

Other design criteria:
Exoskeletal vs. Endoskeletal
___ Design
Suspension
Socket
Complete Transfemoral Rx

Socket design & material
Suspension
Knee
Foot
___/Torque Absorber
Rotator
Socket Designs

PLUG FIT
QUAD SOCKET
Ischial Containment
ok
___ socket

Total contact
Wider in the ___ dimension than AP
Originally made in just thermo-setting laminates
Quadrilateral

ML
Posterior ___

Flat, slants anteriorly to provide initial flexion of 15 degrees
Contoured for hamstrings
Posterior Wall
Posterior ___

Horizontal parallel to floor
Ischial seat
Posterior Brim
Medial ___

Relief channel located anteriomedial for adductor longus tendon
High to prevent adductor roll
Prevents medial movement of limb in socket
Medial Wall
Medial ___

Same height as posterior brim or slightly lower
Socket should not press on pubic ramus
Medial Brim
___ Wall
2.5 inches higher than the medial wall (even higher for shorter limbs)
Provides counter pressure for posterior wall
Scarpa’s bulge—maintains ischial tuberosity on the ischial seat by providing counter pressure against posterior wall (Scarpa’s triangle=sartorius, inguinal ligament, adductor longus)
Anterior
___ Wall

Higher than anterior wall
Inclines medially as it goes distally
Set in 10 degrees of adduction
Lateral
Icelandic Swedish new York (ISNY) or Scandinavian Flexible Socket (SFS)

Same design as ___
Has a flexible socket with a rigid retainer
quadrilateral
___ (NSNA)

ML diameter is less than the AP
Ischial tuberosity sits within the socket
Lateral wall is higher than greater trochanter
Lateral wall is set in 10-15 degrees of adduction
Usually made with thermosetting laminate hard socket, but may be soft socket with rigid retainer
Normal Shape Normal Alignment
___ Design – Normal Shape Normal Alignment

Also known as ischial containment, CAT CAM (Contoured adducted trochanteric-controlled alignment method), and now Sabolich socket
Some contain both Ischium and ramus therefore creating a “boney lock” with the femur.
Closer to anatomical design
Requires test sockets and very good understanding of the theory and fitting principles
Socket
___-CAM

Has a flexible socket with a rigid retainer
CAT-CAM
___

“Containment” of the residual limb
High fit for rotational stability and side to side control
Flexible material for the socket—comfortable
High strength, light weight frame
Sabolich
___

Suction

Partial Suction
-Worn with a type of auxiliary suspension such as a Silesian band or belt

Silesian band or belt
-A webbing belt used as auxiliary suspension

Total Elastic Suspension (TES Belts)
-Another type of auxiliary suspension
-Sometimes called a neoprene belt

Pelvic Band with Hip Joint
Suspension
Suspension continued

Pin Suspension (roll-on silicone liner pin suspension –shuttlecock with lanyard )
Roll on “Seal In”liner
Roll on liner and Coyote Summit Lock
Osseointegration
ok
Suction

___ suspension if possible
Provides greatest feedback-no sock is worn
Many suction designs
Difficult to don
Not indicated for individuals with
-fluctuating volume
-heart conditions
-balance problems
Best primary
___ Belt or Band

Simple
Made of cotton/Dacron webbing
Relatively low profile
Controls rotation well
Auxiliary suspension
Used with partial suction-Patient wears a sock
Silesian
___ (TES Belt)

Very simple to use
Somewhat bulky
Moderate rotational control
Prosthesis may “telescope”
Auxiliary suspension-used with suction, roll on silicone suction, or partial suction
Total Elastic Suspension
___ with Hip Joint

Bulky
Very stable in M/L and Rotational control
Indicated for
-Weak hip abductors
-Short femur
Pelvic Band
Roll-on Silicone Liner with shuttlecock and lanyard

Liners now being used for transfemoral applications. Used with patients who have difficulty donning a traditional suction suspension
Extra guidance needed to get pin in shuttle
Lanyard used to solve this problem
Hand dexterity is a must
Makes socket longer than normal
ok
___ In Liner

Provides a suction socket
Easier to don than traditional true suction
Relatively new and have had good results
Roll-on Seal In Liner
Roll-on Liner with ___

Relatively new
Prevents rotation in the socket
Easy to apply
Works like a ski boot lock
Roll-on Liner with Coyote Summit Suspension
___integration

Advantages:
Less feeling of weight
More control of prosthesis
No perspiration, pain from socket
Easy don and doff
Osseointegration
Osseointegration

Disadvantages:
___ required
-First-fixture threaded into skeleton-wound closed and wait for bone to grow into the threads (6 months)
-Second-re-expose implanted fixture, attach abutment, gradually load limb-another 6 months

Long rehab period
Deep infection risk
If occurs=bone loss, need to re-amputee at higher level
2 surgeries
Structure Design Criteria

____skeletal
Traditional “Hard Finish” Fabrication Method
Durability / Heavy Duty Use
Limited Componentry
Non-Adjustable
Exoskeletal
Structure Design Criteria

___skeletal
Vast Componentry Options
Post Fabrication Adjustability
Light Weight
More “Anatomical” / Soft / Cosmetic
Endoskeletal
Knees
Primary Design Selection

___
Single Axis
Polycentric
Axis
Knees
Primary Design Selection

___
Mediated by K-level
-Constant Friction
-Fluid Resistance
Swing Resistance
Knees
Primary Design Selection

Other Features
Extension Assist
Stance Control
Computer Controlled
Rotator
Torque Absorber
ok
Knees

___ Axis:
Simple
Low Maintenance
Limb Length Considerations
Single Axis
Knees
Axis
___
Multiple “centers of rotation”
Provides added stability
Indicated for anyone especially long limbs
Polycentric
Knees
Swing Resistance

___
Single speed ambulators (K1 or K2)
Constant Friction
Knees
Swing Resistance

___
Hydraulic oil or air (pneumatic)

Variable speed ambulators (K3 or K4)
-Resistance against flexion increases as forces increase
--Increase V -> increase cadence -> increase resistance
--This slows the swing rate which allows the foot to advance more quickly (increased cadence)
Fluid Resistance
Knees

___
Assists extension at terminal swing
Extension Assist
Knees

___
Locked
Friction “Brake”
Mechanical
Hydraulic
Stance Control
Single Axis Constant Friction Knee With Stance Control (Not a SAFETY Knee)

Uses a ___ friction brake
Restricts more flexion when wt put on in 15 –20 degrees of flexion
For K1 or K 2
To 220 lbs.
Comes in Child size
weight-activated
___ Knee

Polycentric
CF –constant friction
Mechanical Stance Control
To 225lbs
Comes in child size
See video
Total Knee
Otto Bock 3R60

___
Hydraulic
Swing Phase Control
To 225lbs

Otto Bock 3R65
Pediatric hydraulic unit
Polycentric
Henschke-Mauch Stance and Swing Control (SNS)

Provides increasing resistance to flexion as knee flexes more & more to prevent falling

In swing, as knee is flexed more than 20 degrees, the foot is lifted and the knee extends
ok
Computer-controlled Hydraulic Units

___ by Otto Bock
Intelligent knee by Endolite
Controls resistance to flexion & extension
Does not provide active flexion/extension
C-Leg
___
Located Proximal to Knee Joint
Allow Pt. To Sit With Leg Crossed
Rotator
___ Absorber

May Be Specific Unit on Shank or Integral With Foot
Absorbs Torque and Thereby Decreases Shear at Residuum / Socket Interface
Torque Absorber
Feet

TT / TF Utilize Same Feet
May See Increased Use of ___ Axis Foot
Single
Transfemoral Considerations

Funding -Functional Levels of Ambulation
K0 - non ambulator
(No prosthetic coverage)

K1 - household ambulator
(SACH, Constant Friction Knee)

K2 - limited community ambulator
(Flexible Keel Foot, Constant Friction Knee)

K3 - unlimited community ambulator
(Dynamic.Response Foot, Fluid Friction Knee)

K4 - high activity
(Dynamic Response Foot, Fluid Friction Knee)
ok
___ Prosthesis Design

Advantages:
___ RL
Self suspending
Long lever arm
Less surgically traumatic

Disadvantages:
Component limitations
Cosmetic concerns
Knee Disarticulation Prosthesis Design

End bearing
Transfemoral Biomechanics

Must provide for ML stability of pelvis during mid-stance on prosthetic side
-Lateral wall of socket ___
adducted
Transfemoral Biomechanics

Provide AP stability of prosthetic knee between heel contact and heel off
-Socket aligned in ___ approximately 5-10 degrees
-Knee joint posterior to TKA line
flexion
TKA LINE

Socket ___ of knee
Knee posterior to trochanter and ankle if drop a plumb line
forward
___ Prosthesis

Patients can walk unassisted but with noticeable deviations
Suspension by socket that encompasses the waist
Requires a lot of gait training in order to learn the proper method of hip, knee and ankle control
HD Endoskeletal Prosthesis
Bilateral Amputees

Limbs shorter so easier to control
Begin training with ___
stubbies
CASE STUDY

35 yo, M, 225#, 5’11”
DOA: 8-10-90, COA: MVC
Right, TF, mid length
Gen. Phys. Cond: Good
Limb and skin: good
Occupation: commercial actor
Activity Level: Moderate
Sports: Swimming & Channel surfing
Prescription recommendation

Socket: total contact Ischial Containment - Good weight distribution and anatomical weight bearing
Structural design - Endoskeletal for adjustability
Suspension: Suction - Best for control of prosthesis
Knee - Polycentric, Hydraulic
Foot - dynamic response/multi axial