How much does the typical transtibial prosthesis cost?
$7,000 - $14,000
What is the purpose of post op care?
- facilitate healing
- reduce edema
- prevent contractures
What is the purpose of the preparatory prosthesis?
- early ambulation
- shape the residual limb
- cost effective
How long does the residual limb take to heal?
How long does the preparatory prosthesis tend to last?
4-6 months until pt has constant volume
What are the advantages of endoskeletal? exoskeletal?
endo: cosmesis, alignable, good selection
exo: durable, light weight, cost effective
What are knee joint/thigh lacers used?
poor stability, small residual limbs, severe scar breakdown
Where is the most common place for a sore to develop on a transtibial (BK) amputee?
what can cause this?
heel too high, foot too posterior, too much socket flexion, heel too stiff, posterior shelf too low
What are the stages of design for a prosthesis?
- Patient eval
- Impression technique
- Positive model modification
- Socket fabrication
- Alignment (bench, static, dynamic)
What are the most common components to begin with in a transtibial amputee?
SACH foot, endo pylon, PTB socket with pelite insert, suspension sleeve
What are the pressure tolerant areas on a BK amputee?
patella tendon, medial tibial flare, medial tibia, pre-tibial muscle, shaft of fibula, gastroc
What are the pressure sensitive areas on a BK amputee?
tibial tubercle, tibial crest, anterior-distal tibia, fibula head, peroneal nerve, distal fibula, hamstring tendons
What are the components of saggittal plane alignment?
A-P placement or TKA
Flexion of socket
What are the components of coronal plane alignment?
Height (patella tendon to floor)
M-L placement of foot
Adduction angle of socket (5-7 degrees)
What are the components of transverse plane alignment?
socket rotation foot rotation (5-7 degress toe out)
What kind of GRF do you want for a transtibial amputee?
placing GRF behind knee –> increase knee flexion moment
How much does a transfemoral prosthesis typically cost?
What types of contractures should you be aware of for transfemoral amputees?
hip flexion and abduction (extensors and adductors cut)
How is a quad socket organized?
narrow A-P, wide M-L
How is an ischial containment socket organized?
wide A-P, narrow M-L
Where is the most common place for a sore to develop on a transfemoral amputee?
What causes it?
A-P too wide, foot too far inset, too much socket adduction, poor M-L stability
What are the most common components for a transfemoral prosthesis?
SACH or single axis foot, endoskeletal pylon, safety knee, ischial containment or quad socket, suction suspension with liner
How do you want to position the GRF in transfemoral patients?
in front of the knee –> increase extension moment
or sach foot with soft heel to bring to foot flat more quickly
What types of feet are recommended for functional level 1?
Single axis, SACH foot, lightweight geriatric
What type of feet are recommended for functional level 2?
flexible (SAFE) foot, multiaxial foot
What type of feet are recommended for functional level 3?
What type of knees are recommended for functional level 1 and 2?
manual lock, friction knee, polycentric knee
What types of knees are recommended for functional level 3?
stance flexion feature, safety (weight activated breaking), pneumatic, microprocessor, hydraulic