PRESCRIPTION PRINCIPLES

TRANSFEMORAL
PROSTHETICS
Jurusan Ortotik Prostetik
Poltekkes Kemenkes Surakarta

Atika Febri Anggriani, STr. Kes

2019
Socket Design Advantages Disadvantages Indications Contraindications
         
Quadrilateral – the Commonly used in many   Amputee with long There are no absolute
ischium sits on a shelf countries   muscular stump contrainidications to any
posteriorly     Successful quad. socket design
      wearers  
         
         
  Improved gait and ML Difficult technique to Vascular amputee
Ischial containment- the stability , does not learn Vascular amputee Bilateral amputee?
ischium is contained in restrict circulation 2 people required for High activity amputee  
the socket casting Bilateral amputee  
Clinic staff have  
knowledge/ experience If clinic staff do not have
of IC experience with IC
 

Socket material Advantages Disadvantages Indications Contraindications

       
Polypropylene Allows total contact Has to be imported Suitable for vast For very heavy patients
  Relatively inexpensive   majority of patients  
  Easy to manufacture      
         
     
       
 
GRP Allows total contact Increased time in If patient is heavy, If patient has allergy to GRP
(Glass Reinforced Can be made manufacture If using particular  
Plastic) lightweight Some chemicals may components  
  Areas of socket can be cause allergy (in manuf.)    
  reinforced      
         
  Expensive    
Flexible materials Allows total contact Needs to be imported For patients with poor  
  High level of comfort   muscle tone, bony  
      residual limbs  
         
     
  Does not allow total If other materials are If any other material is
Aluminum Locally available contact not available available
  Cooler
Suspension Advantages Disadvantages Indications Contraindications
         
Self suspension- No additional straps Sweating- no socks Young active amputee Elderly, poor muscle tone
suction needed worn with good muscle tone Poor hand function
  Good Cosmesis Increased time needed Stable limb volume Excessive sweating
    to ensure good fit   Very short residual limbs
    Difficult to don/ doff    
    Even with good fit can    
    lose suction    
    Embarassing noises    
         
    User who requires Poor upper limb function
Silicone suction Very secure suspension Expensive, excellent suspension , Excessive sweating
suspension Good Cosmesis Donning and doffing is e.g sports activities  
  Silicone also protects difficult Patient with excessive  
  skin needs to be imported, scarring on residual  
    hot – sweaty limb  
        If user is especially
    Reduced cosmesis Majority of amputees concerned about cosmesis
Silesian belt – Secure, comfortable compared to suction Requiring good  
soft belt made of suspension; does not If not correctly suspension and some  
fabric or leather restrict movement ; positioned will cause stability  
  simple to fit and repair. rotation    
  locally available      
  materials.      
  ML stability and     Young active amputee with
  rotational control     good muscle strength
 Rigid Pelvic band- a   Uncosmetic, bulky, Elderly patients with
metal band covered Very good ML stability heavy poor muscle control
with leather and single And rotational control May be uncomfortable needing secure
axis hip joint Can be made form in sitting suspension
local materials
 
Knee joint Advantages Disadvantag Indications Contraindicatio
es ns
         
Single axis Inexpensive, Lack of Suitable for Long residual
  simple design, mechanical most limb
  low stability amputees Inability to
  maintenance   with average control knee with
      stump length muscle action
      and good  
Polycentric   muscle  
Mechanical (Historically – strength Person who is not
stability in gait increased   able to attend for
cycle weight and Knee repairs often
Easier toe bulk) disarticulation
clearance in Now Cost Long
swing , due to transfemoral
shortened residual limb
shank Short residual
Improved limb
cosmesis for Weak hip
long residual extensors
limbs
 
Stance phase Advantages Disadvantages Indications Contraindications
control of knee

         
No stabilizing Patient maintains No additional For young, fit Short residual limb
mechanism use of muscles in stability if needed amputee with good Weak muscles
  controlling   length of residual Flexion contracture
  prosthesis   limb and muscle  
      strength  
         
    Poor gait- need to Young fit amputee with
Manual knee lock – Very stable circumduct, vault to Elderly amputee , good residuial limb able
the knee remains   allow clearance in poor muscle to control knee with
locked throughout   swing phase strength, flexion muscular contraction
stance and swing     contracture  
       
     
Weight activated Provides stability Increased weight , Indoor walker, low
stance control when limb is in Some maintenance If user is walking activity
  flexion required compared on rough , uneven  
    to MKL ground , If user  
      requires some  
      added stability  
    (medium activity)  
       
Hydraulic stance   Heavy, requires  
control Allows easy knee maintenance, Cost Low activity, poor
  flexion in swing ,yet   High activity muscle strength
high resistance to   walker, runner
flexion in stance
Variety of functional
options
 
Swing phase Advantages Disadvantages Indications Contraindications
control of knee

         
Friction control Low weight Can be adjusted Good for children High activity patients
  Simple design but only for one due to durability, using more than 1
  Low maintenance walking speed For users who live walking speed
    Any variation in very far from  
    speed causes clinic  
    uneven timing Patients who do  
      not change  
      walking speed  
         
Extension assist – Cheap  
external: elastic Easily fitted Not durable Active patient, with
strap Provides Reduced effort Uncosmetic For patients who good muscle strength
extension at end from amputee   need help to  
of swing     extend knee  
         
Simple design      
Internal spring Durable Increased weight   For patients who
assist : a spring Does not affect   need help to extend
inside the knee cosmesis   For patients who knee
mechanism is Reduced effort   need help to  
compressed from amputee   extend knee  
during flexion and        
provides extension    
assist
 
Pneumatic Provides control Heavy Patient who Low activity
  of swing phase Expensive walks at Poor muscle
  at different Requires different speeds strength
  walking speeds maintenance    
  (simpler, lighter, Range of    
  less expensive walking speeds    
  compared to is limited    
  hydraulic unit)      
         
Hydraulic  
cylinder Provides control Heavy Patient who Low activity
  of swing phase Expensive walks at Poor muscle
over a wide Requires different strength
range of maintenance speeds,
walking speeds   Heavy user
  high activity
Teen adult male

 
Shin Advantages Disadvantages Indications Contraindications
components
         
Exoskeletal Strong, Durable, Cannot change For heavy Patient requiring
  May be water alignment or patient regular changes of
  proof , socket after limb Patients alignment or socket
  Inexpensive, is fitted , Heavy working in wet/  
  Locally available  dirty  
      environments,  
      Patient doing  
      heavy work  
Endo skeletal Usually   Heavy patients,
 ICRC Lightweight, Expensive, patients working in
 Otto Bock allows change of Weight limits, Children , users dirty/ wet
 Endolite socket and Has to be requiring environments
alignment after imported, regular change
delivery requires of socket and
maintenance height
 
Foot and ankle Advantages Disadvantages Indications Contraindications
components
         
Peg Leg Lighweight, no Poor gait, no Farmer working in All users not working as
  maintenance anterior support , muddy conditions farmers
    lack of cosmesis    
SACH foot  Lightweight, , little   Children, low or High activity users
  maintenance, Heel cushion may medium activity People walking on
  Inexpensive corrode over time users uneven terrain
    Soft heel cushion    
    required for TF    
       
Single axis foot High activity users
  Ability to change Maintenance Patients with Users unable to attend
  stiffness of required limited muscle for regular
  plantarflexion; Increased weight strength and lack maintenance
  improved knee compared to SACH of knee control  
  control Works well Reduced cosmesis    
Multiaxial foot on slopes      
      Low activity patients
    Increased For medium or Indoor walkers
  Allows movement maintenance high activity users, Users unable to attend
  AP and ML planes Expensive patients walking on for regular
  and rotation;   rough ground maintenance
  Ability to change      
  resistance to      
Energy Storing foot plantarflexion      
  Allows different      
heel height   Very high activity Children
  Reduced stability users, Athletic Low, medium activity
If foot is unloaded Increased weight patients engaged patients
quickly it releases High cost in sports  
energy when  
walking
Terimakasih ...