PROSTHETIC KNEE

JOINTS

DOT II
 PROSTHETIC KNEE DESIGNS:

BIOMECHANICS AND FUNCTIONAL CLASSIFICATION.

• There are currently over 100 different prosthetic knee designs
available to the prosthetics field
• It is important to match a component which offers the optimum
function to the amputee.
 Saggital Plane Biomechanics of Gait.

• Prosthetic knees offer no special function in the coronal or transverse

planes beyond simple stability.
• All their functional distinctions occur in the saggital plane and
therefore it is necessary to review saggital plane biomechanics of
normal and then "prosthetic" gait.
• The knee joint, both biological and prosthetic, must facilitate
1. weight acceptance,
2. single limb support
3. limb advancement .
• The stability of a prosthetic knee is most important during during
stance phase
• Because stance phase begins and ends with periods of double limb
support
• There fore,maximum stability is required during single limb support,
which constitutes less than half (40%) of the gait cycle.
• The ideal prosthesis should mimic the alignment and gait
characteristics of the normal limb during each of the phases of the
gait cycle.
 Initial Contact:

• This begins the stance phase and initial double support.

• The hip is flexed, the knee extended and the ankle dorsiflexed to
neutral.
• Prosthetic components can replicate this position easily.
 Loading Response:

• This occurs as the body carries forward and includes elements of

shock absorption, weight-bearing stability and preservation of
forward motion.
• Most knee prostheses require full knee extension for stability and
therefore raise the center of gravity during stance phase.
• Only a few more sophisticated designs allow stable weight bearing in
flexion.
 Midstance

• This period of single limb support demands maximum knee stability,

which is provided prosthetically in several ways.
 Pre-swing
• This is the second period of double support in stance phase.
• The ankle plantar flexes, the knee flexes and hip extension decreases
in preparation for swing.
• Only those prosthetic knees which allow flexion during load bearing
will simulate this response at the knee and only dynamic response
feet simulate ankle plantar flexion by the rebound of a plastic keel
spring
 Initial Swing

• Increasing hip and knee flexion advance the limb as the ankle
gradually dorsiflexes toward neutral. Many prostheses cannot
adequately control heel rise during the initial swing phase.
 Midswing

• The ankle continues to neutral as the hip continues to flex. Gravity

takes the knee into extension. Most prosthetic designs simulate this
well unless there is excessive heel rise in initial swing which delays
forward progression of the shank.
 Terminal Swing

• Limb advancement is controlled by knee extension.

• Many prostheses cannot adequately decelerate the shin to prevent terminal impact as
full extension is reached.
• This disrupts swing phase mechanics and increases energy costs.
• In terms of saggital plane dynamics the ideal knee mechanism would;
1. be stable enough to accept weight in early stance
2. absorb shock and allow smooth forward progression of the body via controlled knee
flexion during weight acceptance
3. support body weight in midstance with a flexed knee
4. begin flexion during single limb weight bearing late in terminal stance
5. respond instantly in the swing phase to a faster pace and to variable cadences.
A Functional Classification of Knee Mechanisms

The five types are classed according to their major functional

characteristics. These are
1. Constant Friction prostheses
2. Stance Control prostheses
3. Polycentric knees
4. Manual Locking prostheses
5. Fluid Controlled devices.
SOCKET ADAPTOR
 Socket adaptor position
• If the socket adapter is located in
the correct position, the
amputee should be able to stand
and maintain balance naturally
without excessive effort.
 Socket adaptor position
• The picture shows an appropriate
individual position of the socket
adapter in frontal plane with the 
socket in equilibrium. 
• The point support (where the socket
adapter should be placed) is depicted
in the shape of a red triangle. 
• A red dot is used to indicate where
two planes (frontal and
sagittal) intersect on the bottom of
the socket
 Socket adaptor position
• The picture shows
a situation where the
socket adaptor is
positioned too far
medially in the frontal
plane.
• The socket is not in
equilibrium and tends to
tilt laterally due to
rotating forces
 Socket adaptor position
• The picture shows the
position of the socket
adapter found without
taking into account a
contracture of the hip
joint in the sagittal
plane. 
• In this case, the amputee
has to strain their back
(depicted by red arrow)
to maintain a vertical
position
 Prosthetic Knee alignment
• The picture demonstrates a
prosthetic knee joint bending
• Prosthetic knee units are
designed to imitate the
movement and functions of
the natural knee
• If it is aligned properly, it will
have its own stability in a
straight position
 Prosthetic Knee alignment
• If this line passes too far behind the knee’s reference
point, it will want to bend making it unstable and risk
buckling when under load.
• If this line is too far in-front of the reference point, it
will become overly stable and will be difficult to bend
when sitting down and walking.
• If the alignment line is in an appropriate position, the
knee will be stable in stance and require minimal
effort to initiate swing
 Prosthetic Knee alignment
• The picture shows a side
on view (sagittal plane)
with three different
positions of the
alignment line in relation
to the knee joints
reference point.
• Note that each model of
knee has its own point in
which the alignment line
should pass
 Antero-posterior alignment
• "Alignment stability" is a
key element in
prosthetic fitting.
• By reference to "TKA,“ a
vertical line in the
sagittal plane through
the trochanter, knee,
and ankle

Prosthetic Knee centre (Left to Right) Anterior,

Through and Posterior to the Lateral reference
(TKA ) line
 Prosthetic Foot alignment
• All prosthetic feet have a
manufacturer’s
recommended alignment
reference point.
• The photo shows the
reference point on a
prosthetic foot as a red dot.
• The vertical alignment lines
found from the prosthetic
socket and knee are shown
to pass through this point
 Prosthetic Foot alignment
• The picture above
demonstrates three
different linear
translation positions of
the foot in the sagittal
plane (side on view).
• Figure 1 Alignment too
far forward
• Figure 2 Correct
alignment
• Figure 3 alignment too
far behind
 3R36

Modular Polycentric Knee (Titanium) with

Extension Assist - Adjustable Stance-
Control and Friction.
Anterior, posterior and side views
respectively (from L-R)
Description
• 3R36 Modular Polycentric “4-bar linkage” knee joint – Titanium- with
internal extension assist.
• Recommended for amputees with mobility grade 1 and 2 (indoor
walkers, and restricted outdoor walkers).
• Approved for patient up to 100kg
Knee Specific details
• Maximum Flexion Angle: 120 degrees
• Knee Locking Mechanism: No
• Stance Phase Control: Alignment
• Swing Phase Control: Adjustable internal extension assist. Adjustable
constant friction.
Indications of 3R36 knee joint
• Recommended for amputees with mobility grade 1 and 2 (indoor
walkers, and restricted outdoor walkers).
• Indicated to patient with up to 100kg mass
• Recommended for hip disarticulation amputees
Contraindications of the 3R36 knee joint
• Not recommended to patient with above 100kg weight
• Not recommended to K level 3&4
Alignment
• The position of the residual limb must be taken into account for the
connection to the socket
• Plumb lines in the frontal and sagittal planes from the hip joint's
center of rotation marked during plaster cast taking and trial fitting of
the test socket will facilitate correct positioning of lamination anchor
or socket adapter
 Alignment
•The reference alignment
line runs through the
anterior, upper axis (i.e. 0-5
mm posterior placement of
the joint , see illustration).
• The two lower axes should
create a horizontal line from
the lateral aspect
Bench Alignment
1. Position the middle of the foot 30 mm
anterior to the alignment reference line
(observe the alignment
recommendation contained in the
instructions for use of the knee joint
and foot)
2. Add 5 mm to the required heel height
(observe the alignment
recommendation contained in the
instructions for use of the foot) and set
correct out-ward rotation of the foot)
3. Position the alignment reference point
(for mono-centric knee joints = rotation
axis; for polycentric knee joints =
anterior upper axis) in relation to the
alignment reference line in accordance
with the alignment recommendation of
the knee joint. Pay attention to the
knee ground distance and outward
rotation of the knee (adapter inserts
provide for a rotation of approx. 5°).
Recommended sagittal position of the
alignment reference point: 20
mm above the medial tibial plateau.
Bench Alignment
4. Connect the foot to the knee
joint by means of a tube adapter.
5. Mark the centre of the socket
proximal and distal on the lateral
side. Draw a line through both
marks from socket brim to the
distal end of the socket.

6. Now position the socket such

that the alignment reference line
passes through the proximal
mark. Set the socket flexion to
somewhere between 3°and 5°;
however, the individual situation
(e.g. hip flexion contractures)
must be taken into account. Also
take into account to the ischial
tuberosity to ground distance.
7. Connect the socket and knee by
means of an Adapter.
Static Alignment
1. To make the load line visible,
the amputee (with shoes)
stands on the L.A.S.A.R. Posture
with the prosthetic side on the
force plate and with the other
leg on the height compensation
panel. The prosthetic side
should at least be loaded with
35% of the body weight.
2. Now adapt the alignment by
only adjusting the plantar
flexion of the foot. The load
line/laser line should be placed
anterior to the alignment
reference point (except for
3R60, see ill.) according to the
alignment recommendation of
the knee joint.
Static Alignment
3. Perform dynamic optimization
during trial walking. You will often
have to take the following aspects
into consideration and make any
necessary adjustments:
• Socket flexion position by verifying
step length symmetry (sagittal plane)
• Adduction position of the socket
and M-L positioning of the socket
adapter (frontal plane)
• Rotation position of the knee
joint axis and out-ward rotation of the
prosthetic foot (transversal
plane)
4. Finally, document the fitting
result using the “Dart fish“ motion
analysis software.
Advantages of 3R36 knee joint
1. Swing phase control with spring extension
assist and additionally adjustable axial
friction.
2. Suitable for transfemoral and hip
disarticulation prostheses.

3. The joint is available in stainless steel

(3R20) and titanium (3R36).
4. Used for K level 1&2, for body weight up
to100 kg.
Diasdvantage(s) of 3R36 knee joint
1. It cant be used for K level 3&4
2. It cant be used for a person having
above 100kg mass
Final product(Prosthesis)
3R20
• 3R20 is the stainless steel Modular Polycentric “4 bar linkage” knee
joint having multiple axes of rotation
• They can be set up to be very stable during early stance , yet easy to
bend to start the swing phase or sit
• the prosthetic knee joint has integrated extension assist
• Control Swing phase with spring extension assist and addionally adjustable
axial friction
• 3R20 is recommended for mobility grade 1 (indoor walkers) and grade
2 (restricted outdoor walkers)
• Approved for patient with a weight of up to 100kg
INDICATION
• K 1 and K2 patient
• Patient weigh up to 100 Kg
• Used for short and long stump
Contraindication
• Not suitable for K0, K3 and K4 patients
• Patient weigh more than 100 kg
ADVANTAGE
• Control swing phase by means of extension assist
• Long and short stump user can use 3R20
• Enhance stance phase stability during gait.
• this is because when the knee is full extended the instantaneous
center of rotation is positioned posteriorly to weight line
• Enhance toe clearance throughout swing phase.
• It’s option for individuals who have short residual limbs or significant
weakness of hip extensors
• Because it inherent stance phase stability
 Disadvantages
• Expensive
• Not suitable for patient weigh more than
100kg
• Less durable
• Require more maintenance than single axis knee unity
• Difficult to initiate flexion in the late stance phase
this is due to its inherent stability
BENCH ALIGNMENT FOR 3R20