TRANSTIBIAL & TRANSFEMORAL

PROSTHETICS
Dr. Aayan Huda (PT)
 TRANSTIBIAL AMPUTATION
• Ideal length- five inches from tibial tubercle
• Minimum length – two inches from tibial
tubercle
• Types: Ultra short (below tibial tubercle),
Short(upper 1/3rd tibia), Standard (junction of
upper and middle 1/3rd ) & Long(junction of
lower and middle 1/3rd)
 TRANSTIBIAL PROSTHESIS
Parts:
• Socket
• Suspension
• Shin
• Ankle joint
• Foot
 SOCKET
• Encloses the stump
• Forms connection b/w stump and artificial
limb
• Protects the stump and transmits forces
• TYPES: Conventional Below Knee Socket,
Patellar Tendon Bearing Socket, Patellar
Tendon Bearing Supracondylar Suprapatellar
Socket, Bent Knee Socket & Slip Socket
 Conventional below knee socket
• Uses: Elderly patients with unstable knee &
quadriceps weakening
• Fabricated causes no pressure over distal
tibia , fibula head and tibial crest
• Requires external knee joint & thigh corset
 Patellar tendon bearing socket
• To distribute the weight in pressure tolerant
areas like patellar tendon and medial tibial
flare.
• Total contact socket: 60 % weight – patellar
tendon & 40% - medial tibial flare
• Name – because of BAR that is built in to
patella tendon (midway b/w patella and tibial
tubercle)
 Supra patellar supracondylar socket
• A modification of PTB
• Trim lines: Anterior – suprapatellar & Medial
and lateral – supracondylar
• Gives good suspension
• Uses: In patients with short stump and genu
recurvatum
 SUSPENSION
• The method of connecting a prosthesis to
residual limb
• Suspension designed according to activity
level, comfort and safety
• If suspension not adequate – motion occur
between socket and limb – called pistoning
Supracondylar cuff
Waist belt
Cuff strap
Thigh Cuff
Vacuum Suspension
Osseous Integration
 SHIN PIECE
• Substitute for the human leg
• Transmit body weight from the socket of the
prosthesis to the prosthetic foot.
• Types: Exoskeltal & Moulded hard plastic hell
• Disadvantage: Fixed alignment after finishing.
TRANSFEMORAL
 TRANSFEMORAL AMPUTATION
PRINCIPLES
• Amputation between femoral condyles and
greater trochanter
• Preserve as much as length as possible
• Countering abduction force of G. MED and
G.MIN – suturing adductors to femur
 TRANSFEMORAL PROSTHESIS
PARTS:
• Socket
• Knee
• Rotator
• Pylon
• Foot
 TYPES OF SOCKETS
• Quadrilateral
• Ischial containment
 Quadrilateral socket
• Made by: University of california
• Have four distinct walls
• The weight bearing takes place at the ischial
tuberosity by the means of ischial support at
the posterior shelf of the socket.
• The suspension is provided by negative
pressure (suction) that is generated by
adequate fitting of the socket over the stump
 Ischial containment socket
• The principal peculiarity of this design is the
medial wall/border of the socket that contains
the ischial ramus.
• The weight bearing takes place all over the
surface of the stump without localizing one
specific point; hence, generating more comfort,
better control over the prosthesis and security
for the user.
• The ischial tuberosity does not suffer from direct,
complete and permanent weight bearing.
 KNEE JOINT PROSTHESIS
• Difficult to replicate
• Modified hinge joint
 Types
SINGLE AXIS KNEE UNITS
• Simple hinge
• Fixed center of rotation
• Allow flexion and extension
• Give support during stance not during swing
• Light weight , durable and low maintanace
• Not good for ones having short stump
 POLYCENTRIC KNEE JOINT
• Moving center of rotation - Rotates in more than
one axis
• During swing phase, it leads to shortening of
distal prosthesis enhancing toe clearance
• Good for long residual limb or knee
disarticulation patients
• Good stance phase stability – so in short stump
ones and hip extensor weakness patients
• Less durable than single axis