Prosthesis After Limb Amputation

Alit PawanaPhysical Medicine and Rehabilitation Department

Airlangga University - Dr. Soetomo Hospital

Amputation

Wrist Disarticulation (Melanoma maligna)Above Knee Amputation (Maligna Fibrous histioma)Below Knee Amputation (Chondrosarcoma)

LevelBelow Elbow 4

Partial Hand 3

Wrist Disarticulation 1

Above knee 1

Below knee 9

Syme 1

Transmetatarsal 1

CausalTraumatic 11

Vascular 7

Malignancy 3

Rehabilitation OPC RSUD Dr. Soetomo (July 2014 – July 2015)

Total : 21 (M=19, F =3)

Upper limb amputation

• Average 5000–10,000 upper limb amputation / year• Often caused by traumatic, cancer and vascular

disease• Most amputation level : transradial (57%) &

transhumeral (23%)• Age : 60% (21 - 64 yo), 10% (< 21 yo)• Ratio UL: LL = 1 : 4.9

Lower limb amputation

• Every years about 159,000 LL amputation in US• 7 % amputation associate with diabetic• Level amputation LL :– hip disarticulation (0,4%),– transfemoral (25,8%), – knee disarticulation (0,4), – transtibial (27,6%), – ankle disarticulation (0,8%), – midfoot (10,5%), – toes (31,5%)

Amputation in tumors

Phase Hallmark

Preoperative Asses body condition, patient education, surgical level discussion, postoperative prosthetic plan

Amputation Surgery & Reconstruction

Length, myoplastic closure, soft tissue coverage, nerve handling, rigid dressing

Acute Post Surgical Wound healing, pain control, proximal body motion, emotional support

Pre-Prosthetic Shaping, shrinking, increase muscle strength, restoration of patient locus control.

Prosthetic Prescription Team consensus on prosthetic prescription and fabrication

Prosthetic Training Increase prosthesis wear and functional use

Community Integration Resume family roles & community activities. Emotional equilibrium & healthy coping strategies. Recreational activities

Vocational Rehabilitation Asses & plan vocational activities for future. May need further training and job modification

Follow-Up Lifelong prosthetic, functional, medical assessment & emotional support

Phase of Amputee Rehabilitation

Levels of amputation upper limb

1. Transphalangeal2. Transmetacarpal3. Transcarpal4. Wrist disarticulation5. Transradial6. Elbow disarticulation7. Transhumeral 8. Shoulder disarticulation9. Forequarter amputation

Partial hand

Levels of amputation upper limb

• Partial toe • Toe disarticulation • Partial foot/ray resection • Transmetatarsal amputation (TMA)• Lisfranc• Chopart• Syme’s

Levels of amputation lower limb

• Transtibial• Knee disarticulation• Transfemoral• Hip disarticulation• Hemipelvectomy • Hemicorporectomy

Levels of amputation lower limb

Levels of amputation lower limb

Prosthesis

• An artificial substitute for a missing body part

• Medical considerations decision for a prosthesis:1. Determination of amputation level2. Careful assessment of bilateral proximal muscle strength

and ROM is critical when planning for prosthetic control mechanisms

3. Evaluation of general health

• Cognitive impairment and other neurologic problems can be a major roadblock to prosthetic training.

Energy Expenditure of Different Levels of Amputation

Energy Expenditure of Traumatic Amputees

Lower Limb Prosthesis

• Parts :– Suspension– Socket– Hip Joint– Knee unit– Shank (Tibia part/ femoral part)– Ankle foot assembly

Transfemoral Amputee Prosthetic Options.

Below Knee Prosthesis

Above Knee Prosthesis

Hip Disarticulation Prosthesis

Below knee prosthesis

PTB Socket

Exoskeleton shank

Ankle foot assembly

Energy Storing Single axis

Bilateral Below knee prosthesis (energy storing ankle foot)

Above knee prosthesis

MicrocontrollerKnee joint

Multiple axisKnee joint

Ground reaction force on standing balance test

Post above knee amputation ec osteosarcoma

Above knee prosthesis

Robotic above knee prosthesisOld above knee prosthesis

Post Hip Disarticulation ec Osteosarcoma

Hip Disarticulation Prosthesis

Hip Disarticulation Prosthesis

Upper Limb Prosthesis

• Cosmetics / pasif prosthesis

• Functional prosthesis– Parts :• Terminal Device• Shank• Socket• Elbow Unit• Shoulder Unit• Suspension

Terminal devices (TD):1. Passive Terminal device2. Body-powered terminal

devices (hooks or hands)3. Externally powered

(electric-powered)

Partial hand prosthesis functional(external powered)

Below elbow prosthesis functional (Body and external powered)

Above elbow prosthesis functional (Body powered)

Shoulder disarticulation prosthesis functional

(Body powered)

Above elbow prosthesis hybrid (body and

external powered)

Above elbow prosthesis functional(external powered)

Shoulder disarticulation prosthesis functional (external powered)

Myoelectric external powered schema for shoulder disarticulation prosthesis

External powered upper limb prosthesis

Conclusion

• Elective surgery for tumor amputation will provide comprehensive amputee rehabilitation to reach functional ability

• Prosthesis component after amputation caused by tumor, traumatic or vascular are the same

• Prosthesis prescription is depend on functional need of amputee patient in the level of their activities.

Thank You