NOT CANDIDATES-Contraindications for prosthetics

1. Age and Alzheimers- not aware, will not be able to use leg
2. Hip Contracture- If they cannot straighten out their hip flexors, they are not candidates. If amputation was years ago,
they are not candidates. Test with Thomas Position, if contracture is greater than 35-40 degrees-> not candidate

Boney Landmarks
1. TKA Line: Trochanter, knee, ankle line. Flexed socket
2. Distal lateral femur
3. Scarpas triangle Sartorius muscle, inguinal ligament, adductor longus muscle.
Can take a lot of compression (socket will press into this)
4. Ramus medial lateral border of AK socket (NO PRESSURE FROM SOCKET)
5. Ischial tuberosity butt bone. Fits inside socket should be a lip
BENCH ALIGNMENT
FRONT
1. The longer the socket, the more adduction (distal end)
2. 10-15 degrees on long stump, out more for short stump
SAGITTAL PLANE:
TKA line
1. 5-10 degrees of flexed socket (leaning forward)
2. TKA line: knee should be slightly anterior from trochanter to ankle
DORSAL PLANE:
1. ALIGNMENT:
STATIC Plumb bob through ischial tuberosity goes through the knee
2.
1. If theinsocket
Put wedgeisunder
divided into thirds from left to right, the ischial tuberosity is on the
medialinternal
2. Slight third of rotation
the socket
(5 degrees) for push off
3. Ramus even with line of progression
4. Big toe even with line of progression
5. Socket flexed 10 degrees like walking with bent knee
6. Knee rotated out (5 degrees)
SUSPENSION
1. Hip attachment belt, suction, or bicycle shorts
2. Silesian Bandage: Have to build these. Attach on sockets, go around waist, go
around loop in the front. stick around like a loop in front.
a. Drill holes anterior, come around the back, then go around front and stick it
through the loop
b. Tools to Rivet: Hammer, Tin-Snips, Draw
c. Placement of strap: in between trochanter and ASIS (interfascial groove).
Take circumference of waist + hip + 7 inches = length of velcro (extra length
for fastening)
LEG LENGTH DISCREPANCY
1. Stand patient up on new leg
2. Place heels 2 inches apart. Why? Locks Pelvis. Then you can accurately check
leg length discrepancy
3. Check the ASIS (anterior superior iliac spine, hip bone flares). Are they level?
4. Watch for scoliosis! Check shoulders. If level at the hips, but shoulders not level, it
could be scoliosis or hip replacement. For scoliosis, the low hip will be on the high
shoulder side
CHECK FOR
1. Pylon leaning too medially or laterally
2. Add and remove magazines under feet until the patient says they are comfortable
(stop when patient can no longer tell difference between 2 heights).
3. Have patient stand solely on prosthetic leg. Make sure they are supported.
DYNAMIC ALIGNMENT: HEEL STRIKE, MIDSTANCE, TOE Gait
OFF. Make sure all screws are tight! DO NOT LET PATIENTS 1. Dynamic alignment is more important than static
FALL. LEG LENGTH DISCREPANCIES will cause endless 2. Take equal strides instead of limping. Tell patient
to step toe to heel
problems-check if you keep running into issues
3. Tell patients to swing their arms when they walk
4. Use crutch on sound side to stabilize when
Pylon leaning walking
1. Lean medially to start so patient can correct/catch Patient Vaulting (patient has to go on toe on sound side)
themselves. If leaning laterally, patient would fall over 1. Leg length discrepancy! Likely scoliosis or hip replacement-
2. Toe in or toe out to adjust discomfort stick magazines under to adjust height
3. If knee is buckling, it is toed out too much 2. Dont know how to walk- a lot of patients have been
amputated for years. Make them use parallel bars.