BK Fitting Protocol

Question 1

Fitting protocol

Answer 1

Static test socket - non weight bearing
Static test socket - weight bearing

Static standing alignment on components
Dynamic alignment in parallel bars

Question 2

Objectives of static test socket fitting

Answer 2

Observe and evaluate overall volume and contours

Adjust PRN for appropriate loading and comfort

Question 3

Static test socket fitting protocol

Answer 3

Don w/initial sock ply and apply light pressure to DE, increasing as tolerated to assess volume comfort

Locate and assess height of MPT relative to patellar bar

Assess DE contact

Adjust volume PRN (socks, pads) and reassess MPT level

Reassess comfort (add socks and pad pressure tolerant areas first, then heat relieve if needed)

Assess posterior trim lines (comfort w/105° knee flexion, hamstring relief)

Question 4

Objectives of static WB test socket fitting

Answer 4

Observe and evaluate overall volume and contours
Adjust PRN for loading and contact
Adjust and evaluates coronal and sagittal alignment lines

Question 5

Static WB test socket fitting protocol

Answer 5

Set stander height/verify stability

Don socket/socks

Support socket as pt stands in parallel bars, socket on stand, adjust stand to level hips

Reassess volume, adjust PRN

Assess comfort, adjust PRN

Evaluate proximal ML (add of medially if loose)

Assess alignment lines, adjust PRN
Coronal - shift wt toward side to simulate MS
Sagittal - leave as is unless flexion contracture >10°

Question 6

Objectives of static alignment in components

Answer 6

Verify comfort

Adjust height and gross malalignments

Question 7

Prior to static alignment on components, perform

Answer 7

Bench alignment
Wrap w/fiberglass
Confirm all screws neutral and tight

Question 8

Static alignment on components protocol

Answer 8

Don w/pt seated

Correct major discomfort or safety issues - stand in parallel bars, equal weight on both feet, resolve discomfort/instability, confirm suspension by picking up foot

Correct height w/blocks under foot (level iliac crests and pt feedback)

Correct gross malalignments - goal: top of foot level with ground and pylon vertical, foot flat on ground
Coronal - angular adjustment for ML stability, linear of foot position grossly off
Sagittal - angular adjustment for stability and comfort in quiet standing
Transverse - toe in / out

Question 9

Objectives of dynamic alignment

Answer 9

Adjust alignment to maintain coronal and sagittal stability through stance
Achieve slight varus thrust at MS
Maintain pt comfort through stance

Question 10

Dynamic alignment protocol

Answer 10

Walking trial within parallel bars (place prosthesis behind and in front to practice loading, then walk slowly w/even step lengths and narrow base)

Correct malalignments - coronal first then sagittal
Adjust heel/keel levers and stiffness

Refine alignment outside parallel bars if appropriate for pt

Assess sitting comfort

Remove prosthesis and assess skin