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Prosthetics/Orthotics > Transfemoral Amputation & Prosthetic Components > Flashcards

Transfemoral Amputation & Prosthetic Components Flashcards

1
Q

Transfemoral Amputation surgery causes loss of what motions?

A

Active
- Knee
- Foot
- Ankle

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2
Q

T/F: After TFA it is okay to put weight on the end of the residual limb

A

False- Very little if any weight can be places on the end

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3
Q

After TFA the thigh muscles are out of balance what two muscle groups overpower the others?

A

Flexors & Abductors overpower the extensors & adductors

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4
Q

Anatomically, why is there a weakness and limited ability to adduct & extend the hip?

A
  • Primary hip abductor & flexor muscles are attached on greater & lesser trochanter on proximal femur
  • Since they are attached above surgical division they are fine
  • Adductor & extensor muscles are attached at lower end and will be divided by TFA
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5
Q

Where does the surgeon reattach the adductor and extensor muscles? What does the prevent?

A
  • Femur or Periosteum
  • Counterbalances the flexion & abduction forces to prevent the femur from drifting outwards
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6
Q

If the femur abducts, weight cannot be loaded as easily onto the side. What may this cause?

A

Bone may press painfully against the socket

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7
Q

By surgically balancing the muscles the leg can be positioned in slight (adduction or abduction) in the socket so most of the WB force is where?

A
  • Adduction
  • Most WB force is on the sides of the leg & not the distal end
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8
Q

What does the myodesis do during TFA?

A
  • Makes residual limb stronger & more balanced
  • Keeps femur centered
  • May help reduce adductor roll
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9
Q

What is the adductor roll?

A

Collection of tissue that sometimes forms high on the inner thigh above the socket line

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10
Q

How does a myodesis help reduce adductor roll?

A

Secures the adductor muscles & the soft tissue over these muscles which appears to restrict the development of a large adductor roll

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11
Q

What is the minimal length of a TFA?

A

7.5 cm

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12
Q

What is the optimal length of TFA?

A

23-30 cm

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13
Q

What are the pressure sensitive areas following TFA?

A
  • Pubic ramus
  • Pubic tubercle
  • Adductor tendon
  • Distal end of femur
  • Greater trochanter
  • ASAI
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14
Q

A single axis hinge prosthetic knee is used for what K levels?

A

K1/2

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15
Q

A polycentric prosthetic knee is used for what K levels?

A

K1/2

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16
Q

A pneumatic & Hydraulic prosthetic knee is used for what K level?

A

K3

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17
Q

A microprocessor prosthetic knee is used for what K level?

A

K4

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18
Q

What type of knee friction is used for K levels 1/2?

A

Constant Friction

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19
Q

What type of knee friction system is used for K3?

A

Variable friction

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20
Q

Which is heavier: Single axis or polycentric prosthetic knee?

A

Polycentric

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21
Q

Between single axis and polycentric prosthetic knee, which is more difficult to reciprocate during gait?

A
  • Single knee axis
  • Polycentric knee makes reciprocal gait more fluid
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22
Q

How many pivoting bars does the polycentric prosthetic knee have?

A

4 or more

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23
Q

Between the polycentric and single axis, which prosthetic knee provides greater stability?

A

Polycentric

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24
Q

T/F: Both the single axis & polycentric may or may not have knee extension assist and/or a weight activated stance phase control

A

True

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25
Q

In a variable friction mechanism during initial swing there is (high or low) friction to prevent excessive knee (flexion or extension)

A
  • High
  • Flexion
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26
Q

In a variable friction mechanism during midswing friction (increases or decreases) to allow the knee to swing easily

A
  • Decreases
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27
Q

In a variable friction mechanism during terminal swing friction (increases or decreases) for initial contact

A

increases

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28
Q

How does a manual locking knee provide stability?

A

Through physical lock on the knee joint

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29
Q

In regards to a manual locking knee what position does the knee remain in when lock is engaged?

A
  • Extended & stable
30
Q

Typically, what patients receive manual locking knees?

A

Those who need assurance the limb won’t collapse during stance

31
Q

How is the friction brake activated in a weight activated knee? And how is it unlocked?

A
  • Body weight
  • Unlocked as weight is relieved and swings freely during swin
32
Q

Typically, what patients receive weight activated knees?

A
  • Elderly
  • Low level ambulatory who may use AD
  • those who need extra degree of security while wearing prosthesis
33
Q

T/F: In a weight activated knee the knee needs to be completely unloaded before it can flex

A

True

34
Q

What are the advantages of hydraulic prosthetic knee?

A
  • Variable friction for improved swing & stance phase control
  • Provides more friction for smoother gait
35
Q

What are the disadvantages of hydraulic prosthetic knee?

A
  • Heavier
  • More expensive
  • More maintenance
36
Q

What are the advantages of a microprocessor knee?

A
  • Decrease falls
  • More active
  • Enhanced confidence
37
Q

What are the disadvantages of a microprocessor knee?

A
  • Heavier
  • Expensive
  • Battery
38
Q

What items should be considered when choosing an appropriate knee?

A
  • User activity level (K level)
  • Ability or potential to reach higher level
  • Constant vs Variable friction
  • Vocational/recreational
  • Maintenance/distance to prosthetist
39
Q

What criteria should the socket meet?

A
  • Fit should be comfy
  • Suspension should be effective
  • It should allow the amputee to move and/or ambulate
40
Q

What is the socket?

A

Interface between residual limb & prosthetic device

41
Q

What are the 2 types of transfemoral socket designs?

A
  • Quadrilateral
  • Ischial Containment Socket
42
Q

Which socket type is narrow A-P?

A

Quadrilateral Socket

43
Q

What type of residual limbs are quadrilateral sockets most successful on?

A
  • Long, firm residual limbs with firm adductor musculature
  • Can be used for mostly all types of residual limbs
44
Q

Where does WB take place at with a quadrilateral socket?

A

Ischial tuberosity by the posterior shelf of the socket

45
Q

How is the suspension provided with a quadrilateral socket?

A

Suction generated by adequate fit of socket over the residual limb

46
Q

Which socket has narrow medial - lateral walls?

A

Ischial containment socket

47
Q

Which is more successful quadrilateral or ischial containment socket?

A

Ischial containment socket

48
Q

With an ischial containment socket where does WB take place?

A

All over the surface of the residual limb w/o localizing in one point

49
Q

What are the advantages of hard socket?

A
  • Very durable
  • Easy to clean
  • Less expensive to produce
50
Q

What are the disadvantage of hard socket?

A

More difficult to adjust fit on bony or sensitive residual limbs

51
Q

What are the advantages of flexible socket?

A
  • Accommodates to change in muscle shape
  • Provide relief for bony prominences
  • More expensive to fabricate
52
Q

What are the disadvantage of flexible socket?

A
  • Less durable
  • Bulkier
  • More expensive to fabricate
53
Q

What are the 5 common types of suspension systems?

A
  • Suction (traditional pull in suction, negative air pressure)
  • Roll on cushion liner
  • Silesian BELT suspension
  • Total Elastic Suspension Belt
  • Pelvic Belt & Hip joint
54
Q

What are the advantages of traditional pull-in suction suspension negative air pressure?

A
  • Enhanced prosthetic control
  • Intimate fit
  • Eliminates/minimizes pistoning
  • Improved proprioception
55
Q

What are the disadvantages of traditional pull-in suction suspension negative air pressure?

A
  • Recent amputation
  • need to control volume/ weight requires consistent limb volume
  • may be difficult to don
56
Q

Is a traditional pull in suction suspension use a liner?

A

No, use w/o liner

57
Q

What are the indication of traditional pull in suction suspension system?

A
  • Long residual limbs
  • Good skin conditions
  • Good patient balance
  • Good upper extremity strength
58
Q

What are the contraindications of traditional pull-in suction suspension system?

A
  • Very short residual limbs
  • UE weakness
  • frequent volume fluctuations
59
Q

What are the advantages of roll on cushion liner?

A
  • Shear on skin
  • Don while seated
  • Softer distal support
  • Smoother donning & doffing
60
Q

What are the disadvantages of roll on cushion liner?

A
  • Expense
  • Durability
  • Hygiene (increased sweating or risk of infection)
  • Possible distal end pulling
61
Q

What are the indications of roll on cushion liner?

A
  • Short to long limbs
  • minor volume changes
62
Q

What are the contraindications of roll on cushion liner?

A
  • Irregular residual limb shape
  • Hygiene concerns
  • large volume changes
63
Q

What are the Silesian Belt Suspension advantages?

A
  • easy to don
  • Adjustable
  • long residual limbs who are not vigorous ambulators
64
Q

What are the silesian belt suspension disadvantages?

A
  • Added bulk around waist
  • less anatomic
  • uncomfortable
65
Q

What are the indications of Silesian Belt suspension system?

A

when other systems are not optimal

66
Q

What are the advantages of total elastic suspension belt?

A
  • Easy to don
  • Comfortable
  • excellent suspension
67
Q

What are the disadvantage of total elastic suspension belt?

A
  • Controlling rotation
  • Durability
  • Heat
68
Q

What are the advantages of pelvic belt & hip joint?

A
  • Control rotation/ m-l stability
  • very short residual limbs
69
Q

What are the disadvantages of pelvic belt & hip joint?

A
  • Bulky, weight
  • Uncomfortable when sitting
70
Q

What is osseointegration?

A
  • Scientific term for bone ingrowth into a metal implant
  • Surgical implant a rod with an external connector that can interface with prosthesis
71
Q

What are the advantages of osseous integration?

A
  • Increased use of prosthesis
  • more stability in walking & standing
  • Ability to walk longer distances
  • Avoiding the skin problems associated with socket prosthetics
  • Easy to remove & replace prosthesis
72
Q

What are the disadvantages of osseous integration?

A
  • Surgical procedure with potentially long recovery time
  • Need to regularly maintain & clean the interface b/w the skin & implant
  • Risk of superficial skin infections or deep tissue infections
  • Potential to bend or break

Prosthetics/Orthotics (12 decks)

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