Transfemoral Gait Deviations

Question 1

Knee anterior to TKA causes:
1.
2.

Answer 1

1. Unstable
2. Causes knee flexion moment

Question 2

Knee posterior to TKA causes:
1.
2.

Answer 2

1. Stable
2. Causes knee extension moment

Question 3

AK bench alignment:
1.
2.
3.
4.
5.

Answer 3

1. TKA aligned in stable position (through or anterior to knee center causing knee extension at initial contact)
2. Socket flexion 5 degrees (in addition to any hip flexion contraction presents)
3. Knee externally rotated 5 degrees
4. Toe out 7 degrees
5. Foot set up underneath ischium

Question 4

Why is the socket pre-flexed?
1.
2.

Answer 4

1. Puts hip extensors in stretched position for better control of prosthesis.
2. Prevents lumbar lordosis and facilitate normal step length.

Question 5

Why is the foot aligned with the ischium?
1.
2.
3.

Answer 5

1. Creates varus moment about ischium
2. puts abductors under tension to provide stabilization to pelvis
3. Lateral wall provides counterforce and restores natural femoral adduction

Question 6

Knee instability at initial contact:
1.
2.
3.
4.

Answer 6

1. Knee unstable TKA alignment (KC anterior to weight line, flexion moment)
2. Heel too firm
3. Insufficient socket flexion
4. Weak hip extensors

Question 7

Uneven step length at initial contact, short prosthetic side step:
1.
2.
3.
4.

Answer 7

1. Knee unstable TKA alignment
2. Knee friction too low
3. Femur pain
4. Mistrust of prosthesis

Question 8

Foot slap:
1.
2.

Answer 8

1. Plantar flexion bumper absent or heel too soft
2. Patient ensuring knee stability

Question 9

External foot rotation:
1.
2.
3.
4.
5.

Answer 9

1. Heel too firm
2. Excessive toe out
3. Patient has poor muscle control
4. Socket tension too loose
5. Medial/Posterior wall angle too tight

Question 10

Abducted gait:
1.
2.
3.
4.
5.
6.

Answer 10

1. Ramus pressure
2. Socket abducted
3. Prosthesis too long
4. Habit
5. Femur pain
6. Abductor contracture

Question 11

Lateral trunk bending:
1.
2.
3.
4.
5.
6.
7.
8.
9.

Answer 11

1. Ramus pressure
2. Prosthesis too short
3. M/L too big
4. Insufficient socket adduction
5. Lack of lateral counterforce
6. Foot too outset
7. Short residual
8. Adductor weakness or contracture
9. Femur pain

Question 12

Pelvic Rise “Hill climbing”:
1.

Answer 12

1. Keel too long

Question 13

Drop off:
1.
2.

Answer 13

1. Keel too short
2. Foot too posterior

Question 14

Excessive Lumbar Lordosis:
1.
2.
3.
4.

Answer 14

1. Ischial pain
2. Insufficient socket flexion
3. Muscle weakness or contracture
4. Short residual

Question 15

Medial whip:
1.
Lateral whip:
1.
Other causes for both:
1.
2.
3.

Answer 15

Medial whip:
1. Knee externally rotated
Lateral whip:
1. Knee internally rotated
Other causes for both:
1. Improper don
2. Socket contours too tight, don’t accommodate contracting musculature
3. Patient has poor control

Question 16

Socket drops away from residual:
1.
2.

Answer 16

1. Bad suspension
2. Improper sock ply

Question 17

Delayed heel rise:
1.
2.

Answer 17

1. Knee too stable (too posterior to TKA)
2. Knee friction too high

Question 18

Excessive heel rise:
1.
2.
3.

Answer 18

1. Knee friction too low
2. Extension aid too low
3. Poor patient control

Question 19

Circumduction:
1.
2.
3.
4.
5.
6.
7.

Answer 19

1. Ramus pressure
2. Prosthesis too long
3. Friction too high
4. Extension aid too high
5. Habit
6. Bad suspension
7. Hip flexor weak must recruit abductors

Question 20

Vaulting:
1.
2.
3.
4.
5.

Answer 20

1. Prosthesis too long
2. Friction too high
3. Extension aid too high
4. Habit
5. Bad suspension

Question 21

Terminal impact:
1.
2.
3.

Answer 21

1. Knee friction too low
2. Extension aid too strong
3. Habit

Question 22

Unequal step length (long prosthetic step length)
1.

Answer 22

1. Insufficient socket flexion

Question 23

Trendelenburg Gait:
1.
2.
3.
4.
5.
6.

Answer 23

1. Insufficient socket adduction
2. M/L too big
3. No bony lock
4. Short residual
5. Abductor weakness
6. Hip pathology