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Prosthetics - Lower Extremity

According to the National Limb Loss Information Center, there are approximately 1.6 million people living with limb loss in the United States, and it is estimated that one out of every 200 people in the U.S. has had an amputation. The major causes of lower extremity amputations are disease, such as diabetes or peripheral vascular disease, trauma, congenital and tumors.

Depending upon the cause of the amputation there are different levels of lower extremity amputations. Listed below are the various levels.

Transmetatarsal

The transmetatarsal amputation is more involved than a simple toe amputation. This type of amputation can sometimes cause one to lose all five toes. However, in most cases a simple shoe filler can help relieve any problems with gait.

Chopart/Symes

A chopart or symes amputation is performed at the ankle joint.

Transtibial

A transtibial amputation, or otherwise known as a below-knee amputation, is an amputation that occurs below the knee joint. Most patients who receive transtibial amputations are very successful prosthetic wearers. There are numerous suspension systems and designs available for transtibial amputees. The patient's prosthetist will work closely with the patient to determine his or her goals and activity levels to create the appropriate prosthetic system.

Knee Disarticulation

A knee disarticulation (sometimes called a through knee) is an amputation that involves keeping the femur intact. Instead, the tendons and ligaments attaching the femur (thigh bone) to the tibia (shin bone) are detached.

There are several advantages of the knee disarticulation over the traditional transfemoral (above-knee) amputation. The first advantage is decreased rehabilitation time since there is less trauma to the femur. Secondly, the adductor group of muscles (the muscles that bring the leg towards the body) is left intact because the bone is not cut. As a result, the patient will have more control over his/her residual limb. The third advantage is that the end of the femur can take some weight bearing at the bottom instead of taking it entirely through the ischium (sitting bone). The last advantage is that the length of the residual limb is as long as possible (the entire femur). More length equals more control over the prosthesis. This translates into more stability and a better gait.

The knee disarticulation level presents an interesting challenge to the prosthetist. For one thing, the end of the femur is larger than the area above it, which means it can be difficult to accommodate this area. Also, because the bone is so long it can lower the person’s knee center compared to the opposite side. Due to these kinds of challenges, few prosthetists, when consulted prior to amputation by a surgeon or patient, will recommend this level over the traditional transfemoral level. It can be a difficult level to fit unless the prosthetist has unique fitting techniques. Westcoast Brace & Limb's prosthetists have many years of experience fitting this unique level of amputation.

Transfemoral

A transfemoral amputation, or otherwise known as an above-knee amputation, occurs in the thigh, through the femoral bone (femur). While no amputation is easy to adapt to, the transfemoral amputation does offer more challenges than the lower level amputations. This level of amputation definitely requires more energy when walking with a prosthetic device. A transfemoral prosthesis is more complex because of the addition of a knee joint. There are many systems available for amputees, including many high-tech options.

Hip Disarticulation & Hemipelvectomy

The hip disarticulation amputation involves removing the femur in its entirety, but leaving the pelvis intact. The hemipelvectomy amputation involves removing the femur and a portion of the pelvis. These are the least common levels of amputation. The main causes for these types of amputations are trauma and osteosarcoma (cancer).

Since these amputations are not very common, the average prosthetist will only see a handful of patients at these levels in his/her career. The prosthetists at Westcoast Brace & Limb have worked with many patients at these difficult levels and have developed some specific techniques that have improved the comfort, fit and function of hip disarticulation and hemipelvectomy patients.

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