Prosthetic Knees

Prosthetic knees can be divided into Mechanical or Computerized.

Mechanical knees can then be subdivided into single-axis and
multiaxis/polycentric knees. All prosthetic knee requires some sort of
stability mechanism, this can be manual or a weight-activated locking system.
They also require a way to control the flexion and extension motion, this can be
done by friction or a hydraulic/pneumatic control. Different prosthetic knee
technology will be mentioned below, manufacturers use a combination of these
technologies together to create different types of prosthetic knees. There are
many varieties of prosthetic knee on the market and this page only covers the
concepts and not specific brands. When assessing a patient for the first time or
when they upgrade their prosthesis it is important to go to ask the prosthesist
and or do a web search to read more about the knee/prosthesis and watch the
available videos. Each knee has different features that will influence the gait of
the individual as well as the rehabilitation with regards to sitting down or
standing up, ramps, stairs, uneven terrain and walking and different speeds.

Mechanical Knees
Single-Axis Knees

 Mechanism: This is a simple hinge type knee.

During the flexion/extension these articulations execute a simple rotation
around the knee axis. They are of simple design and their easy alignment
responds to the rules of mechanics. There are exoskeletal and endoskeletal
knees, both versions can have manual or automatic blocking of the flexion to
be used in users with poor muscle power. The knees without blocking can be
used for regular prosthetic fitting of amputees with adequate muscle control
and/or in situations of limited economic resources.

 Advantages: Very simplistic, durable, very light, and economical.

 Disadvantages: Due to the simplicity the individual has to use their own
muscle power in the limb to keep the knee stable with heel contact and
standing.

 Additional components: A manual lock can be added to give more stability

in standing. A constant friction control can also be added which will prevent
the leg from swinging through very quickly.
Polycentric Knees

 Mechanism: This knee has multiple axes of rotation. Polycentric knees can
be four bar knees (4 axes of rotation) or seven bar knees (seven axes of
rotation). Knees of the most frequent use are of 4 axes (or 4 bars). Without
giving importance to the number of axes, the knees of poly-axial design have
one thing in common - the Instant Centre of Rotation (ICR) is situated much
higher and posterior than the mechanical axes when the knee is in
extension. To localize the ICR of a polycentric knee, we need to extend
virtually the center lines of the lateral bars towards proximal - the
intersection of those lines will indicate the ICR. This causes a high level of
stability in the knee against involuntary flexion during the heel strike.
Standard polycentric knees have a single walking speed but when a
manufacturer includes pneumatic or hydraulic features the patient will be
able to vary their walking speed.

 Advantages: It is very versatile in terms of stability and get be adjusted to

be extremely stable when the patient goes into stance phase, but in the same
time allow an easy swing and allows sitting down with a bent knee. Due to
the multiple axes and the ICR, the prosthetic length "shortens" at the start
of toe-off and will allow for foot clearance. It is suitable for patients with the
potential to be independent with the prosthesis in their home and
community as well as the more active person [4].

 Disadvantages: It is heavier than a single axis knee. More parts that need
servicing. Most polycentric knees do not have stance flexion resistance and
therefore cannot yield during sitting, ramps, or stairs. A person with a knee
that is not controlled by a microprocessor, needs to actively generate a knee
extension moment in the stance phase to prevent the knee from buckling
and cause the person to fall down.

Manual Locking Knee

 Advantages: This will allows for automatic locking of the knee with weight
bearing, but the patient can choose to manually lock the knee. This is
 especially for people who need extra security to keep the knee from buckling
in standing or with heel contact or when walking on uneven terrain. The
indication for this type of knee is usually for K1 ambulators or debilitated
individuals who cannot voluntarily control their prosthetic knee.

 Disadvantages: The patient will need circumduct or hip hitch to allow for
foot clearance when the knee is locked during gait.

Weight-Activated Stance Control

These knees are also called "safety knees"

 Mechanism: There is a constant friction system in the knee, which means it

will apply a braking force as the patient puts weight on the prosthesis, to
prevent the knee from buckling. The rest of the time the knee will swing
freely, until the weight is applied to it.

 Advantages: Very stable knee. Prescribed for first time prosthetic users who
need the stability especially in the older or less active population but are still
able to exert some control over the knee. Or a person who fatigues quickly
after just a few steps. This is especially valuable for the patient who forgets
that they should not put their weight on a partially bent knee, the friction in
the knee will brake if this happens and prevent the knee from collapsing into
flexion.

 Disadvantages: When sitting down the patient will have to take the weight
off the leg to allow it to bend, this means that they will not be able to use the
prosthetic side in the sitting motion. The patient will also need to take the
weight off the leg before the knee will bend, this means that the normal knee
flexion at toe off will not happen. Due to the friction in the knee the patient
will also walk slower and take smaller steps.

Pneumatic or Hydraulic Knees

 Mechanism: This is when a pneumatic or hydraulic component (piston

within cylinders containing air or fluid) is added to single-axis or poly-axial
knee. These components control the swinging action of the prosthetic knee
and allows the individual to vary speeds. When speed is increased the valve
in the cylinder closes and gradually limits the air flow/ fluid to limit fle xion
of the knee, when knee flexion is reduced the individual can walk at a faster
pace. The opposite will happen with slower walking, the fluid or air will be
able to more easier, allowing for more knee flexion and slower gait.
Pneumatic control will compress the air as the knee is flexed and then stores
 the energy and releases it with knee extension. Spring coils can be added for
more control during gait. Pneumatics or hydraulics are also added to
computerized prosthetic knees. Hydraulics are better for v ery active
individuals.

 Advantages: The individual will be able to walk more comfortably at

different walking speeds with a more natural gait. Less expensive and lighter
than computerized knees. Weight can be kept on the prosthetic leg when
sitting down and the knee will assist the individual to sit down. The
resistance in the knee will allow the individual to climb down step over step
when walking down stairs, when weight is kept on the leg before and during
the motion.

 Disadvantages: Hydraulic knees are heavier, need more maintenance, and

have a higher initial cost when compared to pneumatics. Overall cost is more
than earlier mentioned knees.