TRANSTIBIAL PROSTHETIC COMPONENTS REVIEW

Suspension Cuff :
Advantages
 Adjustability
 Ease of donning and doffing
 Easily to replaced
 Provide moderate control of knee extension
Disadvantages
 Restricts circulation
 Can’t use scarring tissue at suspension
 Provides little mediolateral stability compare to SC/SCSP

Waist Belt Suspension :

Advantages
 Ensure positive suspension
 Loose when sitting
 Used by disable athletes in competition
 No circulatory interference
 The weight of the prosthesis is distributed over the iliac crests.
 The elastic strap provides some knee extension assistance.
Disadvantages
 Less cosmetic
 Time consuming for donning and doffing
 Less comfortable
 Belt may interfere with clothing

PTB SC :
Advantages
 M-L knee stability
 Easy to kneel
 Self-suspension
 More surface area supported than PTB with cuff
 Easier to don and doff than cuff
 No restriction of blood circulation
Disadvantages
 Can be difficult to don and doff
 Trim lines may be visible when seated
 Need well defined Femoral condyle
 Not patient adjustable
 More difficult to cast

PTB SCSP :
Advantages
 Anatomical suspension
 No restriction of circulation
 Provide M-L and A-P knee stability
 Control knee hyperextension
Disadvantages
 Can be difficult to doff
 Kneeling is Uncomfortable because the patella is enclosed.
 Trimlines are visible when seated

Joint and thigh corset :

Advantages
 Can be used to take weight off the stump if it is badly scarred, painful, or for very short
stump, increase M-L stability
Disadvantages
 Bad for the blood circulation
 Cause often muscle waste

Silicone pin liner + lock :

Advantages
 Volume change is adjustable with stump socks.
 Available in different softness, features, and activity level
 Many choice of locking mechanism
Disadvantages
 Not good for bulbous shape
  May feel discomfort at distal end of stump

Silicone cushion liner+ valve + knee sleeve :

Advantages
 No mechanical connection between liner and suspension
 Better cushioning than pin liner
 Very secure suspension, less build height than pin
 Could be used for additional suspension
Disadvantages
 Cosmetically poor
 Heavier
 Could be used with many stump socks
 Knee sleeve might be damaged

Silicone seal-in liner + valve :

Advantages
 No suspension sleeve is needed
 Good feedback because of good suspension
 Less build height- good for long stump
Disadvantages
 Good fitting is needed
 Less stump volume adjustability with stump socks. Patient should have stable volume.
 Certain suction seals needed to be inside of socket in order to keep suspension ( not good
for short stump)

Pelite liner :
Advantages
 Good cushioning
 Heat mouldable and adjustable
 Can be locally packed and adjusted
 Cheaper than other liners
Disadvantages
 Can thin out over time.
  Heat reshapes the liner

Silicone liner :
Advantages
 Very flexible
 Good cushioning, decrease incidence of skin breakdown
 Skin friendly
 Available in different shore and features
 Low to moderate activity levels
Disadvantages
 More expensive
 Increased sweating for few months
 Can tear from edge
 Increased hygiene is required
 Good upper limb function is required

Polyurethane liner :
Advantages
 Excellent cushioning
 Extremely flexible
 Decreased shear and shock
 Residual limbs all types especially sensitive, boy and or scarred,
 Low to high activity levels
Disadvantages
 Heavier than pelite liner, and silicone liners
 Can tear from edges
 Need good hand function

TT Prosthetic components (ICRC) :

 Convex ankle
 Two concave cylinders
 Convex disc
 Cylindrical TT cup
 Flat steel washer and countersunk head bolt
 SACH foot
  Hexagonal head bolt and lock washer

Functional Level (K-Level) :

 K0. Prosthesis does not enhance quality of life or mobility
 K1. Household ambulator, fixed cadence
 K2. Limited community ambulator,
 K3. Fixed cadence unlimited community ambulator,

Prosthetic Feet :
 Solid Ankle Cushion Heel (SACH) foot
 Single axis foot
 Multi-axial foot
 Flexible-keel foot
 Dynamic response/Energy storing foot
 Hybrid design

Solid Ankle Cushion Heel (SACH) :

Components
 Solid wood or aluminum internal keel
 Molded foam foot
 Cushion heel wedges
 Belting
 Shank attachment
Advantages
 Moderate weight
 Good durability
 Minimal maintenance
 Good shock absorption fro moderate activity patients
Disadvantages
 Limited plantar flexion and dorsiflexion adjustability
 The heel cushion deteriorates over time
 The rigid forefoot provides poor shock absorption for high out put activities
Functional Level
 1 or 2
  Sometimes 3

Single axis foot :

 Metal single axis joint
 Rubber plantarflexion bumper and dorsiflexion stop
 No inversion / eversion
 Plantarflexion bumper offer shock absorption at the heel strike
 Toes rubber creates push-off
 Bumpers are interchangeable
Advantages Disadvantages Functional Level
 Accommodate Uneven terrain(sagittal plane)
 Bumpers are replaceable
 Relatively inexpensive
 Increased knee stability
Disadvantages
 Increased maintenance
 Heavy
 Contraindicated if knee is stable
 Can’t use in dirty and wet condition
 Less cosmesis
 Tendency to be noisy
Functional Level
 1 or 2

Multi-axis foot :
 It provides motion in all plane (plantarflexion, dorsiflexion, inversion, eversion and in
rotation
 Motion controlled by rubber ring bumper around a ball joint
 Resistance - firmness can be changed
Advantages
 Accommodates to uneven ground
 Provides a smooth / natural gait pattern
 Reduces torque on the stump
 Adjustability
Disadvantages
  Expensive
 Increased maintenance
 Heavy
Functional Level
 3 or 4

SAFE ( Stationary Attachment-Flexible-Endoskeletal) Flexible-keel foot :

Advantages
 Easy to rollover
 Smooth
 Comfortable
 Reliable
Disadvantages
 Limited push-off
 Increased cost
Functional Level
 3 or 4

Dynamic response/Energy storing foot :

Advantages Disadvantages Functional Level
 Store and Release energy
 Smoother gait pattern
 Less energi expenditure
 Cosmesis
 Light weight
Disadvantages
 Material durability
 Expensive
Functional Level
 3 or 4

Hybrid Design – Adjustable Heel Height :

Advantages
 can wear different heel height shoes/without shoes
Disadvantages
 More expensive
 Heavier
 Need more maintenance