Prosthesis

What is prosthesis?
• Prosthesis in Greek means “in addition”. Thus, prosthesis is defined as a
replacement or substitution of a missing or a diseased part.
• Prosthetics is the theory and practice of the prescription, fitting, design,
assessment and production of prosthesis.
• Prosthetics is a unit of rehabilitation medicine dealing with the replacement of
whole or a part of a missing extremity with an artificial device. The device so
manufactured is called a prosthesis.
• All prostheses must fit comfortably, should function well and should look
presentable. The patient accepts and uses a prosthesis much better if it is fitted
soon after operation; delay is unjustifiable now that modular components are
available and only the socket need be made individually.
 Classification of prosthesis

Endoprostheses: These are Exoprostheses: These are for

implants used in orthopaedic replacement externally
surgery to replace joints, e.g. for a lost part of the limb. They
Austin Moore prosthesis are more extensively
used in the lower limbs
Parts of prosthesis
• The prosthesis consists of a socket, designed to be
in close contact with the stump; a suspension to
hold the socket to the stump; a prosthetic
extension with substitute joints; and a terminal
device .
• The sockets are shaped according to the shape of
the stump. These could be end bearing sockets –
where end of the stump bears the weight, or total
contact socket – where the weight is distributed
evenly throughout the surface of the socket.
• The socket is the fundamental component to
which the remaining components are attached.
• Most sockets are double-walled. A plaster cast
moulding of the stump is used to fabricate the
socket for optimal fit, function and comfort.
• The terminal device of a lower limb
prosthesis is a prosthetic foot, called SACH
foot.
• It is a simple device that has a wooden
core surrounded by a solid rubber foot.
• This permits a combination of stiffness with
pliability.
• The cushioned heel absorbs the impact of
heel strike.
 connects the
suspend the socket residual limb
from the residual to the
limb and act as a prosthesis
protective barrier
between skin and
socket
mimic the function of a
natural knee by
providing safety,
symmetry and smooth
movement when
imitate the function walking, stability when
links the main standing and a range of
of a real foot, components
responsible for motion that makes
such as the sitting and kneeling
absorbing the liner, knee and
shock generated by possible.
foot together
impact on the
ground
Types of prosthesis
• Temporary prosthesis (e.g. pylon): These are used following an amputation
until the patient is fitted with permanent prosthesis.

• Permanent prosthesis. The previous phase of recovery contains a

repetitious process of filling the gaps between the residual limb and the
socket of the prosthetic limb as the swelling continues to decrease. Once
the swelling has diminished substantially, the patient will then be ready to
be fitted for the permanent prosthesis.
PROSTHESIS FOR THE LOWER
LIMBS
• Prosthesis for the lower limbs is required in the following situations:
For disarticulation of hip and hemipelvectomy
 Transfemoral amputations(above the knee): Two types of prostheses are
recommended.
• – Suction-socketted limb: This is useful in young adults and is best suited for
cylindrical stumps. It snuggly fits and has a two-way valve mechanism to
maintain negative pressure. The advantages of suction-socketted limb are
that skin infection is less common, there is freedom from harness of any
kind, greater feel of close contact of the prosthesis and the patient feels
that it belongs to him or her. Stump socks are not necessary in this variety
• – Nonsuction-socketted limb: Here, no negative pressure is employed to
hold the prosthesis, but pelvic bands or harness is made use of for holding.
The advantages of nonsuction-socketted limb are, it is easy to wear, there
is no perspiration, it provides a comfortable fit, and there is no difficulty in
changing the stump circumference.
PROSTHESIS FOR BELOW KNEE
AMPUTATIONS(TRANSTIBIAL)
• Patellar tendon bearing (PTB) prosthesis: In
this, the socket is made in such a way that it
fits exactly over the patellar tendon and the
sides of the tibial condyles such that when in
full extension the weight is transferred to
some extent through this to the prosthesis .
This has the advantage over the conventional
prosthesis, which requires the knee supports.
• Conventional type prosthesis: This consists of
the thigh corset, the side steels, the knee
joint, shin piece, ankle joint unit and the foot
piece. It definitely has the disadvantage in
that it is more cumbersome to put on and use
it when compared to the PTB prosthesis.
PROSTHESIS FOR SYME’S
AMPUTATION
• This is a below knee prosthesis used after Syme’s amputation . These
prostheses may have closed sockets or open sockets and may be full
weight bearing or modified end bearing.
SACH FOOT& JAIPUR FOOT
• Ankle Units and Artificial Feet
• Solid action cushion heel (SACH)foot has no ankle joint,
but a simulated action is gained by the compression of
wedge-shaped rubber heel and the whole foot is
incorporated with various layers of rubber with its density
varying, all placed over a wooden insert for the heel and
wooden side keel. This allows smooth movements of the
foot.
• For Jaipur foot rubber and aluminium is the mainstay.
Rubber is waterproof; aluminium is used for the leg piece,
because it is cheap, strong and rust proof. Unlike the
Western model, Jaipur foot is best for foot conditions in
developing countries as it allows sitting on the floor,
squatting and does not require a shoe
Prosthesis for Upper Limb Amputations
• Forequarter amputations: Here the prosthesis merely serves a cosmetic
purpose. A sleeve fitter prosthesis with a plastozoate cap-padded inside with
foam and retaining straps is used.
Shoulder Disarticulation
• • Shoulder piece extended cap to hold the prosthesis.
• • Elbow piece: It can be flexed by pulling on the flexion cord with the
protractors of the shoulder.
• • Hand piece: Either cosmetic or splint hook type.
Above elbow amputation(transhumeral): Same as above except that the elbow
flexion is stronger due to the action of the arm muscles along with the
protractors of the shoulder.
Below elbow amputation(transradial): Here there is a cup socket attached to
the terminal device through an operational cord. The terminal device can be
activated through a loop harness.
For wrist disarticulation: In this, a split socket forearm and a wrist rotation
device is provided. A device can be provided to lock for supination and
pronation.
ong term physical effect of wearing prosthesis
• Increased skin temperature of the residual limb, along with sweating, heat
rash, blisters, contact dermatitis and abrasions.
• Skin issues can progress infections.
• Using lower-limb prosthesis can lead to problems with postural alignment,
muscle imbalances and strains, and gait abnormalities. 
• Back pain, hip pain and leg pain in both the residual limb and the intact
limb.
• The intact limb (lower-limb) more likely to develop joint problems.
 Prosthetic comfort and care
• Remove the prosthesis before going to bed. Examine the device for
loose parts or damage. Examine the stump for blister or other signs of
irritation.
• Regularly inspect the skin of the stump to look for sores or wounds.
• Practice exercises recommended by physical therapist : exercises for
stretching, range of motion, body positioning, and endurance.
• For leg prosthesis, wear proper fitting shoes.
• Clean the prosthesis socket with soap and water.
• Wear clean dry socks with the prosthesis.
• Have the prosthesis examined and serviced once a year to make sure it
is in proper working order.