KNEE

DISARTICULATION.
2018-02-12480.
 PRESENTATION LAYOUT.

• Introduction to KD.
• Socket designs.
• Indications and contra-indications of each socket design.
• Pressure sensitive and tolerant areas of the KD stump.
 INTRODUCTION.
• The knee disarticulation (KD)
otherwise known as Through
Knee (TK) is the lowest level of
amputation in which normal
knee function is completely lost
by the patient on the amputated
side.
 INTRODUCTION
• A long lever arm is available for
the exertion of control forces by
the hip muscles and the
muscles themselves are, for the
most part, intact and operating
in their physiological condition
 THE KD STUMP
• The true disarticulation is a less traumatic operation than
one through the bone, but requires long skin flaps to close
the wound
• A knee disarticulation stump should be capable of taking the
majority of the stump-socket support load on the end-
bearing surface
 KD STUMP CHARACTERISTICS
FULL LENGTH OF FEMUR
• long lever arm
• Greater surface area
• Muscles well maintained
FULL WIDTH OF CONDYLES
• supracondylar suspension
• rotational control
• cosmetic liability.
END BEARING
• physiologically normal
• improved proprioception
 Advantages over TF amputation.
• End bearing
• long lever arm
• no muscle imbalance
• simpler surgical technique
• energy expenditure is documented to be reduced than for TF
 Cont’d
• Self suspending.
• Rotational stability.
• Wound surface minimised.
• Retain distal epiphysis.
• Increased proprioception.
 WHY KD RARELY PERFORMED.
• Despite all these advantages, most surgeons rarely perform KD.
• This aversion is due to their lack of experience with the surgical
procedure and their fear for wound complications, although recent
studies refute these considerations
• Moreover, because of the bulbous end of the residual limb and the
lack of space for a knee joint, surgeons are aware of KD prosthesis
fitting problems.
 Cont’d
 The knee joint is positioned distally from the
KD socket.
• This results in lengthening of the thigh.
Lengthening of the thigh was considered to
be 50 mm or even more
• Due to the lengthening of the thigh, sitting in
narrow spaces can be uncomfortable and
getting into a car can be difficult
• Moreover, especially during sitting,
lengthening of the thigh has a negative
influence on cosmetic appearance
 SOCKET TYPES.
• Conventional.
• Push fit, hard shell.
• Panel.
• Double wall socket.
 CONVENTIONAL.
INDICATIONS
1. Elderly amputees.
2. When stability in needed.
3. Patient preference.

CONTRA-INDICATIONS
4. Poor hand function.
5. Amputees who are sweaty.
6. Amputees with hygiene problems.
 PUSH FIT-HARD SHELL.
INDICATIONS.
1. Young and active amputees.
2. Amputees with loose fleshy
stamp.
CONTRA-INDICATIONS
1.Bulbous stump.
2.Stump with scars and adhesions.
3. Sweaty amputees with hygiene
problems.
 PANEL OPENING.
INDICATIONS.
1. Amputees with unstable
stump volumes.
2. Bulbous stump.
3. Sweaty amputees with hygiene
problems.
CONTRA-INDICATIONS
1. Patient preference.
 DOUBLE WALL SOCKET.

Makes use of a soft liner inside

 Double wall socket.
• A cross sectional view in the
frontal plane of the KD prosthet
socket showing soft liner
padding (Figure A)
• A proximal view into the socket.
The arrow at the anterior brim
facilitate donning (Figure B)
• Trim line of liner higher than
outer hard shell
INDICATIONS
1. Stump with scars and adhesions.
2. Amputees with stable stump volume.
CONTRA-INDICATION
1. Bulbous stump.
2.Amputees with hygiene problems and sweaty,
 PRESSSURE SENSITIVE AND
TOLERANT AREAS
SENSITIVE AREAS.
1. Femoral condyles.
2. Patella (if present).
3. Greater trochanter.
4. Surgical suture.
TOLERANT AREAS.

1.Distal end of stump.

2.Medial flear of stump,
3.Lateral flear of stump.
4.Posterior flear of stump.
5.Anterior flear of stump.
THANK YOU
BY John Chilikwela.