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Prosthetic services

Above knee prosthetics

Prostheses concerning above knee prosthetics consists of a custom-made socket combined with a supportive frame, knee unit, pylon, and foot. Sometimes a suspension sleeve or harness may also be necessary.

The Prosthetic Knee System

Of all prosthetic components that are concerned with an above knee prosthetic, the knee system is arguably the most complex. It should provide:

  • Reliable support when standing,

  • Allow smooth, controlled motion when walking, and

  • Permit unrestricted movement when sitting, bending and kneeling.

Above knee prosthetic knees have evolved considerably over time, from the simple pendulum of the 1600s to those regulated by rubber bands and springs, pneumatic or hydraulic components. Nowadays, some knee units even have advanced motion control that is modulated through microprocessors.

For the trans femoral (including hip and knee disarticulation) amputee, successful function depends on:

  • The correct choice of knee relevant to age

  • Health

  • Activity levels and lifestyle

The latest technology or most advanced knee is not necessarily the best choice for everyone. For some amputees, safety and stability are more important than functional performance. Active amputees prefer a knee that will provide a higher level of function even if the knee requires greater control.

The Different Types of Prosthetic Knees

Since needs differ widely, there are various options to consider. What follows is a brief, yet informative description of the different types of prosthetic knees, including:

  • The New C-Leg®

  • Nabtesco Hybrid Knee

  • Rheo Knee®

  • Power knee)

  • Mauch Knee

  • Mauch Knee Plus

  • Total Knee 2100

  • 3R60 EBS Knee

  • 3R60Pro Knee

Anatomical SIT-Cast

Developed by Otto Bock, the latest innovation to be applied to the established SIT-Cast knee involves the new ramus containment socket (Anatomica). A trans femoral socket that encases the ischial tuberosity (also known as the ‘sit bone’ located in the buttocks) is fabricated using the Anatomical SIT-Cast device. This provides customized residual limb fitting for quality wearing and comfort.

The New C-Leg®

The new, improved C-Leg® gives the wearer confidence in the next step. Ultimately, confidence in a prosthetic device is of the utmost importance. In order to achieve this, Otto Bock have taken the best of the older version of the C-Leg® and created a device that:

  • Affords reliability and security in that the mechanical and electronic adjustments include improved swing phase control which enables the wearer to achieve a more natural gait pattern with an easier and smoother movement at the knee joint.

  • Enables improved stumble recovery which enables the wearer to achieve stability with the sound leg a lot quicker after a stumble.

  • Features an additional activity mode that allows for extra individualized movement patterns that can be selected by the wearer.

  • Provides the added benefit of adjustable damping behaviours when the battery is drained and improved splash protection of the knee joint.

  • Creates additional options for the wearer in that the IC60 Triton prosthetic foot has been approved for the C-Leg®.

  • Now has an increased weight limit of up to 136kgs.

Nabtesco Hybrid knee

As the name suggests, the Nabtesco Hybrid Knee is a new type of prosthetic knee joint. It utilizes a combination of a hydraulic damper and the unique Nabtesco MRS (Mechanism and Reaction Force Sensing) system to enable stance phase control and microprocessor-controlled pneumatic pressure for swing phase control, which enables the joint to respond flexibly to all kinds of movement and changes in cadence.

Many wearers of prosthetic limbs experience anxiety in that the knee might bend while the leg is upright or during heel strike when walking, or that the limb may be slow to come into motion during the swing phase. The Nabtesco Hybrid Knee alleviates this problem and is the most economical bionic knee available on the market. It is also the most preferred bionic knee among patients and medical aids alike.

Rheo Knee®

The redesigned Rheo Knee® by Ossur, is a smart prosthetic knee system that was developed following the introduction of Otto Bock’s C-Leg®. Made in Iceland, the Rheo Knee® follows the same computerized principles as the C-Leg®, but, uses different mechanical technology in that it contains a microprocessor that monitors the wearer’s walking style and type of ground being walked on. It also learns and remembers any changes to the wearer’s walking habits. The Rheo Knee® is incredibly responsive in that it completely frees the wearer from anxiety with respect to its performance.

Features

  • The Rheo Knee® continuously recognises, learns and responds to individual walking styles and keeps pace with changes in speed, load and terrain.

  • Walking effort is reduced to a minimum and motion is much smoother and more natural.

  • Disturbances in the walking path are automatically recognised and stance support instantly activated to protect the user from a potential stumble and fall.

  • The Rheo Knee® system is highly efficient in that only a small, rechargeable battery that lasts up to 48 hours is required to ensure effective operation. In order to preserve battery life, the system can also be switched off when not in use.

Power Knee

Power Knee is the only prosthetic knee joint that is motor powered. It provides active motion and superior power stance stability to replace lost muscle function.

Features

  • Power Knee enables powered extension when standing up, controlled resistance when descending and active flexion and extension during walking and facilitates symmetrical weight distribution and natural gait.

  • Users with a greater degree of functional loss as well as those who are highly active maintain that Power Knee goes a long way towards enabling them to go further by restoring their capacity for endurance.

  • It has been demonstrated that Power Knee significantly reduces rehabilitation time for new trans femoral amputees.

  • The PowerLogic Workbench software inherent in the Power Knee system enables prosthetists and physical therapists to provide patients with visual feedback during training and to log and report on user performance and prosthetic use)

Mauch® Knee

People who demand more out of life need a prosthetic knee that will keep pace with their aspirations. The Mauch® Knee is as versatile and efficient as its users.

Features

  • The cylinder attachment delivers a lower tolerance environment.

  • State-of-the-art bearings contribute to smoother motion and increased durability.

  • Protected by rubber covers at the front as well as the back, the aluminium frame combines strength with an attractive design.

  • Extension stops added to the frame prevent hyper-extension thereby increasing the lifespan of the cylinder.

Total Knee® 2100 

Strong and durable, the Total Knee® 2100 is designed for general use by larger and more active adults.

Features

  • Increased knee stability in early stance.

  • Adjustable stance flexion.

  • Natural, energy efficient gait.

  • Increased toe clearance during swing.

  • Reduces excessive heel rise and promotes knee extension.

  • 3-phase hydraulic swing control accommodates changes in walking speed.

  • Low build height is useful for long limbs or knee disarticulation.

3R60 EBS Knee

EBS’ stands for ‘Ergonomically Balanced Stride’. The patented, unique construction of the 3R60 EBS Knee Joint, which has proven itself over and again, has been further improved and upgraded to the new generation 3R60 Knee Joint.

Features

  • The 3R60 EBS Knee is significantly closer to the physiological gait pattern.

  • With optimized swing phase hydraulics, the 3R60 EBS Knee is smaller and lighter.

  • The 3R60 EBS Knee is suitable for all amputation levels as well as mobility levels 2 and 3

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Prosthetic services

Does your prosthesis hurt? Are you walking with difficulty?

While various levels of amputations are carried out, by far, the most common involve:

  • Below knee (trans tibial)
  • Above knee (trans femoral)

No matter the amputation level, there is a great deal your dedicated prosthetist can do to diagnose and employ the right measures in order to alleviate any painful conditions associated with prosthetic use.

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Prosthetic services

From amputation to prosthesis in three weeks

From post-op to crutches within five days and walking comfortably with a prosthesis in as little as three weeks! The idea of walking with crutches within five days post-op and being able to walk with a prosthesis in as little as three weeks after undergoing an amputation sounds like science fiction – but it is not. It is just up to clever engineering on behalf of Roger Wolfson and a desire to get walking again.

Yet, it is even more surprising to learn that the technique used in creating a prosthesis designed to do just that has been around for many years.

Why surgeons should regularly use the services of a prosthetist when performing an amputation

Should a surgeon perform the amputation procedure in consultation with a prosthetist that is familiar with the Immediate Post-Operative Prosthesis (IPOP) technique, the results can be extremely beneficial to the well-being of the patient, and result in considerable cost savings to both patients and funding sponsors alike.

A scientific paper pertaining to this very topic was presented at an Orthopaedic Surgeons Congress that took place in South Africa recently. However, despite the fact that the Chairman of the Congress raised the burning question as to why, in fact, surgeons don’t regularly consult with a prosthetist around the surgical procedure, the fact still remains that as things currently stand, the number of surgeons that use the services of a prosthetist nevertheless remains fewer than desired.

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Prosthetic services

Measuring Residual Limb

When is the residual limb ready for measurement?

How long does it take before for the residual limb is ready for measurement?

Once the initial measurements have been taken a number of test fittings are carried out.   This is vital for the comfort of the patient. I like to compare the making of a prosthesis to the making of a wedding dress. For a young future bride the making of a wedding dress is of vital importance and she wants to have it fitting absolutely perfectly.

The more fittings the dressmaker is prepared to do for her, the happier she will be as she wants the outcome to be perfect. If the dressmaker’s worth her salt and has pride in her work she will be happy to do the extra fittings even though they are not in the initial cost.

We will do as much as it takes to make sure that the outcome of the prosthesis will give the patient comfort, mobility and confidence. If the patient is a trans femoral (above knee amputee)the process of measuring and fitting for the first walking prosthesis takes between three and five days.

If the amputee is a trans tibial (below the knee amputee) the first walking prosthesis can be anything from one hour to 2 days once both the patient and the prosthetist are happy with the fit. When the final prosthesis is made the time frame should not be longer than three weeks before the finished prosthesis is fitted.

During this process the amputee goes for an extensive exercise program which is carried out by an experienced physiotherapy team.

The Rehabilitation exercise program is optional and it depends on the economic situation of the patient usually the medical aid will pay for this service as they have already invested money in the prosthesis and they would like the amputee to make full use of the prosthesis. Even though the exercise sessions are long and hard my patients report to me that they are a lot of fun. Actually I find them fun because I join in some times especially the dance class.

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