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Thursday, December 5, 2013
What are my Options for Artificial Limbs?
I had a friend in Canada who had one leg amputated above the knee, due to vascular problems, and then within a year, had to have the other leg amputated above the knee. Someone at the hospital told her that because both are above the knee, she cannot be fitted for an artificial leg because you need a kneecap to fit it on. Is this accurate? Is there no way for someone in that situation an artificial limb?
There are certainly prostheses available for above-knee amputees - which means the amputation level is above the kneecap - which means a kneecap is not required for wearing and using them. The socket for an above knee prosthesis may be suspended (held in place) by suction - with or without a roll-on liner... also, a waist belt may be used for supplemental suspension, or as the sole means of prosthetic suspension.
Walking with an above-knee prosthesis following an above-knee amputation on one side due to vascular problems requires up to 80% more energy expenditure compared to a non-amputee. After an above-knee amputation on both sides due to vascular problems, up to 280% more energy expenditure is required to walk with prostheses, compared to a non-amputee.
For this reason, most amputees who've had an above-knee amputation due to vascular problems on one side, and all amputees who've had an above-knee amputation due to vascular problems on both sides, use a wheelchair for longer distances; compared to walking with one (or two) above-knee prostheses, a wheelchair is a much more energy-efficient means of going from one point to another.
However, this does not mean an above-knee prosthesis wouldn't be of benefit. The likelihood of benefit depends on whether an amputee's heart and lungs are able to tolerate the significantly increased energy demand associated with walking with prostheses. Sometimes a cardiac stress test is useful to be sure an amputee's heart is capable of handling this increased physical stress.
Usually, following above-knee amputation on both sides, these amputees start off using what are called "stubby" prostheses - which are just a prosthetic socket with a prosthetic foot attached, and no prosthetic knee unit. If the person demonstrates the motivation and ability to walk with a pair of stubbies, then their prosthetic sockets are progressively lengthened, until the prosthetist feels the person is ready to try using a pair of "articulated" (meaning "with a knee unit") prostheses.
Your friend is encouraged to discuss all of the above with her surgeon, as well as perhaps also with a rehabilitation physician and a prosthetist.
Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University