Prosthetic management of Transfemoral amputees with Integral Leg

Prosthetic management of
Transfemoral amputees with
Integral Leg Prosthesis (ILP)
Stefan Laux
APC Prosthetics
B. P&O, Dipl. P&O(D)
Prosthetic Management of
Transfemoral Amputees with
Integral Leg Prosthesis (ILP)
Stefan Laux
APC Prosthetics
B. P&O, Dipl. P&O(D)
The treatment protocol
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Pre-surgical assessment
Surgical planning
Stage 1 surgery
Stage 2 surgery
Rehabilitation & Prosthetic management
ILP components
Practical demonstration
Patient assessment
EXCLUSION
CRITERIA
Diabetes
Orthopedic assessment
Rehabilitation team
assessment
NO Psychological
assessment
SURGICAL
PLANNING
Peripheral vascular
disease
Chemotherapy
Pregnancy
Skeletal immaturity
Mental illness
Inability to adhere
rehabilitation
program
•  Imaging
–  CT & X-ray
•  Implant selection
–  6 different sizes
–  Femur length
•  Min 140mm
–  Alignment
–  Custom
•  Reaming of femoral
canal
•  Insertion of ENDO
component
•  Closure of residuum
•  Prosthesis must not
worn subsequently
•  Approx 6 weeks post stage 1 •  Inser4on of EXO component • Completed ILP post surgery ILP Rehabilitation
Phase 1
•  Static loading
–  Day 5-7
–  20KG
–  Daily  by 5KG
–  Static loading ≥ 50KG or
≥ 50% body mass  Phase 2
ILP Rehabilitation
Phase 2
•  Rehab Prosthesis
–  Approx day 14
–  Manual lock knee
•  Safe & lightweight
–  Strengthening & balance exercises
–  Early gait exercises with Physio
–  Parallel bars or 2 crutches
ILP Rehabilitation
Phase 3
•  Definitive prosthesis
–  Fitting in parallel bars
–  Laser-alignment platform
•  A-P position of knee joint centre
–  Dynamic alignment
•  Knee rotation
•  Hydraulic/ MP settings
•  Plantar/dorsiflexion
–  Frequent reviews until discharge
ILP components
•  Femoral stem (implant)
•  Dual cone adapter
–  Proximal fixation
•  Dedicated breaking point
•  Abutment
–  Sleeve
–  Rotating disc
–  Screw
–  Prosthesis connection
ILP components
Relevant parts for prosthetic management
ILP components
Silicone cover
•  Protects distal soft tissues
•  Worn 24/7
–  Removed for daily cleaning
•  Requires replacing
–  Wear & tear
ILP components
Sleeve, Rotating Disc & Screw
•  Sleeve
–  30mm diameter
–  Press-fitted to dual cone
–  Attachment for rotating disc
•  5 positions
–  Anchor point for holding bar
•  Adjustments
•  Replacements
ILP components
Sleeve, Rotating Disc & Screw
•  Rotating Disc
–  30mm diameter
–  Failsafe against excessive
torque (25Nm)
•  2 proximal pins
–  Adjusts knee rotation
•  0°, 6° & 12° model
–  Locked to dual cone via screw
ILP components
Sleeve, Rotating Disc & Screw
•  Screw
•  Locks rotating disc
–  Temporary screw
–  Permanent screw
•  25Nm
ILP components
Knee connecting adapter
–  Left or Right
–  30mm clamp proximally
–  Female pyramid distally
–  Knee rotation
•  Anterior guide screw
•  Posterior pinch bolt
ILP components
Knee connecting adapter
–  Posterior offset
•  6,9,15,18,21 & 24mm
•  A-P alignment
–  Femoral adduction
•  ~ 9°
•  M-L alignment
–  Attaches to proximal knee connector
•  Male pyramid
ILP components
Alignment adjustments
•  Rotation
–  Default position determined by sleeve
–  3 rotating disc
–  5 different positions
•  Height adjustments
–  Proximal extension pieces
–  16,35,45,55,65 & 75mm
ILP components
Alignment adjustments
•  Sagittal plane
–  6 types of posterior offset adapters
–  Custom on request
–  Flexion & extension
•  Coronal plane
–  Adduction in knee connection adapter
–  Adduction & Abduction
ILP components
2 Failsafe mechanisms
•  Implant/ dual cone
–  1 pin
–  40Nm
–  Replaced by surgeon
•  Sleeve/ dist connector
–  2 pins
–  25Nm
–  Replaced by P&O
Thank you Stefan Laux APC Prosthe4cs Pty Ltd Email: slaux@apcprosthe4cs.com.au Web: www.apcprosthe4cs.com.au