Individuals facing amputation above the knee can discover a renewed sense of mobility and independence through above-the-knee prosthetics. These prosthetic legs are meticulously designed to replicate the function, and often the appearance, of a real leg. While the benefits of above-the-knee prosthetics can greatly enhance the quality of life, it's important to recognize and address potential problems associated with this type of prosthetic solution. With years of experience in the field, our team at PrimeCare Orthotics & Prosthetics is uniquely qualified and ready to help answer your questions about this topic.
Above-knee amputation is a surgical procedure that involves the removal of the leg above the knee joint. This type of knee amputation is typically the result of critical health issues such as peripheral vascular disease, which restricts blood flow, leading to the death of tissues. Other causes may include unmanageable foot or leg ulcers, particularly in diabetic patients, or severe trauma resulting from accidents. We understand that the decision to proceed with an above-knee amputation is never taken lightly and is usually a last resort when other medical interventions have failed to resolve the underlying problems.
Preparing for a lower extremity amputation requires thoughtful consideration and careful planning. In most cases, you'll work closely with a specialized vascular or orthopedic surgeon who will guide you through the process. Here are some steps you may need to take:
Patients may experience a variety of physical sensations and changes as they adapt to life without the limb. These might include phantom limb pain, where the individual continues to feel the part of the leg that has been amputated. Phantom pain is normal and is often successfully managed with prescription pain medicine.
Initial post-surgery care includes the placement of drains to remove fluid from around the incision and respiratory exercises to reduce the risk of lung infections. Patients are encouraged to take deep breaths and cough frequently, often using an incentive spirometer for help.
Physical care for the remaining limb is critical. Be sure to change positions regularly to prevent complications such as pneumonia or skin pressure sores and specific guidelines for the first 24 hours to reduce swelling. You'll also want to do strengthening exercises for the hip muscles and residual limb, paying special attention to limb positioning to prevent hip tightening.
Wrapping the residual limb with an elastic bandage helps control swelling and forms the limb into a shape suitable for fitting a prosthesis. This wrapping usually starts within days of surgery and continues until healing is well underway.
As the healing process continues, the focus gradually shifts to selecting the appropriate prosthesis for the remaining limb. This involves collaboration between healthcare providers, prosthetic specialists, and the patient, ensuring the prosthesis fits well and enhances mobility. The goal is to integrate the prosthesis seamlessly into daily life, allowing for improved function and independence.
You’re likely wondering “What kind of prosthetic leg do I need for an amputee above the knee?” There are different types of above-the-knee prosthetics to consider, and the PrimeCare Orthotics & Prosthetics team works with the following technologies:
Your doctor will work with you on choosing the best type of prosthetic for your needs.
Those who need above-knee prosthetic legs (also referred to as a transfemoral prosthesis) usually consist of a custom-made socket, a knee, a pylon, a foot, and some way to suspend the prosthesis from the body. It’s common for patients to be fitted for a prosthetic within a few days of surgery.
Immediately following the procedure, you’ll receive an Immediate Post-Operative Prosthesis (IPOP) to help reduce swelling, protect wounds, and speed up the overall healing process. In some cases, you might receive an AK shrinker, a device that helps to shape your limb for the prosthetic and desensitizes the limb to make the prosthetic more comfortable.
Don't rush the process of getting a long-term prosthesis. It’s important to get both the right type of prosthesis and the right fit. During the process, you will:
There are different parts of an above-knee prosthesis — a socket, knee joint, ankle joint, and foot components. As we mentioned above, you’ll first receive a temporary prosthesis while your residual limb heals, shrinks, and changes shape over a few months of healing. Your prosthesis will be modified to fit your residual limb.
Here's additional information on how the parts of a prosthesis work together:
During the rehabilitation process, you’ll begin to learn to function first with a wheelchair and walking assistance devices such as crutches or a walker. Before you learn how to walk with an above-knee prosthetic, you’ll work closely with your physical therapist to learn the necessary skills to use your prosthetic limb. Physical therapists will also provide you with information on how to care for it, including skin checks, hygiene, contracture prevention, exercise, and positioning.
Once you have your prosthesis, you’ll need to invest time into ongoing therapy and at-home exercises under the guidance of your doctor. Through time and consistent effort, you can learn balance and coordination. Try to be as patient as possible as it’s not uncommon for rehab to last up to 1 year. You’ll also want to check the remaining limb daily for any irritation, skin breaks, or redness.
Just because you have a prosthetic, it doesn’t mean that you can have an enjoyable and fruitful life. At home, make sure to discuss with your doctor what you can do. When you get the okay, you’ll be able to wash the remaining limb with soap and water. It’s also possible that you’ll be able to drive depending on your specifics. Some people can return to work as soon as 4-8 weeks following surgery although it could take longer.
As above-knee amputations make it harder to bear weight, the risk of falling is higher. First, those with an above-knee prosthetic leg will use a wheelchair until the risk of falling is low. During this time, you’ll use rehabilitation and physical therapy to build strength. You’ll also be fitted with short prosthetic training feet that help to re-learn balance. Gradually, you'll increase the height of the prosthetic leg to build the strength needed for a full-length prosthetic. Over time and with practice, amputees will be able to walk without the assistance of any devices. In fact, one of our success stories at PrimeCare, Ralph, tells us that one of his biggest accomplishments is walking up and down the stairs without pain after being fitted for his prosthetic.
The distance that you can walk depends on your injury and overall healing process. Some people can only walk a short distance before getting too tired or feeling too much pain while others can get around as they did before surgery.
Different sports have unique requirements. Popular sports for those who have prosthetic legs include cycling and swimming. These are popular as they are non-weight-bearing sports. Other people with prosthetic legs may be able to walk, run, dance, or even garden or practice yoga. Think outside of the standard sports and consider trying something you haven’t tried before.
Learning how to fall properly can help keep those with a prosthetic safe. Your therapist will practice falling with you. If you're falling, make sure to immediately release any assistive devices you’re using and allow the body to be flexible. If possible, absorb the impact with your hands by using slightly bent elbows and immediately roll to the side to minimize impact. Avoid hitting your head by tucking your chin to your chest.
When sitting, keep your shoulders back with your pelvis beneath you. Your limb should be aimed at the floor and hang close to your other leg.
We’ve outlined some common above-the-knee amputation complications.
It can be physically and mentally challenging to adjust to a prosthetic leg. Here are some common obstacles:
There are prolonged physical and psychological stressors that can impact the life expectancy of lower limb amputees. For example, there's an increased morbidity and mortality rate from cardiovascular disease. Stress, insulin resistance, and behaviors including alcohol use, smoking, and physical inactivity are all prevalent in lower limb amputees. Other health complications include infection, excessive bleeding, muscle shortening, and pulmonary embolisms.
Every patient is different, however, the rehabilitation process can last as long as one year.
If you need guidance on above-the-knee prosthetics, our team is here to help! We have a team of caring and qualified practitioners who are dedicated to helping patients in Albuquerque and Las Cruces thrive. Contact us at PrimeCare Orthotics & Prosthetics today!
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