Advancements in prosthetics

1. Dr Fergus Jepson MB ChB MRCSEd DORT FRCP
Consultant in Amputee Rehabilitation
Specialist Mobility Rehabilitation Centre
Preston

2. Introduction
 Developments in prosthetics?
 What can you expect from your centre?
 Are children treated differently from adults?

3. But before…
 Let’s discuss how to classify different prosthetics

4. Sockets and suspension
 Interface between the body and prosthesis
 Below knee amputation
 Anatomical
 Cuff
 Supracondylar
 Suction
 Locking liner
 Above knee
 (TES) Belt
 Suction
 liner

5. Socket – weight bearing
 Below knee amputation
 Patella Tendon Bearing
 End bearing
 Paratibials
 Above knee amputation
 Ischial tuberosity
 Tuber bearing
 Tuber containment
 +/- end bearing
 Bio-designs socket

6. Knee units
 Free or locked
 Simplest is the SAKL – Semi
Automatic Knee Lock
 Locks straight automatically
 Safest and most reliable
 HOKL – Hand Operated Knee Lock
 Ability of patient to choose when knee is
locked
 Option of safety in certain situations –
weather etc
 Free knee
 Always free

7. Knee components
 Free knee continued
 Unicentric
 Polycentric
 Micro-processor controlled
 Pneumatic
 Hydraulic
 Power

8. Ankle/foot
 300+ prosthetic ankles on the market
 Uniplanar
 SACH foot
 Multiflex
 Adjustable heel
 Energy return
 carbon fibre foot spring
 Blades
 Hydraulic foot
 Powered ankles
 (few on the NHS)

9. Accessory components
 Shock absorbers
 Rotation
 Dynamic ankle
 Beach activity limbs
 Sports limbs

10. Cosmesis
 Standard definition
 High definition

11. Upper limb
 Cosmetic
 Standard definition
 High definition
 Functional
 Mechanical
 Body powered
 Split hook
 Mechanical hand
 Myoelectric hand

12. Weight category : 40+kg = adult

13. Developments in Prosthetics
 Microprocessor controlled knee joints
 C-leg, Genium, Orion, Plie

14. Developments in Prosthetics
 Microprocessor controlled hands

15. Developments in Prosthetics
 Powered joints - Knees and ankles

16. Areas of other development
 Non – microprocessor controlled knees
 Very Good Knee – fluidic controlled adaptive knee

17. Areas of other development
 Haudraulic ankle joint
 Echelon foot first: now Echelon VT, Kinterra, Motion control

18. Sports prosthesis
 Running feet
 Dedicated running limbs
 Hybrid limbs

19. Sports prosthesis
 Swimming legs
 Dedicated swimming legs
 Dedicated feet for swimming
 Other sports
 Rock climbing
 Ski feet

20. What can you expect from your
centre?
 Each centre will have a limb prescription policy
 Many centres will have dedicated paediatric limb
prescription policies
 Currently (and historically) each centre has a different
arrangement with their Specialist commissioner
(representing the PCTs for which they served)
 Led to different management

21. What’s coming…
 Changes by the current government will mean
 National commissioning
 National tariff
 National standards
 Your choice to go to which ever centre you choose
 But they should all be the same!
As yet we do not know what that standard will be or how
the tariff will be applied.

22. Paediatric Limb prescription policy
at the SMRC
 2 activity limbs
 Primary limb
 For every day use
 Secondary limb
 Can be a replacement for everyday use or a dedicated sports
limb e.g. running
 Water activity limb
 For showers, swimming, beach, pool
 Others – exceptional circumstances
 e.g. high definition limbs

23. How does this differ from adult
prescription policy?
 Adult prescribing is very dependent on activity levels
 We felt at the SMRC that children should have the
right to run and engage in sports as much as they want
to
 There are no hybrid limbs for children until they can
access adult limb sizes

24. What is also important for multiple
limb loss through meningitis?
 Strong communication between
 Special seating
 Occupational therapy
 Physiotherapy
 Rehabilitation
 Plastics / surgical specialities
 Primary care

25. Summary
 Knowledge of what’s out there is very important
 Discussing with your rehabilitation consultant and
prosthetist how can your mobility be improved
because prosthetics have improved
 Trial children with adult components as soon as their
shoe size and weight category allow

26. The Sky is the limit!
Thanks for listening
Fergus.Jepson@lthtr.nhs.uk
www.littlelegs.org.uk