Lower Limb Prosthetics | PM&R KnowledgeNow

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1. OVERVIEW AND DESCRIPTION

Definitions

A prosthesis is an artificial substitute for a missing body part.

A lower limb prosthesis refers to a prosthesis that replaces any part of the lower limb to restore the functional and/or cosmetic purpose of the lower limb. This may include artificial components that replace the hip, thigh, knee, ankle, and foot.

2. RELEVANCE TO CLINICAL PRACTICE

1. Post Amputation Process and Prosthetic Evaluation

   Pre- prosthetic training

   After the patient has an amputation in the lower extremity, they will remain in the acute care hospital until they are medically stable. After that time, they may be either transferred to a skilled nursing facility (SNF), acute inpatient rehabilitation facility, or discharged home with homecare services. Patients discharged to acute rehabilitation facilities often have better functional outcomes than those with other discharge destinations. During the initial period after acute care, the focus is to determine if the patient is a candidate for a prosthesis based on their functional level and potential for progress and to prepare the residual limb for a prosthesis if they are found to be a candidate. This preparation includes training in mobility and activities of daily living (ADLs) without the prosthesis, skin care education, muscle strengthening, pain management, and shaping and shrinking the residual limb. Early range of motion work and desensitization of the surgical scar are emphasized for optimal recovery. There are various discharge options post-acute hospital care, but patients who receive inpatient rehabilitation immediately after tend to experience reduced mortality and improved access to prosthetic devices. Such facilities effectively manage chronic conditions and surgical recovery, which can enhance overall patient outcomes.

   Prosthetic Evaluation

   The initial evaluation for lower limb prosthetic candidacy should encompass a detailed assessment of the patient’s history, including:

   1. Prior level of function and dependence in ADLs, including any assistive devices used for ambulation.
   2. Geographical location and access to medical care and prosthetic labs.
   3. Cause of amputation and duration since the amputation occurred.
   4. General health and comorbidities such as heart disease, diabetes, and vascular conditions.
   5. Employment status and recreational activities.
   6. Goals of the patient and their support system.
   7. Level of support from family and caregivers.

   The assessment must also include a physical and mental evaluation to discern the suitable prosthetic prescription, which should consider:

   1. Cognitive ability to manage the prosthesis along with learning techniques in therapy.
   2. Upper limb functionality.
   3. Performance of the opposite lower limb.
   4. Residual limb strength, shape, length, and health conditions, including skin integrity and circulation.
   5. Joint and ligament stability of the residual limb.
   6. Presence of joint contractures.
   7. Body weight, as some components have weight limitations.

   Based on the collected information and evaluations, the patient is classified into a specific functional level. The K levels, adopted federally, determine the appropriate components for prosthetics tailored to those levels. Higher K levels indicate more potential for effective prosthetic ambulation.

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