Responses to Mechanical Knee Recommendations for bilateral AK Amputee
Chatelaine Fortenberry
Description
Collection
Title:
Responses to Mechanical Knee Recommendations for bilateral AK Amputee
Creator:
Chatelaine Fortenberry
Date:
11/14/2013
Text:
Thank you to all who responded. Here is my original post and the responses.
Original Post:
Dear Colleagues,
I have a 62 y.o. bilateral AK amputee, K1 and 180lbs, that is doing well
with stubbies, and is now ready to be fit with mechanical knee units.
What would be your recommendations for mechanical prosthetic knees for this
bilateral amputee? Any ideas or suggestions would be appreciated.
Thank you in advance,
Chatelaine Fortenberry, Prosthetic Resident
Responses:
1. Ossur Total knee 2000 They work great on bilateral's and are very safe
for the patient.
2. A good choice would be the Otto Bock 3R93 Safety Knee as it also come
with a cable lock. after he get better you can remove the lock on it (very
easy) and it turns into a safety knee.
3. I have a k2 on a knee by DAW that I like. It has an adjustable centrode
so you can easily control stability. plus daw has a 90 day return policy no
questions asked. It's a 5 bar knee. It is not light about 750 g.
Adjustable centrode gives you good control of the TKA.
4. There are a few options for this patient population, but there is an
important question that must be answered, and that is if you anticipate
that the patient will be strong enough and have sufficient balance to flex
the knees when walking, vs. needing knees to be able to sit when at normal
or close to normal height, but ambulating with locked knees. If it is the
latter, then manual locking knees are the obvious choice, and there are a
number of lightweight options. If they are expected to be flexing, then I
will sometimes use safety knees with the alignment set fairly stable.
Although I have no idea if your patient would otherwise be appropriate for
them, the Otto Bock Compact MPK might be a possibility. Another option
that I have had good results with is the DAW TGK-4002. This is a locking
knee but the lock, when engaged, permits flexion up to 30 degrees, rather
than being locked in full extension, and when unlocked it is free. This
permits a very normal walking pattern, particularly in being able to
initiate hip flexion while still weight bearing, but with the security of
the limited flexion in the event of a stumble. The only disadvantage is
that if your patient anticipates any standing activities for any period of
time, he may be more interested in a knee that will lock in full extension
for maximal confidence and stability. For those patients I would be
thinking about a long-frame 4 bar knee with lock, such as an Otto Bock
3R32. Hope that this was helpful.
5. K level doesn't apply to bilateral. K levels are only applicable to
unilateral lower extremity amputees, although some insurance companies are
demanding their use even for bilaterals. That being said, if the patient
is using these at such a low level and safety is a concern, then I would
recommend a lockable knee such as the Medi OFM2.
6. Hydrolic stance control knees would be best for going from standing to
sitting. Good luck, do a good job.
7. Think about manual locking with WASC like medi. Also consider Hydraulic
on one side if he can walk without one side locked, this makes it much
easier to sit. Also start short and work your way up. You will need to set
the socket very far forward unless you plan on facing the feet backwards or
using the KISS stubbie feet. The hydraulic is K-3 but this person has needs
that exceed simple locomotion, just document why. Let me know if you have
questions. Good luck!
8. I have had success with Total Knee from Ossur fro Bilateral Transfemoral
clients. The stance phase control and toe load release provides effective
stability. The knee extension (lock) allows the client to extend both
knees in a seated position and stand up with confidence.
9. Medi or Ossur or bock manual lock.
10. Many considerations. You almost have to go with hydraulic stance phase
knees if you want him to be able to go from stand to sit in a decent
manner. C-legs or Plié's are the most common for bilaterals and probably
the best option but if you are concerned with cost, castance or mauch or
some type of controlled flexion knee is just about a must. (Bilaterals are
not strictly bound by k-levels although I still have not been told the
proper way to handle it.) safety knees work ok for walking but going from
stand to sit is almost impossible without just falling back into the chair
with stiff knees because they will not bend with weight on them. He should
be doing VERY well with stubbies before adding knees. I like to gradually
increase the height and have them be able to wear these all day long, even
to the store etc. prior to adding the knees. Everybody thinks that adding
the knees will make everything easier but it doesn't. There is a Huge Huge
Huge amount of work required for the bilateral transfemoral. Another small
thing that makes it easier for them once you add the knee is to keep the
knee center below the height of the chair so he doesn't have to work as
hard to get up over the prostheses. good luck.
11. We like the Medi OFM2 which can be set up as a manual lock (trigger
release) and can later be converted to a Safety Knee.
We lock one and release the other for beginning ambulation training.
12. I would consider a 4Bar knee with lock to begin with. And then see if
with therapy he can be weaned off the lock. Medi makes a lightweight knee
and there are probably other companies that offer similar knees. I would be
an interesting research project to track this person as he goes from
stubbies to prosthetic knees and feet. Good Luck
13. I typically go with the Bock swing phase only hydraulic knees, i think
it is 3r49.
Original Post:
Dear Colleagues,
I have a 62 y.o. bilateral AK amputee, K1 and 180lbs, that is doing well
with stubbies, and is now ready to be fit with mechanical knee units.
What would be your recommendations for mechanical prosthetic knees for this
bilateral amputee? Any ideas or suggestions would be appreciated.
Thank you in advance,
Chatelaine Fortenberry, Prosthetic Resident
Responses:
1. Ossur Total knee 2000 They work great on bilateral's and are very safe
for the patient.
2. A good choice would be the Otto Bock 3R93 Safety Knee as it also come
with a cable lock. after he get better you can remove the lock on it (very
easy) and it turns into a safety knee.
3. I have a k2 on a knee by DAW that I like. It has an adjustable centrode
so you can easily control stability. plus daw has a 90 day return policy no
questions asked. It's a 5 bar knee. It is not light about 750 g.
Adjustable centrode gives you good control of the TKA.
4. There are a few options for this patient population, but there is an
important question that must be answered, and that is if you anticipate
that the patient will be strong enough and have sufficient balance to flex
the knees when walking, vs. needing knees to be able to sit when at normal
or close to normal height, but ambulating with locked knees. If it is the
latter, then manual locking knees are the obvious choice, and there are a
number of lightweight options. If they are expected to be flexing, then I
will sometimes use safety knees with the alignment set fairly stable.
Although I have no idea if your patient would otherwise be appropriate for
them, the Otto Bock Compact MPK might be a possibility. Another option
that I have had good results with is the DAW TGK-4002. This is a locking
knee but the lock, when engaged, permits flexion up to 30 degrees, rather
than being locked in full extension, and when unlocked it is free. This
permits a very normal walking pattern, particularly in being able to
initiate hip flexion while still weight bearing, but with the security of
the limited flexion in the event of a stumble. The only disadvantage is
that if your patient anticipates any standing activities for any period of
time, he may be more interested in a knee that will lock in full extension
for maximal confidence and stability. For those patients I would be
thinking about a long-frame 4 bar knee with lock, such as an Otto Bock
3R32. Hope that this was helpful.
5. K level doesn't apply to bilateral. K levels are only applicable to
unilateral lower extremity amputees, although some insurance companies are
demanding their use even for bilaterals. That being said, if the patient
is using these at such a low level and safety is a concern, then I would
recommend a lockable knee such as the Medi OFM2.
6. Hydrolic stance control knees would be best for going from standing to
sitting. Good luck, do a good job.
7. Think about manual locking with WASC like medi. Also consider Hydraulic
on one side if he can walk without one side locked, this makes it much
easier to sit. Also start short and work your way up. You will need to set
the socket very far forward unless you plan on facing the feet backwards or
using the KISS stubbie feet. The hydraulic is K-3 but this person has needs
that exceed simple locomotion, just document why. Let me know if you have
questions. Good luck!
8. I have had success with Total Knee from Ossur fro Bilateral Transfemoral
clients. The stance phase control and toe load release provides effective
stability. The knee extension (lock) allows the client to extend both
knees in a seated position and stand up with confidence.
9. Medi or Ossur or bock manual lock.
10. Many considerations. You almost have to go with hydraulic stance phase
knees if you want him to be able to go from stand to sit in a decent
manner. C-legs or Plié's are the most common for bilaterals and probably
the best option but if you are concerned with cost, castance or mauch or
some type of controlled flexion knee is just about a must. (Bilaterals are
not strictly bound by k-levels although I still have not been told the
proper way to handle it.) safety knees work ok for walking but going from
stand to sit is almost impossible without just falling back into the chair
with stiff knees because they will not bend with weight on them. He should
be doing VERY well with stubbies before adding knees. I like to gradually
increase the height and have them be able to wear these all day long, even
to the store etc. prior to adding the knees. Everybody thinks that adding
the knees will make everything easier but it doesn't. There is a Huge Huge
Huge amount of work required for the bilateral transfemoral. Another small
thing that makes it easier for them once you add the knee is to keep the
knee center below the height of the chair so he doesn't have to work as
hard to get up over the prostheses. good luck.
11. We like the Medi OFM2 which can be set up as a manual lock (trigger
release) and can later be converted to a Safety Knee.
We lock one and release the other for beginning ambulation training.
12. I would consider a 4Bar knee with lock to begin with. And then see if
with therapy he can be weaned off the lock. Medi makes a lightweight knee
and there are probably other companies that offer similar knees. I would be
an interesting research project to track this person as he goes from
stubbies to prosthetic knees and feet. Good Luck
13. I typically go with the Bock swing phase only hydraulic knees, i think
it is 3r49.
Citation
Chatelaine Fortenberry, “Responses to Mechanical Knee Recommendations for bilateral AK Amputee,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/235812.
