Physiotherapy following through-knee amputation

Abstract

Physiotherapeutic treatment considerations specific to the through-knee amputee are presented. Treatment is determined by the assessment findings. The physiotherapy programme includes post-operative exercises, early weight-bearing, bed to chair transfers, bandaging techniques, the counteracting of contractures and gait training. Physiotherapy is a vital part of the rehabilitation of through-knee amputees. Principles of treatment are based on normal human locomotion, the individual patient's health status, biomechanical changes and expected stump functions. The through-knee stump is generally problem free, functional and end-bearing, allowing for a high rehabilitation rate in independent ambulation. It is therefore well suited for the geriatric amputee.

Long‐term Results of Through‐knee Amputation with Dorsal Musculocutaneous Flap in Patients with End‐stage Arterial Occlusive Disease

“…Twenty patients had already had amputations of the affected extremity at the level of the foot or below the knee. There was an average of three previous vascular operations in 41 extremities [1, 2, 3, 4, 5, 6] (Table 2).…”

“…Stump training is started early with isometric exercises to strengthen the muscles and exercises using proprioceptive neuromuscular facilitation. The aim of the physiotherapy is to make the patient strong enough for subsequent rehabilitation treatment at an appropriate center [6].…”

Running patterns of transfemoral amputees

“…Transfemoral amputees walk with an unnatural and stiff gait. This occurs because the natural axial rotation of tibia and fibula in relation to the knee and the foot is absent and because prolonged, active stump hip extension is required to maintain prosthetic stance stability (full knee extension) (Mensch, 1983). When compared to the position of the natural knee during the same phase within the gait cycle (slight knee flexion), the biomechanical difference and the effect on gait synchronization is evident.…”

Effect on knee disarticulation on bone growth in immature rabbits

“…Despite the fact that many advantages can accrue in adults by knee disarticulation (KD) compared to trans-femoral amputation 0, such as, providing a longer lever for attachment of the prosthesis, having a lesser degree of muscular atrophy, having the ability to tolerate full end weight bearing on the stump and with good rotational control and suspension being easily acquired, it is even more advantageous in children because it protects the distal epiphyseal plate and does not result in unusual growth of the joint (Atlas of Limb Prosthetics, 1992;Donaldson, 1962;Jensen and Mandrup-Paulson, 1983;Kegel et al, 1978;Mensch, 1983;Prosthetic and Orthotic Practice, 1970;Tooms, 1992).…”