Overview of Limb Prosthetics

A limb prosthesis is an artificial limb that replaces a missing body part, usually because it has been amputated.

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The main causes of limb amputation are

• Blood vessel (vascular) disease, particularly from diabetes or peripheral arterial disease

• Cancer

• Injury (for example, from a motor vehicle crash, work-related accident, or military combat)

• Birth defect

In the United States, approximately 1 in 200 people are currently living with the loss of a limb, and approximately 500 amputations are done each day. This percentage is likely to increase because, as the population ages, more people will develop diabetes and vascular disease.

For people who have had an amputation, a prosthesis (artificial limb) is often recommended to replace that body part. At a minimum, a prosthesis should enable the person to perform daily activities (such as walking, eating, and dressing) independently and comfortably. At best, a prosthesis may enable the person to function as well or nearly as well as before the amputation.

Success with a prosthesis is most likely to occur when the clinical team involved has many different types of professionals, depending on the person&#;s needs. At a minimum, core team members include the surgeon, prosthetist, and physical therapist. Prosthetists are experts who evaluate the person's overall functional capabilities and develop a prosthesis treatment plan, which includes designing, fitting, fabricating, and adjusting the prosthesis and providing lifetime follow-up care to maintain the prosthesis and provide advice and instruction on care. For more complex cases, the team could also include a physiatrist, occupational therapist, social worker, psychologist, and family members.

People may have concerns regarding passing through airport security with a prosthesis. Security personnel typically do not ask people to remove a prosthesis. If they do, they are obligated to do this in a private setting, because it usually requires removing some clothing. It may be useful for the prosthetist to write a letter stating that the prosthesis has metallic and microprocessor components and that leaving the prosthesis off for more than 10 to 15 minutes could make it difficult to put it back on because the fluid volume of the residual limb will increase.

Goals

Goals range from simple mobility to being able to do high-impact activities, such as running and jumping. The prosthesis' components are customized to help people achieve their different goals. Advances in cushioning materials, prosthetic socket design, and foot, ankle, knee, hand, wrist, and elbow component technology have significantly improved comfort and function. When fitting a prosthesis, the prosthetist works to make sure that the person is comfortable, stable while standing and walking, and able to or achieve individual goals.

Highly motivated, otherwise healthy people with a prosthesis can accomplish many extraordinary feats (for example, go skydiving, climb mountains, complete triathlons, fully participate in sports, or return to demanding jobs or to active duty in the military). Whether a prosthesis is used only for basic mobility or for more demanding activities, it can provide profound psychologic benefits and improve quality of life.

Successful prosthesis use depends on the following:

• The person's other medical conditions

• The person's physical and cognitive capabilities

• The characteristics of the residual limb

• How well the prosthesis socket fits and connects to the body

Prosthesis fitting is a specialized skill. Also it can be hard for people to make the physical and mental adjustments necessary to function with the prosthesis. Thus, the whole process of selecting and adjusting components and assessing overall prosthesis function is challenging and takes significant time. Not all people are candidates for all types of prostheses.

Amputation levels

An entire limb or part of one may be amputated. Doctors weigh many factors when amputating a limb. It is very important to

• Remove dead or infected tissue

• Ensure there is good blood flow in the residual limb

Other important considerations are to

• Preserve muscles and their attachments to bones as much as possible

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• Stabilize bones

• Cover the end of the residual limb with muscle

Preparing for an amputation

Having an amputation is difficult for people. Losing a limb is not only physically challenging, but people's self-image often changes after they lose a part of "themselves." Doctors and prosthetists try to prepare people and their family by explaining why an amputation is necessary and what will happen before and after the amputation and during the prosthesis fitting process. People who understand the process and have realistic expectations of the difficulties they may face and the most likely outcomes are more likely to persevere and have a better result. Doctors sometimes arrange for the person to talk with someone who already has an amputation and has adjusted well to it.

Before doing surgery, doctors try to get people in the best possible medical condition. They try to address existing medical problems, such as poor nutrition, diabetes, and heart or lung disease as much as possible. Because smoking interferes with healing, smoking cessation measures are important. If time permits, people who are weak or debilitated may do therapy and exercises to make them stronger and more flexible.

After surgery

Immediately after surgery, the medical team starts measures to

• Maintain range of motion of joints to prevent them from becoming stiff

• Maintain or increase the person's strength and general conditioning

• Manage swelling (edema) in the residual limb

When recovery permits, people should begin to desensitize the end of their residual limb by massage, tapping, vibration, and starting to bear weight on it.

Prosthesis fitting can begin when the surgical wound is sufficiently healed and the swelling has gone down enough, provided that the person has enough overall strength and joint range of motion. Prosthesis fitting usually occurs approximately 7 to 10 weeks after amputation.

The residual limb continues to change for 6 to 18 months after amputation as more fluid leaves the residual limb and the muscles reshape. While these changes are ongoing, prosthetists may fit one or more temporary sockets until the residual limb stabilizes. When the residual limb seems close to its final size and shape, prosthetists fit the person with a definitive prosthesis. A temporary prosthesis allows people to become accustomed to pressures and forces involved in using a prosthesis.

Early rehabilitation facilitates recovery and future success in using a prosthesis (see Rehabilitation After Limb Amputation). When possible for people whose amputation is scheduled, rehabilitation begins before the amputation. For people whose amputation is done suddenly (for example, because of injury sustained in a motor vehicle crash or combat), rehabilitation is begun as early as the first day after surgery.

More Information

The following English-language resources may be useful. Please note that The Manual is not responsible for the content of these resources.

1. Amputee Coalition: Information to promote limb loss prevention and provide education, support, and advocacy for people affected by limb loss

2. U.S. Department of Veterans Affairs: Rehabilitation and Prosthetic Services: Resources regarding national policies and programs for medical rehabilitation and prosthetic and sensory aids services that promote the health, independence and quality of life for Veterans with disabilities

When an arm or other extremity is amputated or lost, a prosthetic device, or prosthesis, can play an important role in rehabilitation. For many people, an artificial limb can improve mobility and the ability to manage daily activities, as well as provide the means to stay independent.

Prostheses Parts and Types

There is a wide variety of prostheses that are designed to function -- and in many cases look -- like a natural arm, leg, hand, or foot. Although there are many different designs, most have similar parts. These include:

• A socket into which the stump of the amputated limb fits
• The suspension, which holds the prosthesis onto the stump
• The shaft
• The foot, hand, or hook
• A covering for cosmetic appearances

The socket is often lined with foam or silicone to protect the stump. Special socks are also worn over the stump to ensure a proper fit and improve comfort.

Following are some of the most common types of prostheses:

Lower leg and foot. A number of prosthetic feet are available to simulate the action of a natural foot after an amputation below the knee. At least one available foot-ankle prosthesis is controlled by a microprocessor. It uses feedback from sensors to adjust joint movement, making walking more efficient and reducing the risk of falls.

For more information, please visit Prosthetic Parts Manufacturer.