TYPES OF PROSTHESES

TYPES OF PROSTHESES 

·         There are five generic types of prostheses: postoperative, initial, preparatory, definitive, and special-purpose prostheses.

·         Although progression through all five levels may be desirable, only selected amputees will receive the postoperative or initial prostheses, which are directly molded on the residual limb.

·         Most amputees will have preparatory and definitive prostheses, but a much smaller number will receive special-purpose prostheses for showering or for swimming and other sports.

1.       Postoperative prosthesis.

2.       Initial prosthesis.

3.       Preparatory prosthesis.

4.       Definitive prosthesis.

5.       Special use prosthesis.

Initial Postoperative Prostheses (IPOP)

 There are more aggressive approaches to post operative care that may include the use of a rigid

Dressing or what is termed an Immediate Post-Operative Prosthesis or IPOP. An IPOP is an

Immediate postoperative prosthesis that is used as an early form of prosthetic intervention.

•       The benefit of being fit with IPOP prosthesis is early ambulation if allowed by your physician. IPOP prosthesis is also said to help with phantom limb sensation, because you can see that there is a leg, or in this sense, prosthesis attached.

•       IPOP prostheses also protect the residual limb from being injured.

•       Many times, a patient will wake up in the middle of the night to use the restroom, and

Forget that their limb has been amputated.

•       When they get out of bed and try to stand on both limbs, they fall down and re-injure

The surgery site.

•       An IPOP prosthesis will protect the end of the residual limb should this occur.

•       There are many different types of postoperative care and your physician will help you choose which the best is for you.

•       Postoperative prostheses are, by definition, provided within 24 hours of amputation.

•       These are often referred to by various acronyms including immediate postsurgical fitting (IPSF) and immediate postoperative prosthesis (IPOP).

•       Although technically feasible for virtually any amputation, postoperative fittings are currently most commonly prescribed for the younger, healthier individual undergoing amputation due to tumor, trauma, or infection.

•       Its use in the elderly or dys-vascular individual is controversial but can be successful when meticulous technique and close supervision are available.

Initial Prosthesis

•       The initial prosthesis is sometimes used for the postsurgical fitting and is provided as soon as the sutures are removed.

•       This is sometimes referred to as an early postsurgical fitting (EPSF). Due to the usual rapid atrophy of the residual limb, the EPSF is generally directly molded on the residual limb by using plaster of paris or fiberglass bandages.

•       An alternative is to use a weight-bearing rigid dressing. Such devices are used during the acute phase of healing, generally from 1 to 4 weeks after amputation, until the suture line is stable and the skin can tolerate the stresses of more intimate fitting.

•       Postoperative and initial prostheses are most commonly used in rehabilitation units or in hospitals with very active amputee programs. 

Preparatory Prosthesis

•       Preparatory prostheses are used during the first few months of the patient's rehabilitation to ease the transition into a definitive device.

•       They are also used in marginal cases to assess ambulatory or rehabilitation potential and help to clarify details of the prosthetic prescription.

•       The preparatory prosthesis accelerates rehabilitation by allowing ambulation before the residual limb has completely matured.

•       Preparatory prostheses may be applied within a few days following suture or staple removal, and limited gait training is started at that point.

•       Originally, the preparatory prosthesis was a very rudimentary design containing only primitive components.

•       The modern preparatory limb, however, usually incorporates definitive-quality endoskeletal componentry but lacks the protective and cosmetic outer finishing to reduce the cost.

•       It allows the therapist and Prosthetist to work together to optimize alignment as the amputee's gait pattern matures.

•       Different types of knee mechanisms or other components can be tested to see whether individual patient function is improved.

•       Preparatory prostheses are generally used for a period of 3 to 6 months following the date of amputation, but that time can vary depending on the speed of maturation of the residual limb and on other factors such as weight gain, weight loss, or health problems.

•       The new amputee may begin by wearing one thin prosthetic sock in the preparatory prosthesis; after 3 months, he may be wearing ten plies of prosthetic socks to compensate for atrophy.

•       When the number of plies of prosthetic socks the patient must wear remains stable over several weeks, it is usually an indication that the definitive prosthesis can be prescribed.

 Definitive Prosthesis 

•       The definitive prosthesis is not prescribed until the patient’s residual limb has stabilized to ensure that the fit of the new prosthesis will last as long as possible.

•       The definitive prescription is based primarily upon the experience the patient had when using the preparatory prosthesis.

•       The information learned during those months will demonstrate to the clinic team the patient's need for a lightweight design, special types of feet or suspension, or any special weight-bearing problems that may arise.

•       Unless a suction socket is used, the amputee wears prosthetic socks over the residual limb for the same reason that people wear socks when wearing shoes: the textile fibers provide cushioning and comfort, take up shear forces, and absorb perspiration.

•       An additional advantage is the ability to accommodate minor volume fluctuations by wearing more or fewer layers (plies) of prosthetic socks.

•       Once the amputee is wearing ten plies of prosthetic socks, the fit has degraded sufficiently that socket replacement should be considered.

•       A definitive prosthesis is not a permanent prosthesis since any mechanical device will wear out, particularly one that is used during every waking hour.

•       The average life span for a definitive prosthesis is from 3 to 5 years.

•       Most are replaced due to changes in the amputee's residual limb from atrophy, weight gain, or weight loss.

•       Substantial changes in the amputee's life-style or activities may also dictate a change in the prosthetic prescription.

•       Overall physical condition is also a factor since the more debilitated individual generally requires a very lightweight and stable prosthesis.

Special-Use Prostheses

·         A certain number of patients will require special-use prostheses designed specifically for such activities as showering, swimming, or skiing.

·         It is most economical if special-use devices are prescribed at the same time as a definitive replacement is necessary since both can be fabricated from the same positive model.

·         Most require specialized alignment. For example, swimming prostheses are made waterproof and aligned so that the patient can walk without a shoe.

·         In some cases the foot can be plantar-flexed and have a swim fin attached.

·         Snow skiing prostheses require an increase in dorsi-flexion at the ankle and may incorporate additional knee support or auxiliary suspension.

·         Special-use prostheses can be valuable to the amputee who wishes to expand his activities and participate in a full range of sports and recreational activities.