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Evolution of hip disarticulation prosthesis

The document discusses the evolution of hip disarticulation prostheses from the 1940s to recent advancements, highlighting various designs and technologies developed to improve function and comfort. Key designs include the tilting-table prosthesis, U.S. Navy hydraulic prosthesis, and advancements like the bikini hip socket technology that enhances stability and reduces weight. It covers the biomechanics involved in prosthetic stability across different planes and the effects of design on user experience.

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Evolution of Hip Disarticulation Prosthesis Rani kumari AIIPMR, Mumbai
INTRODUCTION • Hip disarticulation is the surgical removal of the lower limb through the hip joint. • 2% of all amputations are at the hip disarticulation level.
Level of amputation in hip disarticulation Above the lesser trochanter True hip disarticulation hemipelvectomy
Evolution 1930 2016
Evolution of hip Disarticulation Prosthesis Tilting-table Prosthesis (1940) Saucer-type Prosthesis(1957) Canadian Hip Disarticulation Prosthesis(1954) UCLA Anatomical H.D. Prosthesis(1980) U.S. Navy Hydraulic Prosthesis(1945)
Cont… Advances flex Hip Disarticulation Socket Design (2001) Silicone frame socket with Hipo-gross-Aqua hip joint (2000) Dycor´s Roller Track Prosthetic Hip (1991) Ortho-system butterfly socket (1997)
Cont… Bikini Hip Socket technology (2013) Re-Defining Hip Disarticulation with the Bikini Socket (2016) Glenrose Semi-flexible Hip Disarticulation Socket (2005)
Socker type Tilting table prosthesis Canadian hip prosthesis US navy prosthesis UCLA anatomical 1940-1980
Tilting-table Prosthesis (1940) The traditional device consisted of a molded leather socket with a laterally placed locking hip joint called a tilting-table prosthesis  A belt around the pelvis and often with a strap over the shoulder. The socket is articulated on the thigh section with a metal joint lateral to the acetabulum.
 Because it is extremely difficult to make a hip joint strong enough to bear the entire load, contact between the socket and the medial edge of the thigh section is essential in weight-bearing, and this is equally important when a lock is used.  Without a lock, the wearer has little control over the limb, most of the stability during the stance phase being afforded by friction between the socket and the thigh section.
U.S. Navy Hydraulic Prosthesis(1945) • At the close of World War II, the U. S. Navy designed and fitted an hydraulic prosthesis with the primary purpose of improving function. The very large ball- bearing hip joint was made strong enough to bear all the weight, thus obtaining a free joint. An extension controlled the motion about the knee joint. • The cylinder in turn was controlled by a valve which was either automatically or manually actuated.
• Normal motion about the hip joint allowed the piston to move slowly, as in an automobile shock absorber, and the knee joint was thus permitted to flex and extend with some damping. But fast rotation about the hip joint (as in stumbling) caused the valve to close and thus stabilized the knee. • The manual control also closed the valve and locked the knee in any position. • Disadvantages of this device- 1. cost 2. Weight 3. Hydraulic prosthetic usually introduces problems of noise, leakage. 4. Occasional erratic behavior.
Canadian Hip Disarticulation Prosthesis(1954) In order to achieve simplicity in assembly and to increase mechanical rigidity, the forward link was lengthened and made strong enough to support all the main loads. The rear link thus acted only as a guide and could be made light and adjustable.
Cont…. To extend the front link to include the knee joint and to replace the rear link with a simple rubber stop to prevent hyperextension. This final configuration, permitted the use of a single broad joint without locks. The most apparent difficulty was the tendency for too long and too slow a stride, and thus the elastic webbing was added to restrain hip flexion.
The ischial seat is nearly always available for direct weight bearing, and the areas for taking pressure elsewhere are large. If the socket is extended in the form of a band across the back of the pelvis and around to the opposite iliac crest, then three points of the in nominate bones are firmly gripped.
Saucer-type Prosthesis(1957) It is essentially a standard above-knee leg with a saucer- shaped socket on top of the thigh. Suspension is by means of a single-axis joint and pelvic band and may include straps that pass over the shoulder. This type is most suitable for short femur amputations because adequate stability is difficult to achieve without the additional bone structure.
Cont… In accord with common practice with above-knee legs, the hip joint is placed well forward, thus providing some measure of stability. A lock may or may not be used at the hip joint, if a lock is used, it is of the semiautomatic type. The lock provides stability (at some loss of function), but it offers mechanical difficulties because all the loads are funneled through the relatively small joint.
UCLA Anatomical H.D. Prosthesis(1980) • The initial concept for a hip disarticulation socket was a one-piece polyethylene design with a laminated frame to which the hip joint would be attached. • Hip disarticulation socket design, which would encapsulate the ischium and ischial ramus in a more anatomical contour than previous socket designs, might produce an improved prosthetic fitting. • The flexibility of such a design applied to a hip socket seemed a reasonable way to provide more comfort.
Cont…… Hip disarticulation socket design, which would encapsulate the ischium and ischial ramus in a more anatomical contour than previous socket designs, might produce an improved prosthetic fitting.  Provide more comfort. This was an attempt at a more anatomical socket, contours detailing the ischial ramus angle and the medial inclination of the ischium were included in the cast. Thus the medial brim need not extend as high or contain as much of the ischial ramus.
Decor's roller track Ortho system butterfly Silicon frame socket Advance flex Glenrose semiflex 1991-2005
Dycor´s Roller Track Prosthetic Hip (1997) • Hip Circumference at trocanteric level Extra Small 27" Small 32" Medium 38" Large 45" Extra Large 52" Positioning the hip joint in the center of the socket rather than anteriorly enhances toe clearance during swing phase because the knee swings forward and upward rather than forward and downward. Hip rotation occurs through a laterally mounted single axis joint with extension stop and flexion bias. Vertical loads are supported by a wheel attached to the thigh pylon component trans versing a hemispherical track built into the socket.
Strength and weight is enhanced because the supporting structure is always directly under and opposed to the dynamic applied load. Alignment Coupling Provides 1" from neutral A-P to M-L travel, 360 degrees rotation. The ADL Coupling allows the prosthetist to use the same below knee endoskeletal definitive kit for both intermediate and definitive prosthetics. *Supervised intra-clinical use only
Ortho-system butterfly socket • ORTHO-SYSTEMS was founded in the year 2000 with the goal of developing a system which delivered what it promised and was suitable for a wide range of orthoses. Our functional classification assists in selection of the correct orthosis type, and all our products are weight classified to ensure they meet the necessary demands.
Cont… • Special Features • All Hipo hip joints are problem free around sand and dirt. • The Hipo-gross-Aqua for the nicest time of year. • Individually custom fabricated and suitable for patients with difficult stump conditions. • Ideal as an alternate prosthesis. • An individual, distinctive hip joint which can be modified on-site by the attending prosthetist. The hip joint is easily lengthened for patients who are still growing.
Silicon frame socket • Silicone Frame Socket This ischial ramus containment socket fastens the pelvis diagonally on both sides between the iliac crests and the ischial tuberosity. • This technique has been realized by Udo Danske. A silicone liner in the shape of a swimsuit is fashioned in order to spread out the forces and protect the skin. Then a two-piece rigid frame fastening both ilia is fabricated. • The iliac crest and spine are left uncovered and an opening is provided at the level of the
• Posteriorly, the socket is trimmed so that the frame lies on the sacrum but lumbar vertebrae are left free. The Gleiter at the sacral level maintains the stability of the rigid two piece frame while the Mammut, positioned on the side, holds the socket together and enables donning of the prosthesis.
Advances flex Hip Disarticulation Socket Design (2001) • This new design “locks” the prosthesis onto the wearer on three planes: frontto-back, side-to-side, and top-to- bottom. The intimate fit resulting from this three-tiered approach to suspension prevents pistoning (that is, movement up and down and side to side in the socket), improving the HD amputee’s ability to efficiently control the prosthesis.
• n addition, by using ultralight materials for the socket, its weight drops to less than one-quarter that of traditional acrylic or silicone sockets. Reduced weight translates directly into less energy expenditure.
Glenrose semiflexible socket design The Glenrose socket design is made of three layers and encompasses the affected side and iliac crest, reducing the band passing around the sound side between the iliac crest and the greater trochanter to 50 mm (Figure 1). The basic design is similar to the traditional Northwestern University Diagonal Socket.6 The major differences between our design and the Northwestern University design are in the aggressiveness of the trimlines and improved suspension method presented below. The Glenrose Socket Design, anterior view. (A) Semi-flexible layer; (B) Semi-rigid layer; (C) Rigid layer.
• Socket Layers 1. Semi-flexible butterfly (portion A of Figures 1-3). The first layer is made of a soft thermoplastic elastomer. This layer provides a soft flexible transition on the medial wall, a high friction surface to aid suspension, and a flexible, forgiving trimline above the iliac crest. • The butterfly shape allows movement of the iliac crest suspension without buckling of the material. This piece is difficult to fabricate and requires a skilled technician to accomplish. Glenrose Socket Design interior, viewed from above from the sound side. (A) Semiflexible layer with butterfly shape; (B) Semi-rigid polyethylene layer.
Bikini Hip Socket technology • Published on Oct 25, 2013 • The latest prosthetic socket interface advancements radically changes life for individuals with hip disarticulation/hemipelvectomy levels of amputation. Developed by Jay Martin, CP, FAAOP, the patented Bikini Hip Socket technology effectively distributes mechanical forces through compliant materials, providing the most comfortable interface
Cont…. • It provides a more direct biomechanical link between the body movement and the prosthesis, resulting in superior control and functional outcomes. • It is also less than half the weight of conventional prosthetic sockets. For more information on this technology, visit martinbionics.com.
Biomechanics  Anterio-posterior stability At initial contact, as the prosthetic heel touches the ground, the GRF passes posterior to the ankle axis, the heel cushion compresses and the foot is lowered to the ground. • At the same time an extension moment is created at the prosthetic knee as the GRF passes anterior to the prosthetic knee joint axis.
Cont….. • By midstance, alignment stability is maximal as the GRF now passes posterior to the prosthetic hip joint axis and anterior to the prosthetic knee joint axis. • As forward progression continues into pre-swing, the GRF moves posterior to the prosthetic knee axis, allowing the knee passively bend to facilitate swing phase foot clearance, while weight is being shifted onto the opposite limb.
 Medio-lateral stability- • To reduce undesirable perineal pressure, the canadian type socket is contoured to avoid excessive mediolateral motion. • Throughout the stance phase of the prosthesis, the body’s center of gravity “W” exerts it’s downward force medial to the vertical support point “I”. • The short distance between the line of gravity and the vertical support point minimizes the displacement. • Sliding is reduced further by the diagonal forces exerted by the waistband over the sound hip as “H” and by the socket “S”. I W H S I
Stability in the sagittal plane-  Hip joint is located in front of the weight line ,creating an extension moment of force .  Knee joint is located behind the weight line so that gravity tend to extend the knee.  Reference line through the hip and knee joint should pass at least one inch behind the heel. Stability in the frontal plane-  Instability in the frontal plane is reduced by aligning the prosthesis with a narrow base, approximately 3 inch between heel centers.  A wider base would force the amputee to bend his trunk laterally in order to move his center of gravity over the prosthesis.
Evolution of hip disarticulation prosthesis