This document discusses advances in hip disarticulation prostheses. It begins by describing hip disarticulation amputation and challenges with prosthetic fitting at this level. It then covers the evolution of prosthetic designs including traditional tilting-table models, the seminal Canadian design, and more recent designs incorporating lightweight materials and anatomical shaping. Key components like the socket, hip joint, and suspension methods are examined. The document emphasizes ongoing efforts to improve mobility, comfort and long-term prosthetic use for individuals with hip disarticulation amputations.

1. ADVANCES IN
HIP-DISARTICULATION
PROSTHESIS
:Presenter:
AKSHAY H. CHAVAN
1st–Masters Of Prosthetics & Orthotics (2018-19)
AIIPMR, Mumbai.

2. • Hip disarticulation is the surgical removal of the
entire lower limb by transection through the hip
joint.
• Trying to overcome the loss of three weight-bearing
joints, rather than one or two.
• Not routinely seen in the average clinical practice.
• Reduced mobility and increased energy expenditure
during gait.
• Prosthesis fitting is therefore limited to motivated
and physiologically vigorous individuals and even
then a significant number don’t become long term
user.

3. CAUSES OF HIP DISARTICULATION AMPUTATION
1. Malignant musculoskeletal tumors (most often in younger patients)
2. Limb ischemia (perivascular disease and complications to diabetes)
3. Trauma (such severe traumas often result in the death of the patient)
4. Severe lower limbs infections (chronic skin or bone infection)
5. medical negligence
Most Prosthetist have little experience with this type of amputation-Only
20% of hip amputees use a prosthetic leg full-time (i.e. 8 to 12 hr./day)
From these 20%, only a small minority use a prosthetic leg without a cane
or crutch
This small minority of full time users without walking aids consists
primarily of the young patients with malignant tumors.
There is a persistent belief within the medical community that most
middle aged hip-disarticulation amputees will ambulate with crutches or a
wheelchair only!!!

4. LEVEL OF HIP DISARTICULATION
Modified hip
disarticulation
True Hip
disarticulation
Transpelvic amputation
Hemipelvectomy

5. PROSTHETIC MANAGEMENT FOR HIP DISARTICULATION
 Due to energy requirement for prosthetic use is as high as 200% of normal
human ambulation. There is a high rejection rate of prosthetic use at this level
of this amputation.
 There is a lack of muscles power available to control hip, knee, and ankle joint
which results fixed and slow cadence.
 Only those patient who has developed sufficient balance are likely to wear
prosthesis for ambulation.
 Usually the mobility with crutches and the sound leg is much faster and
requires less energy expenditure than using a prosthesis
 Selection of appropriate component is challenge for prosthetist
 Less lever arm

7. BIOMECHANICS OF H.D.PROSTHESIS
• The Canadian design HD prosthesis was introduced by Colin McLaurin and the
biomechanics of this prosthesis were clarified by Radcliffe in 1957.
• The high level prosthesis is stabilized by the ground reaction force, which occurs
during walking.
• For example when standing in the prosthesis, the person’s weight bearing line
falls posterior to the hip joint, anterior to the knee joint and anterior to the ankle
joint.
Knee Joint
Knee Axis
SEF
Knee Joint
Knee Axis SEF
Single
Equivalent
Force
(Projection of
CG)

8. Medio-lateral stability

9. Anterio-posterior stability

10. ALIGNMENT OF H.D. PROSTHESIS
5° to 10°
external rotation
The length of the prosthesis is 12 mm shorter than the sound side, so that the foot can clear the
floor during midswing.
Single-axis knee is placed 15 mm posterior and a dynamic response midfoot is placed 20 mm
anterior to the bisection.

11. Evolution of hip Disarticulation Prosthesis
Prior to 1954 consisted of a moulded leather socket with a
laterally placed locking hip joint called a tilting-table prosthesis.
 Later, "Canadian" design was introduced by McLaurin in
1954 with the use of free hip, knee, and ankle joints.This is now
the standard for prosthetic fitting worldwide, and locking joints
are very rarely necessary.
 A molded plastic socket encloses the ischial tuberosity for
weight bearing, extends over the crest of the ilium to provide
suspension during swing phase.
 On this concept, Lynquist proposed a fitting concept for a
Canadian type plastic socket. Which proved to be effective for
achieving comfortable weight bearing via the soft tissues, even
though there is no bony structure on the involved side of these
amputation.

12. THE SAUCER-TYPE PROSTHESIS
It is essentially a short 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.

13. 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.

14. TILTING-TABLE PROSTHESIS
• The traditional device prior to 1954 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.

15. A strap is fastened to the socket
and passed under rollers attached
near the medial brim of the thigh.
These rollers also take the
downward thrust of the socket, and
a metal track may be attached to
the socket for the rollers to bear
upon.
Variations in tilting-table prostheses:
strap and-roller medial support.,
anterior view and medial view.
TILTING-TABLE PROSTHESIS

16. When the hip joint is fully
extended, the latch flips by dead
center and secures the socket to the
thigh.
A hip lock is necessary with this
arrangement.
Variations in tilting-table prostheses:
latch type medial support, cross-
sectional view
TILTING-TABLE PROSTHESIS

17. Variations in tilting-table
prostheses: hip joint below
socket. anterior view and medial
view.
 The walking function is identical,
but the hip joint has been lowered
to a position beneath the socket
where a full-width bearing may be
made much lighter.
 Because of the position of the joint
directly below the center of
gravity, however, a lock must be
used.
TILTING-TABLE PROSTHESIS

18. This design uses a track-and-roller
mechanism in which the center of
rotation is a few inches lower and
anterior to the acetabulum.
But binding of the rollers on the
tracks prevented free motion, but it is
worth noting since in principle it is
almost identical to the present
Canadian type, and it seems to be
designed with a view toward
improving function.
Variations in tilting-table
prostheses: track and- roller joint.
TILTING-TABLE PROSTHESIS

19. CANADIAN HIP DISARTICULATION PROSTHESIS
FOR DECADES SURGEONS AND
PROSTHETIST STRUGGLED WITH THE
CHALLENGE TO FIND A GOOD
PROSTHETIC FIT.
The first experimental prosthesis
employed a four-link mechanism
The socket was plastic and the thigh
section aluminum alloy.
It was intended that a posterior
strap be used to lock the leg in full
extension, but initial trials indicated
adequate stability without a lock.

20. THE CANADIAN-TYPE HIP-DISARTICULATION
PROSTHESIS: FINAL DESIGN
• 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.

21. Socket
Prosthetic
Hip joint
Prosthetic
foot
Knee
joint

22. SOCKET TECHNOLOGY FOR HIP DISARTICULATION
 In addition to previous technologies ,
by using ultralight materials for the
socket, its weight drops to less than
one-quarter that of traditional sockets.
 Reduced weight translates directly into
less energy expenditure.
 The new socket design further differs
from traditional models in that it
actually consists of two parts the ultra
light frame and a flexible inner socket.
 This softer inner socket increases
comfort and improves the hygienic
properties of the prosthesis.

23. This new design “locks” the prosthesis
Onto the wearer on three planes: front-
to-back, side-to-side, and top-to-
bottom.
The intimate fit resulting from this
approach to suspension prevents
pistoning.
 Achieving this LOCK requires the
socket closely around the anterior
pubic bone, the posterior sacrum, the
ischial tuberosity, and the ileac crest.

25. CANADIAN-TYPE HIP-DISARTICULATION SOCKET
 This is bucket type socket design.
 Hip disarticulation socket design, which would encapsulate the Iliac crest,
ischium and ischial ramus.
 It provide lateral stability using three point pressure system.
 Anteroposterior stability.
 45 degree inclination angle from posterior and anterior side .
 Joint attached at anterodistal end.

26. UCLA Anatomical HIP-DISARTICULATION SOCKET(1980)
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.
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.

27. Dycor´s Roller Track socket (1997)
Positioning the hip joint in the centre 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.

28. • 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.
• The basic design is similar to the traditional North-
western University Diagonal Socket. The major
differences between this design are aggressiveness
of the trim lines and improved suspension method
presented below.
• 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 SEMIFLEXIBLE SOCKET DESIGN

29. DIAGONAL SOCKET DESIGN
• It has the opening for donning located
on the sound side.
• The socket margin on the amputated
side is no higher than the level of the
anterior superior iliac spine.
• The rigid anterior and posterior
sections of the socket rise diagonally
from this level to cover the ilium on the
sound side, because both anterior and
posterior sections of the socket
contribute support, antero-posterior
movement of the socket on the pelvis is
minimized, reducing a painful pressure
on the inferior ramus.
• In addition the lateral support necessary
to prevent the stump from falling out of
the socket is more directly and firmly
achieved.
The Glenrose Socket Design,
anterior view. (A) Semi-flexible
layer; (B) Semi-rigid layer; (C)
Rigid layer.

30. 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 iliac
crest is fabricated.
• Here iliac crest and spine are left
uncovered Posteriorly, the socket is
trimmed so that the frame lies on the
sacrum but lumbar vertebrae are left free.

31. Hip disarticulation
socket with revofit
Modified hip
disarticulation socket
with suction valve

32. BIKINI TYPE HIP SOCKET TECHNOLOGY
• Developed on Oct. 25, 2013 Developed by
Jay Martin
• The latest prosthetic socket interface
advancements radically changes life for
individuals with hip disarticulation and
hemipelvectomy levels of amputation which
is Developed by Jay Martin.
• The Iliac Crest Stabilizers are self adjustable
for a perfect fit everyday.
• 1/3 size
• 1/3 weight
• 3 times more comfortable

33. • Instead of encapsulating the entire pelvis with a thick bulky bucket,
they designed lightweight, bikini socket and iliac crest stabilizers
provide a more direct biomechanical link between the device and
its user, resulting in superior control, comfort, and functional
outcomes.
• The open air design makes wearing the prosthetic significantly
lighter, cooler, and more breathable.

34. PROSTHETIC HIP JOINT
• Functions of the Prosthetic HIP Joint
•Mobility
•Stability
•Durability
•Comfort

35. • The hip joint is screwed to the socket lamination
plate with the double hinged plate.
• For sitting, using a lever.
• Flexion and extension are adjusted by sliding the
extension stop bumper on the tube.
• Hip rotation is adjustable.
MODULAR SINGLE AXIS HIP JOINT, WITH LOCK
MODULAR SINGLE AXIS HIP JOINT, WITH EXTENSION ASSIST
 Instead of the lock, the joint has an extension
assist with lateral latex bands for stride
control and a built-in adjustable extension
stop bumper.
 The extension assist limits the range of motion
of the joint while walking.

36. MODULAR SINGLE AXIS HIP JOINT, WITH INTERNAL EXTENSION ASSIST
• Adjustable extension assist is located in the lower
section of the joint and limits the range of motion
while walking.
• Low structural height (= laminate thickness), which
minimizes the pelvic tilt in the seated position.
• Abduction/adduction, flexion/extension and
rotation can be continuously adjusted.
SINGLE AXIS HIP JOINT H1S ENDOLITE /OTTOBOCK 7E7
 This type of hip joint makes it more
stable.
 Super light weight design.
 Maximum load capacity of 100 Kg.

37. POLYCENTRIC PROSTHETIC HIP JOINT
Features:
• Tracks hip movement to optimize gait.
• The hip folds anteriorly to ensure good sitting comfort
and Cosmesis.
• 130 degree flexion/extension
• Alignment allows adjustment in all planes
HYDRAULIC POLYCENTRIC PROSTHETIC HIP JOINT
• harmoniously damping joint movements in both the swing
and the stance phase with the goal of allowing prosthesis
wearer to achieve a gait pattern that comes close to the
physiological model.
• controlled heel strike
• Significant reduction of pelvic tilt, harmonious hip extension
• Controlled and smooth rollover on the prosthesis under full
load
• Small, lightweight and suitable for a body weight up to 125
kilograms

38. HELIX 3D PROSTHETIC HIP JOINT
• The joint consists of a so-called spatial four-axis
mechanism with hydraulic stance and swing phase
control.
• less sudden pelvic movements during weight transfer.
• Support for swing phase initiation
• Control of hip movements during the swing phase
• Three-dimensional movements in terms of the
relationship between hip joint extension / flexion and
transversal pelvic rotation
• Produces a three-dimensional hip movement & promotes
a symmetrical and natural gait pattern.
• Reduce the risk of falling and thereby to increase
functional safety.
• Makes a large flexion angle possible, to facilitate everyday
situations like putting on shoes or getting into a car.

39. The four-axis polycentric structure of the described hip joint consists
of two ball joints and two single-axis connections, with the rear axis
tilted in relation to the structure. Ball joints form the two anterior
connections. Specialised hydraulics control the level of stance and
swing phase resistance in this hip joint .

40.  Produces a three-dimensional hip movement & promotes a symmetrical and natural gait
pattern
 Three-dimensional movements in terms of the relationship between hip joint extension /
flexion and transversal pelvic rotation

41. KNEE JOINTS FOR HD PROSTHESIS
Single axis knees are not recommended for HD prosthesis. True but, a well aligned single axis knee
works very well in an HD prosthesis
Most widely utilized due to its light weight,
low cost, and excellent durability.
 Friction resistance is often eliminated
 For the Canadian hip disarticulation design,
more sophisticated mechanisms have proved
their value and are gradually becoming more
common.
 SINGLE-AXIS CONSTANT-FRICTION
 WEIGHT ACTIVATED SAFETY KNEE JOINT
 Second most frequently utilized component.
 Because there is very little increase in cost or weight and
reliability has been good
 Missteps causing up to 15 degrees of knee flexion will not
result in knee buckle, which makes gait training less difficult
for the patient and therapist.

42.  Slightly heavier than the other, this component offers maximum stance-phase stability.
 Because the stability is inherent in the multi linkage design, it does not erode as the knee
mechanism wears during use.
 Good toe clearance
 Any fluid-control mechanism (hydraulic or pneumatic) results in a smoother gait.
• In addition, a more rapid cadence is also possible.
• The preferred mechanism has separate knee flexion and extension resistance adjustments.
• In essence, the limb steps forward more rapidly.
• As the shank moves into extension, the fluid resistance at the knee transmits the momentum
up to the thigh segment and pushes the hip joint forward into flexion
POLYCENTRIC KNEE JOINT (WITH OR WITHOUT FLUID CONTROL
MECHANISM )

43. Microprocessor controlled knee joint
• Assists the user in maintaining knee stability on a variety of surfaces.
• Reduces the risk of falls.
• Adjustable flexion extension
• Microprocessor controlled SNS resistance.
• Step over step stair climbing

44.  Increased security and confidence/ Stumble Control.
 Reduces conscious effort and stress for user to maintain knee
stability.
 Step over step stair climbing

45. TUBE CLAMP ADAPTER
Adjustable Offset
Adapter (Titanium)
Adjustable
Height
Adapter
(Titanium)
(Aluminum)
Angled
Adapter for
HD
Prosthesis
(Titanium)
Male
Adapter
(Titanium)
 The adapter is
available with three
angles that is
10°,20°,30°.
 It establishes the
connection between
the pyramid adapter
in the knee joint and
the tube of the
anteriorly located hip
joint.

46. FOOT MECHANISMS FOR H.D. PROSTHESIS
• Dynamic response feet are commonly chosen for their lightweight
design. Because of the slowed gait of the hip disarticulation patient,
only in the more active patient can true dynamic responsiveness be
observed.
• An inexpensive solid ankle cushioned heel foot with a soft heel
cushion can also be used to increase knee stability.
• Although single-axis and multiaxial feet may be used to increase
stability, they add substantial weight to the distal end of the limb.
 Recommended for the Canadian hip disarticulation
design due to its moderate weight, low cost, and
excellent durability.
 The heel is composed of a foam wedge that provides
cushioning in the heel section during heel strike.
 Used on an amputee’s initial prosthesis, when the
potential functional level of an amputee has yet to be
determined.
SACH FOOT

47. SINGLE AXIS FOOT
• In those cases where slightly more knee stability is
desired
• The single axis foot includes bumpers, which control
ankle flexion.
• This allows the prosthetic forefoot to contact the
floor quickly during after heel strike. heavier than
more basic feet, such as the SACH.
MULTI AXIAL FOOT
•Multi axial feet have liabilities similar to the
single-axis versions but add extra degrees of
freedom in hind foot inversion/ eversion and
transverse rotation.
• In addition to accommodating uneven ground,
absorbing some of the torque of walking, and
protecting the patient's skin from shear stresses.

48. FLEXIBLE-ENDOSKELETON FOOT
• The solid-ankle flexible-endoskeleton (SAFE) foot
inaugurated a class that could be termed "flexible-
keel" designs.
• Offers some transverse rotation as well.
DYNAMIC-RESPONSE FEET
o Provide a active push-off
o This foot typically returns 90% of stored energy and is recommended for a
wide range of age, activity and amputation levels.
o a combination of creative design and innovative lightweight construction
technology
o controlled movements help the user build more confidence in the
prosthesis.

50. Prosthetic Rehabilitation Is To Aid The Amputee To Gain Independence At The
Highest Level They Can, With The Most Efficient Gait Possible