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PROSTHETICS
KNEE JOINTS.
Christian
Medical
College
K E Z A I A H S
P&O Department
CONTENT
• INTRODUCTION
• EXOSKELETAL & ENDOSKELETAL
• TYPES OF KNEE JOINTS
• SINGLE AXIS
• CONSTANT FRICTION
• POLYCENTRIC
• MANUAL LOCKING
• WEIGHT ACTIVATED STANCE CONTROL
• VARIABLE FRICTION
• PNEUMATIC OR HYDRAULIC
• COMPUTERIZED
Christian
Medical
College P&O Department
Introduction
Prosthetic replacement of the
anatomical kneeProsthetic
replacement of the anatomical knee
Prosthetic knees allow a person who has
sustained an amputation at or above the
knee to regain use of the knee and ankle
joints and participate more easily in their
daily activities.
Knee Joints
Exoskeletal
Endoskeletal
Exoskeletal prostheses have a hard outer plastic or metal
shell in the shape of the limb. They are permanently fixed
and not adjustable. Exoskeletal prostheses are more durable
and may be preferred by people who do physical labor or
are in harsh environments that could damage the
prosthesis.
Endoskeletal prostheses have a central inner skeletal
structure and are adjustable, but less durable. The
endoskeletal system is often covered with a soft material in
the shape of the limb and a synthetic skin.
Liceria & Co.
Types of
Knee Joints
Prosthetic knees are divided into two
categories, mechanical or computerized
Mechanical knees are further
divided into single-axis, multi-
axis, and polycentric knees
Liceria & Co.
Single-Axis Knee Joints
This is the simplest type of prosthetic knee joint
that allows for rotation around a single axis
during flexion and extension of the knee.
Single-Axis Knees
Mechanism
• Individuals who use this type of knee require
good muscle strength, as this type of
prosthesis can be difficult to control.
• These are sometimes recommended when
there are limited economic resources,
as it is the most cost-effective option.
Single-Axis
This is a very simplistic design, durable, as
well as light weight, which can be helpful
for new amputees, who are just learning to
walk.
Due to this simplistic design, the user has to
generate significant muscle power to keep
the knee stable while standing and
walking.
Most cost effective
Creates an unnatural gait pattern due to
the simplicity of the single-axis design
Can be difficult to control the locking
and unlocking during gait, putting the
user at higher risk for falls and injuries.
Mechanical Knee Joints
Advantages Disadvantages
Constant friction Knee Joints
This system uses constant
pressure against a rotating
surface to resist knee flexion. The
amount of pressure is set by the
Prosthetist and should not be
altered by the user. External
spring(s) may be used to assist
the knee to straighten faster than
it bends.
Constant friction
Knees Mechanism
Simple
Can only be adjusted to one walking
speed. Other speeds will have
compromised gait.
Lightweight
Requires accurate adjustment by trained
practitioner.
Dependable
Will require periodic adjustment to
remain effective
Can be found in both monocentric (single axis) and
polycentric (multi axial) knees.
Knee becomes less stable as the knee
wears (monocentric design).
Mechanical Knee Joints
Advantages Disadvantages
Polycentric Knee Joints
Polycentric knee allows multiple points of rotation around
several axes. Polycentric joints can have either 4 or 7 bars,
meaning that you can either have 4 points of rotation or 7
points of rotation.
Polycentric Knees
Mechanism
• This type of joint provides good stability when there is
involuntary flexion during the heel strike phase of
walking because the center of rotation is located more
proximally and posterior when the knee is fully
extended
• This knee is typically recommended for active people,
or people who are more likely to walk independently,
without a gait aid.
Can be very stable in stance phase
Much heavier than a single-axis joint
prosthesis
Allows the user to sit down with a bent knee
Greater energy requirement of muscles
during walking to maintain gait efficiency
and balance.
Due to the multiple axes and the center of rotation, the
prosthetic length “shortens” at the start of the swing
phase of walking to allow for foot clearance
Lighter than computerized knees
Less expensive than computerized knees
Mechanical Knee Joints
Advantages Disadvantages
Manual Locking
Knees Mechanism
This type of joint locks while the
user is weight-bearing on it. They
will need to manually disengage
the lock to be able to sit down.
Knee Joints
Very stable
The user will need to swing the leg out
or hike the hip to allow for adequate
foot clearance during gait. This is an
unnatural gait pattern, which can lead
to further issues in the future in
surrounding muscles and joints.
Allows for an automatic lock in weight-
bearing, with the additional option to
manually lock the knee. This is especially
important for people with less muscle control
and balance, or who need more security while
walking on uneven terrain.
Need to manually unlock the knee to sit
with a bent knee
Mechanical Knee Joints
Advantages Disadvantages
Weight Activated Stance Control (Safety)
Knees Mechanism
This knee provides a constant
friction force while weight is on
the limb. This helps to prevent it
from buckling when standing on
that leg, while still allowing it to
swing freely when unweighted.
Knee Joints
very stable knee that is commonly prescribed
when individuals first start using a prosthesis, and
in older individuals and the less active
community.
With this prosthesis you are unable to
get into a sitting position without
taking all your weight off the leg.
This is also for people who can exert some
control over their knee, but who fatigue
quickly after a few steps, or people who forget
that they cannot put weight onto a bent knee
while using their prosthesis.
The individual has to take all of the weight
off their affected side to allow it to swing
resulting in a less efficient gait pattern
Due to the constant friction in the knee, the
individual will walk slower, with smaller steps.
Mechanical Knee Joints
Advantages Disadvantages
Variable friction
Knees Mechanism
Variable friction utilizes a fluid
control system (hydraulic or
pneumatic) to control the
amount resistance to knee bend.
As knee bend increases,
resistance increases and vice
versa.
Knee Joints
Progressive resistance as knee bends. Can be expensive.
Can be found in both monocentric (single axis)
and polycentric (multi axial) knees.
Heavier and more complex than other
systems.
More natural gait.
Requires accurate adjustment by trained
practitioner.
Can be adjusted to allow for a range of
cadences.
May require periodic adjustment.
Mechanical Knee Joints
Advantages Disadvantages
Pneumatic or Hydraulic
Knees Mechanism
Pneumatic/hydraulic components (pistons with cylinders
containing air or fluid) can be added to either single-axis
or polycentric mechanical knees, as well as computerized
knees
Knee Joints
• This is to help increase mobility and control with
the leg and allow the user to vary speeds.
• When walking faster it will limit the air flow and
fluid to reduce the flexion of the knee to allow a
faster walking pace. The opposite will happen
with a slower gait.
Allows the individual to walk more
comfortably and with a more natural gait
pattern.
Hydraulic knees are often more
expensive and heavier than pneumatic
knees, they also need more
maintenance.
This type of knee also allows the individual to
walk up and down the stairs with a reciprocal
gait pattern, due to the resistance provided
during flexion while there is weight on the
leg.
Cost is higher than mechanical knees.
This is both less expensive and lighter than
computerized knees.
Mechanical Knee Joints
Advantages Disadvantages
Computerized
Knee
These knees have microprocessors to allow feedback
from within the knee or foot joint. Information from the
sensors adjusts the range and speed of knee flexion and
extension, according to the user’s requirements.
Knee Joints
• Knee extension is powered, and resistance is provided
through knee flexion, allowing the individual to more easily
get in and out of a sitting position, and navigate stairs using
a reciprocal gait pattern. It also allows for a symmetrical
weight distribution and a natural gait pattern.
These are much more advanced, which allows the
gait to be more natural as well as allowing the leg
to adjust to different speeds. Some offer stumble
control, which will automatically put the leg into a
position to prevent you from falling. This type of
prosthesis allows the user to adjust to changes in
speed, environment changes and specific situations.
These also have different programmable modes for
when you are doing different activities (i.e. cycling)
These are very expensive
and need to be charged
regularly.
More efficient gait pattern with less energy
expenditure during gait
Heavier than the other
options and can also be
damaged by different
environmental conditions.
Mechanical Knee Joints
Advantages Disadvantages
Allows the user to navigate stairs using a
reciprocal gait pattern
Can be more difficult to cover or wear
certain types of clothing overtop
Learning curve when first starting to use
this type of device
Regular maintenance required
Mechanical Knee Joints
Advantages Disadvantages
THANK YOU
End Slide
P&O Department

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Tans femoral Amputee : Prosthetics Knee Joints.pptx

  • 2. CONTENT • INTRODUCTION • EXOSKELETAL & ENDOSKELETAL • TYPES OF KNEE JOINTS • SINGLE AXIS • CONSTANT FRICTION • POLYCENTRIC • MANUAL LOCKING • WEIGHT ACTIVATED STANCE CONTROL • VARIABLE FRICTION • PNEUMATIC OR HYDRAULIC • COMPUTERIZED Christian Medical College P&O Department
  • 3. Introduction Prosthetic replacement of the anatomical kneeProsthetic replacement of the anatomical knee Prosthetic knees allow a person who has sustained an amputation at or above the knee to regain use of the knee and ankle joints and participate more easily in their daily activities. Knee Joints
  • 4. Exoskeletal Endoskeletal Exoskeletal prostheses have a hard outer plastic or metal shell in the shape of the limb. They are permanently fixed and not adjustable. Exoskeletal prostheses are more durable and may be preferred by people who do physical labor or are in harsh environments that could damage the prosthesis. Endoskeletal prostheses have a central inner skeletal structure and are adjustable, but less durable. The endoskeletal system is often covered with a soft material in the shape of the limb and a synthetic skin. Liceria & Co.
  • 5. Types of Knee Joints Prosthetic knees are divided into two categories, mechanical or computerized Mechanical knees are further divided into single-axis, multi- axis, and polycentric knees Liceria & Co.
  • 6. Single-Axis Knee Joints This is the simplest type of prosthetic knee joint that allows for rotation around a single axis during flexion and extension of the knee. Single-Axis Knees Mechanism • Individuals who use this type of knee require good muscle strength, as this type of prosthesis can be difficult to control. • These are sometimes recommended when there are limited economic resources, as it is the most cost-effective option. Single-Axis
  • 7. This is a very simplistic design, durable, as well as light weight, which can be helpful for new amputees, who are just learning to walk. Due to this simplistic design, the user has to generate significant muscle power to keep the knee stable while standing and walking. Most cost effective Creates an unnatural gait pattern due to the simplicity of the single-axis design Can be difficult to control the locking and unlocking during gait, putting the user at higher risk for falls and injuries. Mechanical Knee Joints Advantages Disadvantages
  • 8. Constant friction Knee Joints This system uses constant pressure against a rotating surface to resist knee flexion. The amount of pressure is set by the Prosthetist and should not be altered by the user. External spring(s) may be used to assist the knee to straighten faster than it bends. Constant friction Knees Mechanism
  • 9. Simple Can only be adjusted to one walking speed. Other speeds will have compromised gait. Lightweight Requires accurate adjustment by trained practitioner. Dependable Will require periodic adjustment to remain effective Can be found in both monocentric (single axis) and polycentric (multi axial) knees. Knee becomes less stable as the knee wears (monocentric design). Mechanical Knee Joints Advantages Disadvantages
  • 10. Polycentric Knee Joints Polycentric knee allows multiple points of rotation around several axes. Polycentric joints can have either 4 or 7 bars, meaning that you can either have 4 points of rotation or 7 points of rotation. Polycentric Knees Mechanism • This type of joint provides good stability when there is involuntary flexion during the heel strike phase of walking because the center of rotation is located more proximally and posterior when the knee is fully extended • This knee is typically recommended for active people, or people who are more likely to walk independently, without a gait aid.
  • 11. Can be very stable in stance phase Much heavier than a single-axis joint prosthesis Allows the user to sit down with a bent knee Greater energy requirement of muscles during walking to maintain gait efficiency and balance. Due to the multiple axes and the center of rotation, the prosthetic length “shortens” at the start of the swing phase of walking to allow for foot clearance Lighter than computerized knees Less expensive than computerized knees Mechanical Knee Joints Advantages Disadvantages
  • 12. Manual Locking Knees Mechanism This type of joint locks while the user is weight-bearing on it. They will need to manually disengage the lock to be able to sit down. Knee Joints
  • 13. Very stable The user will need to swing the leg out or hike the hip to allow for adequate foot clearance during gait. This is an unnatural gait pattern, which can lead to further issues in the future in surrounding muscles and joints. Allows for an automatic lock in weight- bearing, with the additional option to manually lock the knee. This is especially important for people with less muscle control and balance, or who need more security while walking on uneven terrain. Need to manually unlock the knee to sit with a bent knee Mechanical Knee Joints Advantages Disadvantages
  • 14. Weight Activated Stance Control (Safety) Knees Mechanism This knee provides a constant friction force while weight is on the limb. This helps to prevent it from buckling when standing on that leg, while still allowing it to swing freely when unweighted. Knee Joints
  • 15. very stable knee that is commonly prescribed when individuals first start using a prosthesis, and in older individuals and the less active community. With this prosthesis you are unable to get into a sitting position without taking all your weight off the leg. This is also for people who can exert some control over their knee, but who fatigue quickly after a few steps, or people who forget that they cannot put weight onto a bent knee while using their prosthesis. The individual has to take all of the weight off their affected side to allow it to swing resulting in a less efficient gait pattern Due to the constant friction in the knee, the individual will walk slower, with smaller steps. Mechanical Knee Joints Advantages Disadvantages
  • 16. Variable friction Knees Mechanism Variable friction utilizes a fluid control system (hydraulic or pneumatic) to control the amount resistance to knee bend. As knee bend increases, resistance increases and vice versa. Knee Joints
  • 17. Progressive resistance as knee bends. Can be expensive. Can be found in both monocentric (single axis) and polycentric (multi axial) knees. Heavier and more complex than other systems. More natural gait. Requires accurate adjustment by trained practitioner. Can be adjusted to allow for a range of cadences. May require periodic adjustment. Mechanical Knee Joints Advantages Disadvantages
  • 18. Pneumatic or Hydraulic Knees Mechanism Pneumatic/hydraulic components (pistons with cylinders containing air or fluid) can be added to either single-axis or polycentric mechanical knees, as well as computerized knees Knee Joints • This is to help increase mobility and control with the leg and allow the user to vary speeds. • When walking faster it will limit the air flow and fluid to reduce the flexion of the knee to allow a faster walking pace. The opposite will happen with a slower gait.
  • 19. Allows the individual to walk more comfortably and with a more natural gait pattern. Hydraulic knees are often more expensive and heavier than pneumatic knees, they also need more maintenance. This type of knee also allows the individual to walk up and down the stairs with a reciprocal gait pattern, due to the resistance provided during flexion while there is weight on the leg. Cost is higher than mechanical knees. This is both less expensive and lighter than computerized knees. Mechanical Knee Joints Advantages Disadvantages
  • 20. Computerized Knee These knees have microprocessors to allow feedback from within the knee or foot joint. Information from the sensors adjusts the range and speed of knee flexion and extension, according to the user’s requirements. Knee Joints • Knee extension is powered, and resistance is provided through knee flexion, allowing the individual to more easily get in and out of a sitting position, and navigate stairs using a reciprocal gait pattern. It also allows for a symmetrical weight distribution and a natural gait pattern.
  • 21. These are much more advanced, which allows the gait to be more natural as well as allowing the leg to adjust to different speeds. Some offer stumble control, which will automatically put the leg into a position to prevent you from falling. This type of prosthesis allows the user to adjust to changes in speed, environment changes and specific situations. These also have different programmable modes for when you are doing different activities (i.e. cycling) These are very expensive and need to be charged regularly. More efficient gait pattern with less energy expenditure during gait Heavier than the other options and can also be damaged by different environmental conditions. Mechanical Knee Joints Advantages Disadvantages
  • 22. Allows the user to navigate stairs using a reciprocal gait pattern Can be more difficult to cover or wear certain types of clothing overtop Learning curve when first starting to use this type of device Regular maintenance required Mechanical Knee Joints Advantages Disadvantages