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Trans Femoral Alignment procedure

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by

Aruna Maduranga

on 11 February 2014

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Transcript of Trans Femoral Alignment procedure

Trans Femoral Alignment procedure
FONTS
Dynamic Alignment
These are some common transfemoral gait deviations

Coronal View
1. Swing phase whips
2. Circumduction
3. Abducted gait
4. Lateral bending of the trunk
5. Rotation of foot on heel strike

For a very long and strong stump, the foot should be placed a bit medially to the plumb line. This will help to give a patient a narrow walking base which is closer to normal gait.
Setting the socket in about 5o adduction will place the abductor muscles in a good position to stabilize the pelvis

BENCH ALIGNMENT
Making proper relationship between Socket,Shank, Knee joint and foot.

Normal to long stumps with normal strength
Sagittal View
Socket is in about 5 degree flexion
vertical line from the trochanter passes just anterior to the knee joint and falls at 1/3 of foot from posterior
The flexion and adduction angles should be built into the socket. The posterior and medial brims have to be kept horizontal.
If the patient has a hip flexion / abduction contracture, the set-up should follow the angles as measured at patient assessment.
Setting the socket in flexion will increase the hip strength in hip extensors.
The knee joint is placed in 5o of external rotation in relation to the medial wall of the socket.

This rotation will compensate for normal internal rotation of the thigh during hip flexion.

Socket flexion will be increased up to 15 degrees.

The socket will be placed in less adduction

Knee will be placed more posterior to the TKA line.
Short Stump
Static Alignment
To check the fit of the socket.

To check and alter the bench alignment to suit the individual patient.

To check the length of the prosthesis.

To check the quality of suspension

The goals of static alignment are:
Procedure
Watch patient walk with the old prosthesis and record the abnormal gaits.
Take off the old prosthesis and check the stump and record any abnormal sign.
Check the bench-alignment of the new prosthesis again.
Ask the patient to put on the new prosthesis alone.
Check the adductor channel
Ask patient to stance with equal weight on both legs
Check the fit of the socket. Follow the procedure for socket test.
Check the stability of the prosthesis (alignment)
Pole is vertical
The seat is horizontal
Are the flexion and adduction angles correct?
Is the prosthesis stable when the patient shifts weight medio-laterally and anteriorposteriorly?
Check the TKA line and posterior plumb line.
Does the external rotation of the prosthetic foot match the sound leg?
Check the length
Check suspension
Saggitle View
6. Instability of knee
7. Vaulting
8. Lumbar lordosis
9. Terminal swing impact
10. Drop-off
11. Uneven heel rise
12. Uneven timing
13. Uneven length of steps
14. Uneven arm swing

Dynamic Alignment
1. Check foot function
At heel strike
• During heel strike the heel wedge of SACH foot should compress 1-1.5 cm as the amputee places the prosthesis forward and shifts the weight onto it.

o If the compression is too much, replace the foot with one that has a firmer heel.
o If the compression is too little, replace the foot with one that has a softer heel.

At push off
• At push-off the foot should allow easy roll-over from heel-off to toe-off, this in turn affects the action of the knee joint.

If the resistance to “dorsi-flexion” is too great it will be difficult to roll over, difficult to start knee flexion and thus difficult to initiate swing phase.
If the resistance to “dorsi-flexion” to too little, roll over will happen either too early or too fast. The patient will “drop off” the prosthesis.
Check toe rise
Excessive toe rise at heel strike can be a result of too little socket flexion.

Too little toe rise can indicate too much socket flexion.

Dynamic Alignment
2. Check knee function
The knee should flex easily at push-off, but be stable at heel strike and during stance phase.

• Several factors affect knee stability:
• TKA line
• Foot and ankle action
• Socket flexion

If the knee is unstable during stance phase:

• Check the TKA line. Ensure the knee axis is just posterior to the TKA line.
• Check the foot and ankle
o Early instability can be due to the heel being too hard adding to the flexion moment at the knee.
o Mid-Late instability may be due to the forefoot being too soft, allowing the knee joint to pass anterior to the TKA line and thus initiate flexion.

If the knee is too stable in stance phase:
• Check the TKA line, if the knee is very posterior to the line it will be difficult to initiate swing.

• Check the foot and ankle to make sure that the roll over is smooth and easy. If the resistance to roll over is high the knee will have an extension moment placed upon it.
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