A Bilateral Above-Knee/ Hip-Disarticulation Fitting
GEORGE R. JAY, M.D. LESTER SABOLICH, C.P.O.
The rehabilitation of the bilateral lower-extremity amputee poses many problems to the clinic team. This is particularly true in the case of the cardiovascular patient, when gangrenous extremities may necessitate levels of amputation not ideally suited to a return to an ambulatory life. The prosthetic prescription must be made to conform not only to known biomechanic principles, but also to the patient's habits and life style. While suction is undoubtedly the best suspension available for the above-knee prosthesis, the geriatric amputee usually finds it difficult to don a suction socket because of the required exertion and his limited ability to bend forward.
Similarly in bilateral fittings, particularly for high amputations, suction may not be the suspension method of choice. The case presented illustrates our solution to the problem of attaching an above-knee prosthesis to a hip-disarticulation prosthesis so that the patient could apply both prostheses himself.
Although this particular amputee was an adult, the principle of the connecting and locking mechanism used could be applied equally well to children.
The patient is a 55-year-old white male who sustained an acute myocardial infarction in September 1969. He then developed mural thrombus and had multiple emboli to the femoral arteries bilaterally. Multiple femoral arteriotomies and embolectomies were performed, without success. He developed gangrene of both legs, and eventually his right thigh was amputated at the subtrochanteric level with a supracondylar amputation on the left limb done one week later. His wounds healed satisfactorily, and he was able to transfer to a wheelchair when dismissed from the hospital. He was seen at The University of Oklahoma Health Sciences Center Amputee Clinic for his prosthetic prescription and rehabilitation. His physical examination indicated an amputation at the supracondylar level on the left side and a very short stump on the right. The patient was fitted with an above-knee prosthesis on the left It included a quadrilateral socket, a pelvic belt, and a hip joint. He received intensive physical therapy and gait training and was ambulatory with crutches. Approximately four months later, this man was fitted on the right side with a Canadian hip-disarticulation prosthesis with a constant-friction knee and an articulated ankle The patient required a special lock mechanism to attach the left above-knee prosthesis to the pelvic band of the Canadian hip-disarticulation prosthesis (Fig. 1 ). He subsequently received gait training and is now fully ambulatory with the aid of crutches (Fig. 2 ).
Description of the Locking Device
The locking device consists of a metal plate attached to the laminated pelvic band of the hip-disarticulation prosthesis. A vertical slot in the plate has a projecting metal pin onto which is fitted the drilled metal-bar extension from the hip joint of the above-knee prosthesis (Fig. 3 and Fig. 4 ). The connection is then secured by a heavy-gauge metal bar which is attached by a hinge to the metal plate and swung across the fitting. This bar is then locked by a shorter bar (Fig. 5 ) which is rotated downward.
Amputee Clinic, Children's Hospital Oklahoma City, Oklahoma