Choice of Prosthetic Knee for Bilateral Knee Disarticulation

INGE B. SHAW, RPT**Winnepeg, Manitoba

A 5-year-old bilateral knee disarticulation amputee has been walking independently since training with his initial prostheses. His fitting with free-motion knee joints was delayed until we were reasonably sure that he would continue walking unaided. Initial fitting with rigid pylons was at 8 months. At 2 years of age, knee joints with manual locking controls were incorporated to allow for sitting but still ensure stability in walking. The locks were discarded at age 5. Alignment changes were necessary to enable the boy to manage the free hinges. Children with congenital bilateral knee disarticulation should be fitted with rigid sockets as soon as their mental and physical development permits. They should be encouraged to become independent in walking. Free-motion knee joints should not be incorporated into the prostheses until one can be reasonably sure that this will not reduce independence. Use manually locking knees in the meantime. A reasonable goal for use of free-motion knee joints is 5 years of age.

**Rehabilitation Centre for Children, 633 Wellington Crescent, Winnipeg, Manitoba, Canada R3M 0A8