Hydraulic Prosthetic Knee Joints Provide More Natural Mobility for ...

For patients who have lost a leg, regaining mobility is a top priority. However, development of more true-to-nature prosthetic limbs and joints has come an amazingly long way from the often thought of peg leg and hook hand. Over the past several years, medical prosthetic technology has advanced drastically, allowing for patients to regain the normalcy in their life that they would not have had access to in the past.

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Otto Bock Healthcare GmbH, Duderstadt, Germany, a company with 90 years of orthopedic experience, has developed a more natural-feeling prosthetic knee joint to not only allow more comfortable and natural ambulation, but also provide a long-lasting, durable solution so patients can spend less time at the orthopedic mechanic, and more time living life as usual.

Otto Bock has developed their 3R60 and 3R78 prosthetic knee joints with their patented “EBS,” or “Ergonomically Balanced Stride”, system, which allows for an individually adjustable stance, reducing the strain on the hips and spine of the wearer. Suitable for patients up to 275 pounds, higher than with many traditional prosthetics, the joint is able to be adapted to patient weight and activity for additional comfort and stability, especially on uneven terrain, and four modular connectors make it an appropriate prosthetic for various levels of injury. The joint system uses special engineered components and features to mimic the motion enabled by a biological knee joint, unlike monocentric, single-jointed traditional prosthetics. (See Figures 1a and b)

How It Works

In the joint itself, needle and bronze bearings, as well as PTFE guide tape, were replaced with plastic components from igus®. These plastic components are extremely light, do not require external lubrication, and also possess very low coefficients of friction, with excellent wear-resistance. According to Otto Bock, these plastic components allowed for the further development of their EBS joint systems to where they are today. The EBS joint system is lightweight and shock absorbing, allowing for more comfortable walking, and is extremely low maintenance thanks to low-wear, media-resistant, and corrosion-free components, meaning fewer trips to the orthopedic mechanic. The plastic bearings used in the joint were selected for special characteristics specific to the demands in a prosthetic knee joint. There are bearings made of different varieties of plastic material, including iglide® Q, which was selected because it is extremely resilient under high loads and exceptionally shock absorbing, making it an excellent buffer for impact loads. The material is also resistant to many chemicals, including solvents, oils, and weak acids. The bearings also have a low moisture absorption rate, letting the user walk in all weather without increased friction. The shock absorbing qualities of the plastic material, coupled with swing phase hydraulics, act as a substitute for cartilage in a biological knee, cushioning the force of two to four times the patient’s body weight that occurs with each step.

In prosthetic knee joints that utilize metal bearing systems, dirt, dust, pet hair, and other common debris is attracted to the external lubrication, therefore impeding the friction surface which can lead the knee to seize up and the patient to stumble or fall. The specialized plastic bearings in the EBS system are self-lubricating, using microscopic particles of solid lubricant included throughout the plastic material. Without external bearing lubricant, dirt and debris from everyday wear is not attracted to the joint, and any dirt is simply embedded into the plastic material with no noticeable increase in friction.

Material Advantages

Patients using the EBS prosthetic joint are able to walk more naturally and comfortably than those with traditional prosthetics. The EBS joint gives a higher ground clearance in the swing phase of a patient walking due to the polycentric nature of the system. Polycentric knees, with more than one axis of motion, are more stable than single axis systems, which are essentially a hinge. The polycentric system gives a much more “knee-like” feel, and with added hydraulic power in polycentric joints like the 3R60, patients are able to have more variability in the walking speed and function, but at a price.

Typically, polycentric knee joints are heavier and more expensive than single-axis joints, even more so with added weight and cost of added hydraulics. Otto Bock’s joint systems, however, have compensated for the added price and weight by substituting plastic components that are very light weight and low cost, too. At only 1.8 pounds, the joint offers a joint flexion angle of 175 degrees, limited only by shaft connections/forms or optional cosmetic cover. The mini hydraulic system utilizes piston rings with separately adjustable flexion and extension to control the behavior of the joint during the swing phase of the walking motion. A rubber bumper is compressed during stance phase flexion, generating the corresponding movement resistance, which is adjustable per patient requirements. The hydraulic components absorb subsequent stance phase extension. The five-axis polycentric design structure of the EBS joint allows for separation between the swing and stance phases. In the stance phase, flexion is made possible by interplay between the lower front axis as the joint’s center of rotation with the EBS’s pivoting mount and the posterior link of the polycentric structure. The EBS pivoting mount also visualizes the degree to which the EBS function is used.

Piston rings are applied in the mini hydraulic unit in the top and bottom pistons located in the pneumatic cylinders. The piston rings replaced PTFE guide tape, used to create bands. When producing the knee joints, each piece of PTFE tape, supplied as a large coil, had to be cut to the appropriate size for the particular joint, then packed and stored in strips, inevitably with some error in sizing. If the strip was too long, it had to be cut again. Cropping on the cutting edge could leave the band too short, keeping it from properly fitting into the driving band groove. Instead of the lengthy and error-prone process of sizing, cutting, and fitting the PTFE tape, the piston rings simply snap onto the piston, greatly reducing the production costs and lowering the total cost of the joint. When tested within Otto Bock EBS joints, barely any perceptible wear was reported on the piston rings, even under maximum stresses, and according to the company, increased the quality, functionality, and durability of their overall system.

This article was written by Ellen Rathburn, Technical Copywriter for igus, Inc. East Providence, RI. For more information on Otto Bock, visit http://info.hotims.com/-189  . For more information on igus, visit http://info.hotims.com/-163  .

Selecting a prosthesis is a big step toward returning to life. We know it’s not simple, but this guide will help you choose the right prosthetics. With high technology and determination, all kinds of prosthesis have raised the confidence of many by allowing them to walk again powerfully.

These innovative improvements have made them more effective and comfortable. There are various points to consider when selecting the proper one. Take this guide, and let’s go through each step together.

Prosthesis Through the Ages

The prosthesis has been used for thousands of years. In ancient Egypt, people wore artificial toes, some over 3,400 years old. One of the earliest examples is the “Greville Chester toe,” made from cartonnage, a mix of glue, plaster, and linen. This material was flexible and could be adjusted to fit the user. Another prosthesis from that time is the “Cairo toe.”

In ancient Italy, a Roman used a limb prosthesis called the “Caupa leg.” This was crafted from bronze and hollowed-out wood and held in place with leather straps. Likewise, early artificial feet were made of iron and bronze in Switzerland and Germany during the 5th and 8th centuries.

In U.S. medical history, prosthesis were needed to support soldiers who lost their limbs during the war and pave the way for prosthetics. Since antiquity, an artificial leg could be made of iron or wood. French doctor Ambroise Pare crafted the first genuinely working prosthetic for soldiers returning from war during the pre-industrial period.

During this phase, the need for amputations during the American Civil War triggered a shift in prosthetic innovations. The Limb-Hanger, with a rubber-covered wooden leg and added comfort at the heel, was invented. Modern prosthetics, like legs, are much more advanced. Wooden and leather prosthesis limbs have been transformed into plastic, titanium, aluminum, and silicone-infused prosthetics.

Because of these advanced materials, modern prosthetic legs function better and demonstrate superior advancements over previous-century models.

Safety Measures You have to Take After Amputation

You might face serious accidents or injuries, along with diabetes complications, infections, blood vessel diseases, congenital disabilities, and other health conditions that can lead to leg amputation.

If you have diabetes, don’t choose your regular slippers because your wound gets worse day by day. The biggest task is to choose the best diabetic footwear. With diabetes, we have to be careful, or else it leads to amputation.

“Got questions about diabetes? Find answers in Diabetes FAQs: Clear Answers to Your Most Common Questions—read now!”

The best approach after an amputation includes focusing on hygiene practices, physical exercise routines, and general maintenance because these elements play a vital role in aiding recovery and adaptation.

Do’s after amputation

• Give importance to cleanliness.

• Apply suitable coverings

• Keep skin hydrated

• Stay alert for changes

• Upgrade hygiene standards

• Adhere to medical guidance

• Stay active

• Use compression socks soon after wounds heal.

Don’ts

• Don’t press your stump unnecessarily, you may harm yourself or have an uncomfortable situation. 

• Do not use chemicals, especially soaps that may become the reason for skin rashes in the stump part. 

• Prevent exposure to moisture for long periods that could lead to infection or skin problems. 

• Always remember to seek your clinician’s attention for discomfort or pain. 

• Do not ever attempt to change your prosthesis on your own. 

Find easy recovery tips after amputation in our blog Life After Above-Knee Amputation: Simple Recovery Steps—click to learn more!

Mental Challenges

From a psychological perspective, common difficulties that may appear while using a prosthetic limb include coming to terms with a new physical appearance, mastering new tools, and adapting to new schedules. Accept these as an initiation to develop yourself and learn independence.

When people seek the right clinic to offer a thorough service from amputation to prosthesis fitting, these challenges can be easily met and achieved without much fuss. Select a clinic that can handle every aspect of your life, and you will get a step closer to an entire, independent life.

Growing self-confidence and conquering fears

• You can celebrate small victories to boost confidence.
• Face fears with determination, turning them into opportunities for growth.
• Embrace each step forward as a path to greater independence.

Controlling levels of anger and developing proper patience

• Just view frustration as a sign of progress and learning.
• Practice patience, knowing that every challenge builds resilience.
• Stay positive, understanding that persistence leads to success.

Adjusting daily life and embracing new routines

• Discover creative ways to modify daily routines.
• Focus on how each adaptation brings new possibilities.
• Embrace the changes, leading to a more empowered and active life.

Utilized an artificial limb? Engaging in physical activity?

Here is some helpful information on the top exercises you should follow along with your fitness routines:

• Strength exercises – Workouts designed to build stronger muscles to accompany a sturdy base.
• Flexibility exercises – Relieve soreness in your muscles and joints.
• Cardiovascular exercises – Bolster vascular fitness, flexibility, and strength of muscles.
• Stability and coordination Exercises – Help improve balance.
• Prosthetic-specific exercises – Help in using a prosthetic device optimally.

“Read our blog for simple driving tips after amputation.”

There is Always a Question that One May Ask: How Do I Choose the Correct Prosthesis?

Essential points to consider:

1. Daily activity: Before choosing any prosthesis, consider your daily activities and how to use them.

2. Fit & Comfort: Every prosthesis is designed to fit your body perfectly. So, take the exact measurements and look for parts that can be adjusted for best comfort and fit.

3. Technology and Features: Regarding technology, there are basic and advanced features, with standard functionality for daily use and advanced features with high-tech options like microprocessors for enhanced movement and control.

4. Consultation with Professionals: Get the expert prosthetist’s advice regarding getting the best fit for your needs.

What Kind of Prosthesis can People Use?

You have multiple needs, and various advanced prosthetic types are available. Some prostheses are designed for above-knee amputations that support a person’s thigh and the lower section of the leg. At the same time, others are intended for below-knee amputations to support the lower leg and foot. Additionally, cosmetic prostheses mainly focus on looking like natural limbs, with less emphasis on functionality.

1. Lower extremity prosthesis

This lower extremity prosthesis is an artificial limb that replaces a missing portion of the lower leg. Amputation can occur, and there are several prosthetic leg types, such as “transtibial” below the knee, while “transfemoral” means above the knee prosthesis.

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2. Upper extremity prosthesis

Amputation of the shoulder joint to the fingers is commonly known as artificial hands. There are different upper limb prosthesis: shoulder, arm, elbow, forearm, wrist, and hand.

3. Cosmetic Prosthesis (Silicone)

Cosmetic prosthesis mainly focuses on looking like natural limbs with less emphasis on functionality.

1. Lower Extremity Prosthesis

A lower limb prosthesis is an artificial leg fitted after amputation on the inferior limbs at the upper thigh or knee. Ankle or foot prosthetics are designed to help you remain mobile and functional. Under lower extremity there are major two types of amputation.

• Amputation Above knee
• Amputation below knee

Normally, below knee amputee needs less energy compared to above knee. But for that you can’t compromise with any kind of prosthetics. You have to choose your below knee prosthetic legs wisely as your activity level and other preferences.

Above-knee amputation is a complex amputation in which you need to concentrate more on caring for your stump after amputation, exercising before fitting a prosthetic leg above knee, proper prosthetic walking with gait training, and getting the best knee joint and prosthetic foot.

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Some accessories are essential for functionality, comfort, and proper fitting for an above- or below-knee prosthesis.

1. The Socket

The socket, attached to the limb’s thigh-side stump, can be customized to ensure comfort and security. Its fit considers the limb’s size and shape.

2. Artificial Knee Joint

A prosthetic knee joint is a further requirement of the above knee prosthesis. It contains mechanical, pneumatic, and hydraulic knee joints for easy bending and straightening of the leg. More complex joints, such as microprocessor-controlled joints, are possible. These joints allow varying levels of mobility and stability depending on the remaining limb portion.

“Learn about different prosthetic knee options in our blog Prosthetic Knee Joints: Types, Benefits, and How to Choose the Best One—click to find the right fit for you!”

3. Pylon

The pylon connects the foot of the prosthesis, the prosthetic leg, and the socket, so it must act like a bone. It is made of titanium, stainless steel, carbon fiber, and aluminum, which are very lightweight.  

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Additional reading:
Key Questions to Ask When Ordering Tape Production Machine

4. Prosthetic foot

Unlike old prosthetics, nowadays, we have merged with advancements in prosthetic foot technology so that individuals can regain mobility and lead independent lives. Whether you are looking for the best prosthetic foot for basic daily activities or a high-tech prosthetic foot and ankle for active movement, options are available to meet your needs.

Prosthetic foot are designed to mimic how a human leg naturally walks. You can select from affordable prosthetic foot to complex models, including dynamic response, energy return, and adaptability to different surfaces and terrain.

5. Suspension System

A suspension system securely affixes the limb’s remains to the prosthesis. It includes conventional vacuum systems, sockets, belts, and straps designed to maintain the prosthesis’s position during movement.

6. Prosthetic Liners

Liners are unpadded or minimally padded soft sleeves made of gel or foam worn over the socket’s residual limb. They enhance comfort, prevent skin irritation, and equalize pressure.

7. Socks

These socks are prosthetic sleeves placed over the liner, which assists in increasing or decreasing the socket’s looseness. The liner comes in different sizes, so the exact amount may be used to suit the wearer’s preference. It absorbs sweat by forming filaments between the socket and limb part and decreases friction.

8. Cosmetic Covering

The cosmetic covering is a soft, flexible garment that enhances the prosthesis’s natural appearance. It conceals the pylon and other components to make the prosthetic leg realistic. The covering can be altered to match the user’s skin tone and texture.

9. Adjustable Wrench

Like the other parts of this prosthesis, users can use this adjustable wrench for timely changes while tightening or loosening the bolts and screws, trying to make changes or little modifications.

10. Prosthetic Lubricant

This lubricant is applied to the socket or liner to reduce friction and prevent chafing. It helps you move smoothly against the skin, reducing discomfort and irritation.

11. Protective Cover

A shield prevents the prosthesis from damage caused by water or dirt. It is mainly used by active outdoor users, where the prosthetic might be exposed to harsh conditions.

Aren’t Prosthetic Legs Custom-Fit for Individual’s Needs?

A single product can’t accurately match everyone’s comfort and needs. Accurate measurements are essential to getting the best prosthesis, so each individual receives a customized product tailored to them. The terrain where the product will be used also plays a vital role, as everything from design to materials must be considered.

1. Evaluation and Dimensioning

Start by evaluating the user’s lifestyle, needs, stump size, and general physique. Then, measure the residual limb precisely to ensure the prosthesis is comfortable and functional.

2. Parts Selection

The Prosthetic Knee joint, Foot, Adaptors, and Pylon are customized according to user activity, weight, and surface the user intends to cover. This guarantees that the prosthesis can meet the user’s needs for simple and complex tasks.

3. Socket Design

The socket is custom-made based on the measurements taken during the assessment. An appropriately crafted socket ensures that the prosthetic leg stays securely attached and distributes balanced pressure. It also maximizes comfort and prevents skin irritation.

4. Suspension System

It is a prominent one that helps to keep the prosthetic leg attached to the body. The user can choose depending on the extent of amputation, comfort, and lifestyle. Vacuum, suction, and pin lock suspension systems offer total comfort that does not restrict the body movements.

5. Liner and Padding

Prosthetic Liners, such as silicone liner prosthetics and padding, protect the residual limb and reduce pressure between the socket and skin for the remaining part of the body. They are made from flexible materials that can stretch and are cut to the wearer’s size. Selecting the liners is also unavoidable to avoid skin breakdown.

6. Alignment and Adjustment

After choosing the prosthesis, it should be positioned correctly to allow the user to walk normally. Angle positioning and relative height should be considered. When the prosthesis has been established, frequent follow-up appointments are essential to aid the user in adjusting. 

Routine Care and Adaptation

• The process will continue after the initial fitting. Routine care is essential to check whether the prosthesis continues to function well and its functionality. 
• The residual limb shape usually changes over time or according to the user’s activity level; the adjustment is inevitable. 
• Proper maintenance, regular checkups, and potential adaptations are the key to long-term usability and comfort.  

Getting Used to a Prosthesis is a Challenge

• Heavy Sweating: It can affect the prosthesis and cause skin issues.
• Shifts in Limb Shape: The shape of the residual limb often changes during the first year after amputation, affecting the fit of the prosthetic socket.

• Limb Weakness: Weakness in the remaining limb can make it challenging to use the prosthesis for long periods.
• Phantom Sensations: Intense pain in the area where the limb is amputated can make it challenging to use a prosthesis effectively. (Intense pain in the part of the body that is already amputated can also make it challenging to use a prosthesis effectively.)

Regular Maintenance and Updates are Critical to Your Prosthetic Leg Longevity

Once fitted with a prosthetic leg, it may seem perfect initially. However, for various reasons, it might need to change over time to continue effectively meeting your needs. 

• Body Changes: Your body will change over time, and the prosthesis might need adjustments to fit properly. 
• Daily Life Changes: You may require updates to your prosthesis in your daily activities or physical demands.
• Medical Changes: You are new, and changing health conditions might affect how your prosthesis works or fits. 
• Wear and Tear: Regular prosthetic use can lead to wear and tear, which might mean that your prosthetics must be repaired or replaced over time. 
• New Technology: The field of prosthetic technology is evolving. New developments can offer better features and improvements. It’s important to consider updating your prosthetics to take advantage of these advancements.

Get the best prosthetic leg in India at the best price. Read blog: Where to Get the Best Prosthetic Leg in India? Expert Recommendations ()

2. Upper Extremity Prosthesis

Artificial hands are devices that help amputees whose hands were amputated regain their lost dexterity and improve their ability to interact efficiently with the environment during daily activities.

Classification of upper extremity prosthesis

1. Partial hand prosthesis

It supports the amputee in getting active in daily routines by getting absent fingers designed to mimic natural movements. Users with below-the-elbow amputations can now move their wrists and have better hand function because of the trans-radial prosthesis.

“Get all the essential details about artificial hand from our blog ‘What is an Artificial Hand? Everything You Need to Know Before Choosing One‘—Read now!”

2. Elbow disarticulation

Following an elbow amputation, patients may be able to rotate their shoulders with a shoulder-driven prosthesis.

3. Transhumeral prosthesis

This is the best option for amputees who have lost a limb above the elbow. Advanced control features allow users to incorporate elbow and shoulder flexion seamlessly.

4. Shoulder disarticulation prosthesis

The shoulder joint amputation demands a prosthetic device that recreates complete hand-level upper limb structure and function.

5. Forequarter Prosthesis

This aids those with severe limb loss in gaining routine functional abilities by all-embracing the shoulder and collarbone for a single-arm prosthetic replacement.

What are the key components and accessories of upper extremity prosthesis?

Each component supports each function and movement, and they are:

• The socket is customisable and connects the prosthesis to the residual hand.
• Different suspension systems help to keep the prosthesis secure. Examples are suction systems and harnesses.
• The terminal device is the functional end part, such as a prosthetic hand, hook, or other specialised tool.
• Joints can be placed in different hand parts, such as the wrist, elbow, and shoulder joints, to increase flexibility and movement.
• The control system can be body-powered, myoelectric (muscle signal controlled), or hybrid and can be used for doing activities.

3. Silicone Prosthesis

You might lose your fingers, ears, or any other body parts. A silicone prosthesis can replace these to improve their appearance and comfort. However, it won’t actively involve you in daily activities.

• Silicone prosthesis restore self-esteem.
• It improves psychological well-being.
• Improves active social interaction and quality of life.

Conclusion

Expanding the traditional concept of an artificial limb from the ancient period to modernity highlights how it has developed this technology. Take all these advancements gladly because every move is a step toward independence and self-assertiveness. Celebrate the victories, stay active, and never hesitate to seek professional advice to get the best fit. The world of prosthesis is evolving rapidly, and with the proper knowledge and support, you can stay ahead, enjoying enhanced mobility and a more fulfilling life

KARE: Prosthetic and Orthotic India

At KARE, India’s No 1 prosthetics and orthotics solution, we cover a broad category of prosthetics and orthotics services, from the basic to the advanced level. We provide the best prosthetics and orthotics in India, and solutions from the cheapest to the most advanced artificial leg.

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In addition, we will provide guidance and therapies to assist in walking by our professional physiotherapists and follow up with you to ensure your comfort. If you feel discomfort after the fitting, we can make changes for your comfort. Find the KARE center near you and meet the best prosthetic leg price in India and exceptional services we provide!

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