Prosthetic Problems

The importance of a correct fitting prosthesis to the health, comfort and gait of the amputee cannot be exaggerated

Common problems encountered by amputees

• Bony osteophytes or spurs from trauma or from periosteum that was incorrectly stripped during surgery
• A fibula bone that is longer than the tibia
• The failure of a myoplasty or myodesis
• Osteoarthritis
• Adductor Roll
• Poor socket fit or suspension
• Weight bearing pressure caused by ill fitting socket.the socket must be designed to distribute these forces over as large a surface area as possible and as evenly as possible over pressure-tolerant areas.
• The presence of ongoing pain, skin breakdown 
• A change in the ability to put on and remove the prosthesis
• Contractures: Hip and knee flexion contractures affect prosthetic fitting and function. Knee and hip contractures also decrease cosmesis and efficiency of ambulation.
• Phantom sensation and phantom pain: Phantom sensation is the perceived sense that the amputated limb or part of the amputated limb is still present.
• Phantom pain: Is the sensation of pain originating in the amputated part. Individuals describe a burning, stinging, or cramping pain.
• Sweating is a very common problem and sometimes can restrict the wear of a prosthesis
• Congestion: When the proximal part of the socket fits too snugly on the residual limb, venous outflow can be obstructed. When this is problem is combined with an empty space more distally in the socket, swelling can occur until that empty space is filled. In an acute choke situation, the skin is red and indurated and may have an orange-peel appearance, with prominent skin pores. 
• Dermatologic problems: Contact dermatitis or sebaceous cysts, folliculitis, excessive sweating, and scar management.
• Energy Consumption: The increased energy requirements of prosthetic ambulation can limit the use of a prosthesis.

Unless you have previously tried a comfortable prosthesis it is difficult to appreciate the immense difference a properly fitted leg or arm makes to your health and well-being.

The Pediatric Amputee

For the youngest children that are crawling, if the device interferes with their crawling it should be removed. However, there is definitely a time where between the ages of 8 to 15 months when a child is ready for a prosthetic device. It helps the children stand and it should be utilized.

Many children prefer to hop as opposed to using their prosthetic device. Keep in mind that years and years of hopping on the sound leg can over time, lead to arthritis and other severe conditions at a later age. Hopping should be discouraged for all amputees.
 

When children enter into adolescence they face similar challenges as others of their age. Teenager strive to be like their friends and not different and being an amputee can become especially difficult. Often times at this stage, teenagers prefer to have a silicone cosmetic cover on their limb. 

Once your child starts attending school, a meeting with school administration should be set up in advance to discuss:

• Ensure that your child will be able to participate in physical education activities.
• Ensure that your child is not just sitting on the bench watching the other children participate.

Upper Limb Myoelectric Prosthesis Instructions

Your prosthesis requires regular care and maintenance to keep it working properly.

• Avoid using your prosthesis in wet or excessively humid areas (near pools, in saunas, etc.).
• Never submerge your prosthesis in water.
• If you are caught in the rain, try to keep your prosthesis dry. If rain or other water does drip inside the prosthesis, allow the prosthesis to dry at room temperature. 
• The prosthesis should not be used in excessively dusty environments for extended periods of time. The dust may adversely affect the electronics.
• The glove of the hand is sensitive to heat, which may melt it. Use the same care with it as you would with your own hand.
• If you notice a tear in the glove, call us as soon as possible. The tear may allow dust and water to penetrate the hand shell and forearm and adversely affect the electronics.

General advice
 

• Never walk on the prosthesis without a shoe on unless advised. You can change shoes, but be sure that they have the same heel height as the shoes you wore to the fitting.
• Wash your residual limb daily with soap and water, rinse and dry carefully. Do not soak as this makes the skin tender. The best time to cleanse your residual limb is at night. Your residual limb must be thoroughly dry before applying the socket. If perspiring excessively during the day, remove socket and pat residual limb dry, changing socks if needed. Discontinue wearing your prosthesis while waiting for a breakdown or abrasion to heal. Report any problems to your prosthetist or your GP.
• Do not shave your residual limb or apply lotions or moisturizers to your residual limb, unless instructed by your prosthetist or GP.
• Any major changes in your body weight may alter the fit of the prosthesis.
• Any major changes in activity level or lifestyle may affect the function of the prosthesis and your comfort.
• Check the fitting daily to make sure there are no pressure points.
• If using a silicone liner, make sure this is cleaned daily and dry before it is worn against your skin.

Common Questions

Is your skin reddened?
Does the redness go away within 20 minutes without the prosthesis on? If the redness does not resolve within 20 minutes, reduce the wearing time. If the redness continues, stop wearing the prosthesis and call your prosthetist for an adjustment.
 
Has your prosthesis developed an odor?
Have you been regularly washing your residual limb and your prosthesis? Wash your limb with a mild soap without fragrance and rinse and dry well. Your socks should be washed regularly with a mild detergent. Every night, the socket (and/or liner) should be wiped with a soft cloth and mild soap.
Your prosthesis should not be submerged in water.