A prosthesis is a substitute for a lost limb, in our case a leg. Choosing it is an important process, and here you should be guided not only by price. It is also necessary to take into account the patient's age, his willingness to use an artificial limb, weight and height, and much more. To take all factors into account, you should definitely consult a doctor. When there are no contraindications, it’s time to choose a prosthetic leg and find out how much it costs.
Kinds
The type of prosthesis depends on the height of the limb removal. So, for the hips there are several varieties:
- Monroe sleeve;
- longitudinal or transverse oval;
- framed.
For the hip joint, one type is made, consisting of clamps, an upper element and a knee joint.
A prosthetic foot is largely a cosmetic device.
When it comes to shins, choose from:
- frame;
- modular;
- tire-leather.
For the knee there are the following designs:
- total;
- connected;
- unicondylar.
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A modern modular hip prosthesis consists of a prosthetic socket, a socket adapter, a knee joint, a load-bearing module (replaces the lower leg) and a foot. This type of hip prosthesis is used for the vacuum method of fixing the prosthetic socket on the patient’s stump. In this case, the hip prosthesis is attached to the patient's stump using an elastic broach and/or a cover for putting on the hip prosthesis (for example, Easyfit).
Before putting on the prosthesis, the cover is put on the stump, and the distal end of the cover is pulled out of the hole in the socket. In this case, the soft tissues of the patient’s stump are deeply “pulled” into the sleeve. Then, using a valve, air is pumped out of the sleeve, so it is tightly fixed due to the created vacuum.
To remove the prosthesis, it is necessary to open the valve and remove the stump from the prosthesis socket. When using this system, the patient's body weight is distributed on the ischial tuberosity.
When providing prosthetics for patients after hip amputation, silicone covers (liners) are also used.
First, the patient “rolls” a special silicone “stocking” (cover) onto the thigh stump. When putting on a silicone cover, it is necessary to prevent air from entering between the skin of the stump and the silicone cover. Also, when putting on, you should prevent the appearance of air “pockets” between the skin of the stump and the silicone.
(Scheme):
Then the patient puts the prosthetic sleeve on the femoral stump with a silicone cover on, and the prosthesis is fixed using a special rod (pin) in the locking device under the prosthetic sleeve.
The silicone liner is detached from the sleeve using the release button.
First, the patient is given a prosthesis with a temporary stump sleeve (therapeutic-training) to train stability and walking, since the size of the stump can still change in volume during the first few weeks after amputation. After stabilization of the stump size, the temporary stump sleeve of the prosthesis is replaced with a permanent one.
The lower limb prosthesis may have the following configuration:
A silicone cover (silicone “stocking”, similar to a protective knitted cover on the stump) protects the stump and is the connecting element between the limb stump and the prosthetic socket.
The stump sleeve of the prosthesis is designed to accommodate the patient’s limb stump.
The locking device ensures reliable fastening of the pin located at the lower end of the silicone case in the prosthetic socket and securely fixes the prosthesis on the lower limb.
The carrier module is an energy return system made of carbon fiber with energy return properties (or a tubular adapter, for example, made of titanium). It replaces the lower leg and provides a connection between the foot and the prosthetic socket.
The prosthetic foot is made from plastic or carbon fiber (the choice of material depends on the patient's activity level) and provides reliable support and a balanced gait.
Shoes specifically tailored to the specific needs of prosthetic wearers are recommended for safer and more comfortable walking.
For above-knee amputations, a mechanical knee joint with specially adapted functions is used. Replaces the natural knee joint.
A lower limb prosthesis—a combination of a prosthetic socket, a silicone sheath, a knee joint, and a prosthetic foot—is tailored to the individual needs of the prosthesis owner. In addition, the prosthesis has a cosmetic coating. This contributes to a positive psychological perception of the prosthesis by patients.
Photo: General view of the medi modular hip prosthesis:
Good shape and thorough cleaning of the silicone liner and skin are of great importance for achieving long-term and successful operation of the prosthesis. A cover with a pin hole placed on the stump makes it easier to put on a modular hip prosthesis. When putting on the liner, the pin enters the sleeve lock with a fairly audible click. When you press the button in the form of a pin, the liner is easily separated from the prosthesis.
The silicone liner can also be used separately from the prosthesis to apply measured pressure on the soft tissue of the stump, which is practiced, for example, in elderly patients.
Lower leg prosthesis:
There are several types of lower leg prostheses: Frame, leather-splint and modular.
The frame prosthesis of the lower leg is currently the least popular; it is gradually being replaced by modern modular prostheses.
The leather-splint prosthesis of the lower leg consists of a distal, modular part (foot and load-bearing module with a prosthetic socket). A special feature of this prosthesis is the presence on the side surfaces of the prosthesis of additional metal stiffening ribs (so-called “splints”) with hinges on the sides of the preserved knee joint of the amputated limb. The “splints” continue down the thigh and carry a leather retainer that is secured to the thigh. This design serves to securely attach the prosthesis to the short stump of the leg and creates anterior-posterior and lateral stability of the limb when standing on the prosthesis. Such prostheses are used after amputations with a very short stump of the leg, due to the very short "lever" arm created by the short stump.
Modular lower leg prostheses are the most modern prostheses.
A modern modular lower leg prosthesis attached to a silicone cover consists of a prosthetic socket, a locking device for fixing the silicone cover in it, a supporting module and a foot.
To fix such a prosthesis, no additional bandages or splints are required.
A type of modular lower leg prosthesis is a prosthesis with a vacuum fixation system (for example, medi Cushion silicone technology using a vacuum valve and a special medi Genu sleeve knee pad).
Perhaps the only limitation in the use of modular lower leg prostheses with silicone covers for the stump is the situation when the lower leg stump is excessively short and forms a very short lever arm. In this case, standing on the prosthesis, walking and securely fixing the prosthesis on the stump is very difficult.
Mechanical prostheses
Modular is a design with hinges, which are an analogue of a joint. The latter are driven by mechanics (springs) or electronics. The simplest models have only 1 module, while complex ones have three.
A leg prosthesis makes it possible to preserve mobility in the lower leg or knee, provides good stability, and does not cause pain to the patient. A person receives complete freedom of movement and can go wherever he wants.
Designs with processors make it possible to use even femoral prostheses completely unnoticed. A disabled person adapts very quickly and may soon completely forget about the absence of a leg.
The sports version is a special development necessary for those who are used to living an active life. This type of product is made individually and takes into account all the anatomical features of the patient.
The design has many advantages, including:
- excellent shock-absorbing ability;
- increased strength;
- convenience.
This model has one drawback - high price. For example, a lower leg prosthesis will cost at least 150,000 rubles. How much can a hip cost? From 400,000.
A hinged prosthesis is suitable for someone who has had a completely amputated leg. It is attached in the thigh area. The structures are assembled on a metal base and, at the owner’s request, are masked with overlays that completely follow the shape of the limb.
Hinged prostheses have the following advantages:
- light weight;
- high strength;
- proper stability;
- convenience.
Such products make it possible to walk for a long time and at a fast pace. Thanks to the ability to bend, the prosthesis allows you to perform any normal actions - getting on a bus, climbing stairs, sitting down, etc.
How much does the hinged option cost? Minimum 270,000 rubles.
In what cases is amputation necessary?
Amputation is carried out in case of diseases, injuries, when re-engraftment of a separated leg or part of it is impossible. Surgery to remove the lower leg or the entire leg is indicated:
- with gangrenous changes;
- irreparable deformation;
- thrombophlebitis;
- congenital pathologies;
- soft tissue ischemia;
- atherosclerosis;
- necrosis of muscles or skin.
Surgical treatment saves a person’s life, but thereby deprives him of his ability to work. The following symptoms indicate the need for amputation:
- immobilization;
- insensitivity;
- insufficient blood circulation;
- change in skin color;
- suppuration or fistula.
Surgery is performed only when indicated. The decision to amputate is made based on data from a comprehensive examination:
- angiography;
- radiography;
- Ultrasound;
- thermography.
After the operation, the patient loses the ability to move normally without additional devices - orthopedic walkers, crutches, canes. To return him to an active life, prosthetic limbs are performed. When a replacement is installed, motor activity is partially restored.
The success of rehabilitation depends on which part was amputated. The quality of life is determined by the reliability of the structure’s attachment to the remaining part of the leg, its model.
High-tech prosthetics
Vacuum prosthesis is another relative novelty. It got its name because of the method of fastening. In fact, the device is suctioned to the stump by a sleeve and remains in this position until the patient opens the valve.
Wearing the described product has several advantages:
- vacuum activates blood supply and prevents muscles from atrophying;
- the load on the spine is reduced;
- support function is stabilized.
How much does such a prosthetic leg cost? For example, for a foot it will cost 100,000 rubles. There are no hips of this design.
The intelligent option is a modern development, controlled by a microprocessor. The product is equipped with a pneumatic drive that completely compensates for the functions of the lost limb.
Exercises for muscle development
To prevent muscle atrophy, it is necessary to perform regular physical exercises, which will eliminate the formation of stagnation and will also help improve blood circulation and cell nutrition. Physical exercise also strengthens the muscular-ligamentous system, improves motor skills, and prevents pain when walking with a prosthesis.
The rehabilitation period lasts for each patient with its own characteristics, but doctors recommend everyone to perform a special set of exercises. It includes doing the following:
- Feet together, the injured leg with the prosthesis is raised forward as high as possible. Performed in a standing position and lying on the back and stomach, alternately.
- Lying on your back, the healthy leg is bent at the knee. The affected leg with the prosthesis is raised to the level of the knee of the first leg.
- You need to lie on your side, raise the injured limb, and fix it in a 60-degree position for a few seconds.
It is necessary to control your feelings during activity. If discomfort or pain occurs, be sure to consult a doctor and change the level of stress. Over time, with regular training, the muscles will get used to such loads and will respond adequately to any manifestations of movement.
How to choose
Doctors say that the sooner a person receives a prosthesis, the easier it is for him to adapt and return to a full life. Thus, the issue of purchasing a product should be resolved as quickly as possible.
It is imperative to consult a doctor. The fact is that for some chronic diseases (for example, varicose veins), wearing prostheses is contraindicated.
The type of device is selected depending on the level at which the leg was amputated. So, if the amputation was performed high, then it is better to take the hinged version.
In the case of the foot, a modular prosthesis is suitable - it looks aesthetically pleasing and does a good job of performing the supporting function. It is also the optimal solution when looking for a lower leg replacement.
Rehabilitation is an important stage of prosthetics work.
Each person has to overcome the postoperative period in their own way. After amputation of a limb, a person is faced with the question of how to return to his former life. In addition, you need to learn the rules of caring for postoperative sutures and stumps, and gradually return the usual mobility to the joints. During rehabilitation, in order to avoid swelling of the stump and after healing of the wound, in order to independently care for it, you need to learn:
- Massage techniques;
- Correct application of the elastic bandage;
- Do the necessary set of physical exercises;
- Develop joints, bring them into a mobile state.
All these procedures are possible only after the wounds have completely healed and if there is no pain. Therefore, each patient is accompanied by an experienced prosthetist until his complete rehabilitation. He is also involved in the psychological preparation of the patient, going through all stages of recovery with him: from making an impression to the full operation of the prosthesis.
Prices for prosthetic limbs in Moscow
Prosthetics is a multi-stage process in which several specialists participate. Pricing is influenced by various factors:
- device design;
- volumes of prosthetics;
- qualification of an orthopedic doctor.
The production of prosthetic legs is carried out by a prosthetic technician. It determines the appropriate sleeve, its shape and dimensions. Features of the choice of design depend on the length of the stump, the level of leg amputation, and the degree of activity of the patient.
The cost of a prosthetic leg is $2500-5000. Foreign-made models are 2-4 times more expensive. Before you buy a limb replacement, you need to make sure of its quality. The discrepancy between the parameters of an artificial leg and a healthy one will certainly affect the biomechanics of movements.
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