Appendix
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Orthopedics

Prosthetics in Orthopedics

This activity reviews orthopedic prosthetics that are currently used in practice. It discusses both lower limb and upper limb prostheses and the different devices that make up their componentry. Also discussed are the complications associated with prosthetic devices and emerging advances in technology. This activity also highlights the critical role of the interprofessional team in caring for patients with prostheses. Objectives: Explain the different components of lower limb prostheses. Describ

v1 · Reviewed Nov 7, 2026 by Automated Clinical Reviewer (Strict Verbatim v1)
  • Amputees may also experience what has been termed as a painful residual limb.
  • In the acute phase, the skin over the stump site becomes red and indurated and may result in an "orange-peel" appearance.
  • A clinical evaluation of the significance of the prosthetic limb can be obtained from a questionnaire with a mixture of performance tests and self-reported quality questions.
  • Another clinically significant indicator is dynamic balance, as evaluated by a four-square step test, socket comfort, pain, and distance walked in a 6-minute test.
  • Mobility assessments can be performed pre-fitting and post-fitting to check the speed of ambulation.
  • Amputees may also experience what has been termed as a painful residual limb.
  • This pain can be generated from heterotopic ossification at the bony amputation site, excess bony prominences, a prosthesis with a poor fit, neuroma formation at the site of nerve transection, and insufficient soft tissue coverage of the stump site.
K-Classification System for Functional Ambulation
Level 0: Does not have the ability or potential to ambulate or transfer safely with or without assistance, and a prosthesis does not enhance their quality of life or mobility.
K-Classification System for Functional Ambulation
Level 1: Has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence—typical of the limited and unlimited household ambulator.
K-Classification System for Functional Ambulation
Level 2: Has the ability or potential for ambulation with the ability to traverse low-level environmental barriers such as curbs, stairs, or uneven surfaces—typical of the limited community ambulator.
K-Classification System for Functional Ambulation
Level 3: Has the ability or potential for ambulation with variable cadence. Typical of the community ambulator who has the ability to traverse most environmental barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion.
K-Classification System for Functional Ambulation
Level 4: Has the ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress, or energy levels—typical of the prosthetic demands of the child, active adult, or athlete.
  • Prosthetic training for amputees is a significant part of their recovery and healing process.
  • This is a multidisciplinary approach involving surgeons, clinicians, physical therapists, occupational therapists, and prosthetists.
  • Training programs are center-specific but help teach patients how to don and doff their prosthesis, inspect their amputation site for wounds and skin breakdown, and perform safe transfers.
  • Comprehensive programs, including mental training combined with gait training, have shown improved outcomes in transtibial amputees.
  • More advanced training sessions assist amputees with non-assistive weight-bearing and with more advanced weight-bearing on uneven surfaces and stairs.
  • Physical therapists, orthotists, and prosthetists are significantly involved in all aspects of preparing a patient's stump for prosthetic intervention, creating the prosthesis, and making sure the patient can use it properly.
  • It is important to ensure an appropriate prosthetic fit.
  • Poor-fitting prostheses can cause friction between the skin and the prosthetic socket and need to be refabricated.
  • Osseointegration is the direct attachment of a prosthesis to the underlying skeletal structure.
  • This technique bypasses any issues associated with a traditional socket design, eliminating complications of poorly fitting prostheses and dermatologic problems.
  • In addition to the decreased complications associated with osseointegrated prosthetics, many patients benefit from reduced energy expenditure, improved range of motion, walking ability, and sitting comfort.
  • Physical therapists, orthotists, and prosthetists must all monitor and communicate any issues related to a prosthetic limb.
  • Interprofessional communication is vital to make sure each team member is informed when issues arise, such as a poor-fitting prosthesis or functional limitations of the patient, and the issues are addressed via a multidisciplinary approach.
  • The prosthetic socket serves several important roles. It protects the residual limb but also allows for weight-bearing and load distribution.
  • The suspension mechanism attaches the prosthesis to the residual limb.
  • An articulating knee joint is sometimes appropriate for the prosthesis.
  • The pylon or “shell” portion of a prosthetic is what attaches the socket to the terminal device.
  • The terminal device is the last piece of the prosthetic puzzle.
  • Contact dermatitis may result and Is most commonly caused by liners, socks, and suspension mechanisms.
  • Painful scarring may result as a complication of the surgical amputation but may be exacerbated by prosthetic wear.
  • Amputees may also experience what has been termed as a painful residual limb.
  • In some cases, the increased metabolic demand can so much that it limits a patient's ability to ambulate after a lower extremity amputation.
  • review
    Prosthetics in Orthopedics. StatPearls [Internet] — Kevin P. Smidt, Ryan Bicknell — StatPearls Publishing, 2023

Decision support only. Verify against local protocols and current labeling. Source: www.ncbi.nlm.nih.gov