This presentation by from the International Committee of the Red Cross describes problems and corrections for transfemoral static alignment in lower limb amputee prosthetic fitting.

1. 1

2. 2
FEET DISTANCE : ~10 cm
KNEE AXIS IS HORIZONTAL
TUBE IS VERTICAL
FOOT (with required heel height)
IS FLAT ON THE FLOOR
PROSTHESIS
TF STATIC ALIGNMENT:
ANTERIOR VIEW
PATIENT
SHOULDERS ARE HORIZONTAL
ILIAC CRESTS ARE HORIZONTAL
LEGS ARE IN EXTENSION
WEIGHT IS EQUAL ON BOTH FEET

3. 3
TF STATIC ALIGNMENT:
LATERAL VIEW
INITIAL FLEXION = ~ 5°
TKA (Trochanter-Knee-Ankle)
LINE IS 10-15mm ANTERIOR
FROM KNEE AXIS
TUBE IS VERTICAL
FOOT (with required heel height)
IS FLAT ON THE FLOOR
PROSTHESIS
SHOULDERS ARE HORIZONTAL
ILIAC CRESTS ARE HORIZONTAL
LEGS ARE IN EXTENSION
WEIGHT IS EQUAL ON BOTH FEET
PATIENT

4. 4
AXIS IS INCLINED!
CAUSE:
EXCESSIVE ABDUCTION
OF THE SOCKET
TF STATIC DEVIATION
TUBE IS LATERALLY
INCLINED!
SOLE IS SUPINATED!
FORCES
PLUMBLINE IS
LATERALLY DISPLACED!
CORRECTION:
1- ADDUCTION OF THE SOCKET
2- TRANSLATION LATERALLY
PROBLEMS!!!
EXCESSIVE PRESSURE AT
THE MEDIAL PROXIMAL AND
LATERAL DISTAL AREAS.
GAP AT THE LATERAL
PROXIMAL AREA.
LATERAL INSTABILITY.
2
1
P
P
GAP

5. 5
AXIS IS HORIZONTAL
FORCES
TUBE IS VERTICAL
CAUSE:
LATERAL DISPLACEMENT
OF THE SOCKET
PLUMBLINE IS
LATERALLY DISPLACED!
SOLE IS FLAT
CORRECTION:
TRANSLATION MEDIALLY
TF STATIC DEVIATION
P
P
PROBLEMS!!!
EXCESSIVE PRESSURE AT
THE MEDIAL PROXIMAL AND
LATERAL DISTAL AREAS.
GAP AT THE LATERAL
PROXIMAL AREA.
LATERAL INSTABILITY.
GAP

6. 6
AXIS IS INCLINED!
CAUSE:
EXCESSIVE ADDUCTION
OF THE SOCKET
PLUMBLINE IS
MEDIALLY DISPLACED!
SOLE IS PRONATED!
FORCES
TUBE IS MEDIALLY
INCLINED!
CORRECTION:
1- ABDUCTION OF THE SOCKET
2- TRANSLATION MEDIALLY
2
1
TF STATIC DEVIATION
P
P
GAP
PROBLEMS!!!
EXCESSIVE PRESSURE AT
THE LATERAL PROXIMAL AND
MEDIAL DISTAL AREAS.
GAP AT THE MEDIAL
PROXIMAL AREA.
MEDIAL INSTABILITY.

7. 7
AXIS IS HORIZONTAL
TUBE IS VERTICAL
CAUSE:
MEDIAL DISPLACEMENT
OF THE SOCKET
DIRECTION OF FORCES
PRESSURE !
PRESSURE !
PLUMBLINE IS
MEDIALLY DISPLACED !
SOLE IS FLAT
CORRECTION:
TRANSLATION LATERALLY
TF STATIC DEVIATION
PROBLEMS!!!
EXCESSIVE PRESSURE AT
THE MEDIAL PROXIMAL AND
LATERAL DISTAL AREAS.
GAP AT THE LATERAL
PROXIMAL AREA.
LATERAL INSTABILITY.

8. 8
TUBE IS ANTERIORLY INCLINED!
HEEL IS RAISED !
WARNING!!!
EXCESSIVE INITIAL
FLEXION OF THE SOCKET
(MORE THAN 5°)
PLUMBLINE IS ANTERIORLY DISPLACED
DISTANCE IS MORE THAN 10-15mm !
ISCHIAL SEAT ISANTERIORLY INCLINED!
CORRECTION:
1- EXTENSION OF THE SOCKET
2- TRANSLATION POSTERIORLY
1
2
TF STATIC DEVIATION

9. 9
INITIAL FLEXION = 5°
TUBE IS VERTICAL
WARNING!!!
ANTERIOR DISPLACEMENT
OF THE SOCKET
PLUMBLINE IS ANTERIORLY DISPLACED
DISTANCE IS MORE THAN 10-15mm
HORIZONTAL
HEEL IS FLAT
CORRECTION:
TRANSLATION POSTERIORLY
TF STATIC DEVIATION

10. 10
TUBE IS VERTICAL
WARNING!!!
INSUFFICIENT INITIAL
FLEXION OF THE SOCKET
(LESS THAN 5°) KNEE IS FLEXED !
TKA LINE IS POSTERIORLY
DISPLACED (INSECURE KNEE !)
Due to this deviation patient flexes his hip
in order to be able to activate extensor
muscles. But nevertheless, all phases of
the gate including stance phase are
VERY INSECURE
- prosthetic knee is always flexed and
TKA line falls posterior from the knee axis!
ISCHIAL SEAT IS
POSTERIORLY INCLINED!
HEEL IS FLAT
CORRECTION:
1- FLEXION OF THE SOCKET
2- TRANSLATION ANTERIORLY
1
2
TF STATIC DEVIATION

11. 11
INITIAL FLEXION = 5°
TUBE IS VERTICAL
WARNING!!!
POSTERIOR DISPLACEMENT
OF THE SOCKET
TKA LINE IS POSTERIORLY
DISPLACED (INSECURE KNEE !)
HEEL IS FLAT
Due to this deviation all phases of the gate
including stance phase are
VERY INSECURE
- TKA line falls posterior from the knee axis!
CORRECTION:
TRANSLATION ANTERIORLY
TF STATIC DEVIATION