About Amputation

Leg Amputation

If your amputation is planned, the various aspects and the rehabilitation program will be explained to you. On the other hand if your amputation is the result of an accident or sudden trauma you will not get this information until afterwards and you will also find that counseling will be offered to help overcome the psychological effects. The rehabilitation team are usually well organised group with a lot of valuable experience who will discuss with you whether a prosthesis is feasible and what type will be suitable.

Immediately after surgery, measures are taken to prevent secondary disabilities, especially the tightening of the muscle, tendons, ligaments, or skin that could prevent the normal movement of the hip or knee. Exercises for general conditioning, stretching of the hip and knee, and strengthening of all extremities are started as soon as the you are medically stable. Exercises will be set that you can do in bed or in a chair and you will begin standing and balancing exercises with parallel bars as soon as possible.

Generally  it has to be recognised that age will play a major part in how much mobility you gain on your new prosthesis and younger people may attain quite high levels. There will be days when your stump is sore or you do not feel so good and a wheelchair will be required instead of your artificial leg.

Unilateral amputation (One limb): Walking requires a 10 to 40% increase in effort after below-the-knee amputation and a 60 to 100% increase after above-the-knee amputation. To compensate, older people generally walk more slowly. As a general rule, you can achieve most of the things that you could have done prior to the amputation with a well-fitting prosthesis and good rehabilitation.

Mobility after a below-the-knee amputation differs greatly from that of an above-the-knee amputation. People who have had a below-the-knee amputation and are fitted with a prosthesis usually become mobile quite quickly. Elderly people who have had an above-the-knee amputation may find that they do not have the energy, flexibility and skills required to deal with an above-the-knee prosthesis and to control the knee joint, and may find a fixed knee easier to use.

Bilateral amputation (Two Limbs): Amputation of both legs is not  so common and is usually the result of a trauma. As with unilateral amputation, what can be achieved depends on whether the amputations are above or below the knee. If you have a bilateral below-the-knee amputation with well-fitting prostheses you should be able to walk again without a cane. As a bilateral above-the-knee amputee with prostheses you will probably be able to walk with the support of two canes. Older people with bilateral above-the-knee amputations may not have the necessary energy or strength to walk with prostheses.

Amputees with one below-the-knee and one above-the-knee amputation can generally walk using the one functional knee joint in the same way that a unilateral above-the-knee amputee with a prosthesis would do. Regardless of the level of the amputations, walking distance is generally limited and a wheelchair may be needed, especially outdoors and for long distances.

Stump Conditioning and Prostheses

Immediately after the amputation the stump will be swollen and it takes a while for this swelling to reduce, usually about a month. To help taper the stump and prevent swelling from the excessive accumulation of  fluid in tissue you will be encouraged to wear an elastic stump shrinker or elastic bandages. 

Early walking with a temporary prosthesis enables you to be active, accelerates stump shrinkage, prevents joint stiffness, and helps to reduce phantom limb pain. Using a temporary prosthesis or  walking aid, you can start walking exercises between parallel bars and progress to walking with sticks until a permanent prosthesis is made.

The permanent prosthesis will be made to suit your needs and ability, and you will not get more than you need as every extra bit adds additional weight to the leg. The manufacture of a permanent prosthesis will only take place once the stump has shrunk properly. For most patients with a below-the-knee amputation the prosthesis amounts to a socket, pylon and foot with ankle, that is kept in place by a sock that fits over the knee joint.. For above-the-knee amputees there are several knee options available and the socket is secured by a belt which fits around the waist. There are also silicon suspensions that allow the limb to be fitted with out the need for belts.

Care of the stump and prosthesis

You have to learn to care for your stump. Because your artificial leg is intended only for walking you will remove it before going to bed and it is then that you should inspected the stump thoroughly using a mirror if necessary, it should be washed with mild soap and warm water, dried thoroughly, then dusted with talcum powder. If the skin of the stump is too dry, moisturising cream or baby lotion can be applied. If the stump sweats excessively, you can use an antiperspirant. Should the skin get inflamed, the irritant must be removed immediately, and talcum powder or skin cream applied. If the skin is broken, the prosthesis should not be worn until the wound has healed.

Your stump sock should be changed daily, and mild soap may be used to clean the inside of the socket. Standard prostheses are neither waterproof nor water-resistant, so if any part of the prosthesis becomes wet, it must be dried immediately with a dry towel.

Complications

Stump pain is a common complaint and is only felt in the stump. You need to differentiated this from phantom limb pain. Mild to severe pain may be felt when the stump is manipulated by medical staff when being examined or when a prosthesis is used. Pain can also be caused by a socket that is not fitting very well, which may be caused by swelling of the stump or a change in body weight. However, the most common causes are nerve damage or bone formations at the site of the amputation. Nerve ends can be encouraged to settle with well fitting socks, whereas bone formations usually require further surgery.

Phantom limb pain can occur if the patient had a painful condition before amputation, although with good surgery techniques and post operative pain control this can be avoided. Treatments such as simultaneous exercise of both legs, massage of the stump, percussion of the stump with fingers, and ultrasound are effective in reducing or eliminating this condition.

Phantom limb sensation is a painless awareness of the amputated limb, sometimes accompanied by mild tingling. Most amputees experience this sensation, which may last several months or years, but usually disappears without treatment. Frequently, amputees sense only part of the missing limb, often the foot, which is the last phantom sensation to disappear. Some amputees can even describe the position of the foot. Phantom limb sensation is not harmful; however, amputees, without thinking commonly attempt to stand particularly when they wake at night to go to the bathroom.

Follow-up

Follow-up examinations are performed every 3 to 6 months for the first 2 years for patients who successfully complete a prosthetic rehabilitation program. The stump usually continues to shrink with use and an adequate fit of the prosthesis can be achieved by adding layers of socks, although eventually a new socket will be needed. Because of continuous use, components of the prosthesis will wear out and this may cause your gait to alter. One positive benefit of a prosthesis is that you can replace parts without surgery.

At each visit, the circulatory status of the unaffected leg should be checked. With age circulation tends to become poorer and this can lead to patients who have had a below-the-knee amputation due to vascular disease to eventually require an above-the-knee amputation.

An amputee wheelchair, generally has the rear wheels set back to compensate for the absence of leg weight and to prevent tipping, and will be a constant companion to an amputee as you never know when fatigue or illness will make it difficult to walk with your prosthesis.

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