Prosthetic knee joints

Submitted by :- Ravi
MPO 1st yr
Introduction
• For above knee amputees the prosthetic knee
system is among the most complex of all
components in prosthesis.
• This is because knee must give support when
people stand, allow smooth motion when people
walk and permit movements when people sit
bend or kneel.
• Even in normal gait cycle the knee has to be in full
extension at the time of heel strike, goes into
flexion just prior to foot flat and toe off and goes
through different angles of flexion and extension
in swing phase.
Functions of Prosthetic knee joint
(1) support during stance phase,
(2) smooth and controlled swing phase, and
(3) unrestricted flexion for sitting, kneeling, stooping, and related activities.
Classification of Prosthetic knee joints
• Prosthetic knee joint are broadly classified as:
1. Mechanical
2. Microprocessor

• Prosthetic knee joint classification are divided into :-

1. Axis
2. Friction ( motion control )
3. Braking or locking mechanism (Stability options)
4. Microprocessor control
MECHANICAL KNEE UNIT
• Simple hinges and bars that allows the prosthetic shin to swing freely
in flexion and extension.
On the basis of their Axis of Rotation these mechanical knees can be
further classified into two types. These are :
1. Single Axis Knee Units
2. Multi Axis Knee Units (Polycentric Knee Units)
Single axis knee joint
• Simple hinge
mechanism

• How stance stability

achieved?
• on alignment stability
(involuntary control)
and
• amputee muscle
contraction
(voluntary control).
 • Advantages–
 Durable
 Light weight
 Costs less than other knee systems
• Disadvantages –
 Fixed cadence
Indications:-  Low stability
 Single-speed walking only
if hip control is good or
better
 when maximum
durability is required
Walking with single axis knee joint
Knee stability
Polycentric knee
• Human knee is also polycentric, during normal knee flexion and
extension, the knee axis moves about a changing centre of rotation
(centrode).
• Most commonly used four bar linkage joint.
• A changing center of knee rotation occurs,
• Adds to stability during initial contact
• Shortening of the shank for toe clearance during swing
Polycentric Knee Mechanism
 Stability in Stance phase of a Four Bar
Linkage Knee
 Alpha Stability(a)
• distance from the T.A. line to ICOR.
• A positive alpha value
• knee center which is posterior to the
T.A. line.
• This is a stable or "positive stability"
condition.
• A negative alpha value
• the knee center anterior to the T.A.
line
 In single axis knee
• alpha is zero at full extension.
• As it begins to flex , alpha becomes negative
• and progressively more unstable as flexion continues.
 Whereas, a four bar knee,
• has a positive value of alpha at full extension.
• As flexion begins, the value becomes smaller but it
remains positive for the first few degrees of flexion.
 Hence, the polycentric knee unit provides better
stability than single axis knee unit.
Stability Beta (B) :
• Numerically it is equal to the
perpendicular distance between Knee
center and ICOR.
• We know that the instantaneous center
of rotation is superior to the level of the
mechanical (or cosmetic) knee center
(point Kc ).
• With this prosthetic knee the patient
gains a mechanical advantage over a
typical single axis knee.
• This mechanical advantage is gained in
two ways as a result of raising the
instant center.
• Given figure is a free body diagram of AK
prosthetic shin shortly after heel strike.
• For stability net moment about point ‘f”
must be equal to zero
That is ,.
L.y = E.h
• On increasing the height of ICOR i.e if
value of beta increases, the value of "y"
and of L will remain unchanged.
• but, the value of "h" will increase and for
the above equation to balance; the value
of E will proportionately decrease.
• This simply means that the moment
tending to cause knee buckling is reduced
and therefore the patient uses less force,”
E”, to hold the knee in extension.
• The second way in which knee stability is increased by raising
the knee center is demonstrated in.
• This represents a typical above knee prosthetic thigh.
• To analyze this situation,
• moments are summed about the point "t “ to equal zero:

• It is noted that if the knee center is raised, the value of x2

would remain constant.
• This condition would also decrease the value of E (reduce
buckling force as seen above) and thus reduce the values of
E‘ and H proportionately.
• It is also observed that X1 would decrease in value creating a
second way in which H would be proportionately decreased.
• This second advantage can also be described as increased
leverage for the residual limb
shortening of the shank for toe clearance
during swing
• Poycentric design provides ability to rotate the shank under the knee
during sitting, which enhances sitting cosmesis for very long residual
limbs.
• Indication:-
 Knee • Advantages :-
disarticulation  Stable without disrupting swing
 Short above-knee phase;
amputations  special design provides cosmesis for
 Individuals with long residual limbs
weak hip extensors • Disadvantages:-
 Increased weight
 maintenance and
 initial cost
 Lack cadence response (more than
single axis)
Braking or locking mechanism
• There are two type of knee units:-
1. Manual knee locking
2. Weight activated (Stance control knee)
Manual locking knee
• For patients who must rely on mechanical stability in stance.
• This unit is basically a single-axis knee with the addition of a locking pin
Mechanism.
• The prosthetic wearer can manually unlock the knee by manipulating a
pulley or lever system attached to the outside of the socket.
• The pin automatically locks with a distinctive click when the knee is fully
extended.
• Walk with their prosthetic knees locked in extension.
• Although it provides maximum mechanical stability in stance,
• it also significantly compromises mobility and toe clearance in swing.
• The prosthesis is often fit to be slightly shorter than the sound side limb to
facilitate toe clearance during swing of the prosthesis.
• This unit is often used in the initial training prosthesis for patients when
balance, endurance, or cooperation may be problematic.
• Indication :-
 Elderly individuals
 Poor coordination
 Poor vision
 Muscular weakness
 Ultimate knee stability
 Also known as knee of last resort
• Advantages:-
 Eliminates knee flexion

• Disadvantages:-
 Abnormal gait
 Awkward sitting
Stance control knee
• Has a braking mechanism that is activated when weight is applied
through the knee during the stance phase of gait .
• The intent of the braking mechanism is to prevent (or at least reduce)
unwanted knee flexion during stance.
• The sensitivity of the braking mechanism can be adjusted to match the
individual's level of activity and ability to control the knee voluntarily.
• the braking mechanism provides additional mechanical stability to keep
the knee from rapidly buckling.
• If initial contact is made when the knee is not completely extended, as when
walking on uneven ground,
• During swing phase, the weight- activated stance control knee unit
functions like a single-axis knee and has similar disadvantages.
• Advancement of the prosthetic shin occurs at the same rate regardless
of changes in gait speed; minimal cadence responsiveness is present.
• This type of knee unit is most often prescribed for individuals who have
recently undergone amputation, and who have short residual limbs or
weakness of hip extensors and would otherwise have difficulty in
actively stabilizing their prosthetic knees.
• Basic function- • Advantages:-
 Increased weight bearing stability  Improved knee stability
• Indications:- • Disadvantages:-
 Elderly  Delayed swing phase
 Genral debility  Must unload fully to flex or sit
 Poor hip control
Prosthetic knee joints on the basis of Friction
• Three type of friction are commonly used
• These are
1. Mechanical constant /variable
2. Pneumatic variable
3. Hydraulic variable
Mechanical friction
• Often use with single axis joint
• All knee systems require some degree of swing control to maintain a
consistent gait.
• In many cases, this control is provided by mechanical friction at the
axis of rotation and is adjusted to match the normal cadence of the
opposite leg.
Constant friction (single axis)
• Provides uniform resistance throughout the gait cycle
• Friction can be adjusted to the individual’s normal cadence so the
pendulum action of the shank will correspond to that of the opposite
limb
• Their main disadvantage is that the knee is adjusted for a single
walking speed at any given time.
 • Advantages
 Durable
 Inexpensive
 Simple
 lightweight
• Disadvantages
 No stance stability
Only Indication- living in a
remote area without access to a  No cadence respose
prosthetist.
 Mechnical frition may loose
 Debris may interfere the fuction easily
Variable friction
• Variable friction provides increased resistance as the knee bends from
full extension. This provides “cadence response,” allowing variable
walking speeds;
• This responsiveness provides less resistance at higher speeds.
• However, this system requires frequent adjustment and replacement
of moving parts.
Pneumatic control
• Use compressed air to serve as a friction control.
• Unaffected by drastic changes in air temperature
• Knee friction resistance remains same regardless
of temperature.
• Energetic walkers frequently overpower the
pneumatic resistance.
• Gait control can be further enhanced with the
addition of a spring coil.
Mechanism of working
• Mechanism consists of a piston rod that is attached to the thigh section
of the prosthesis behind the knee bolt.
• Knee flexion forces the piston down into the cylinder, which in turn
forces air through a bypass channel at the bottom of the cylinder.
• The air travels upward within and around the sides of the cylinder,
through a port at the top of the cylinder, and back into the central
cylinder above the piston.
• Resistance to knee swing velocity can be adjusted for the individual
amputee by adjusting the opening size of the port at the top of the
cylinder.
• An adjustment knob is turned clockwise or counter clockwise to either
decrease or increase this port opening.
• Decreasing the opening provides greater restriction of the amount of air
passing through the port and, therefore, greater swing-phase control.
Setting this opening too small would make the swing too stiff, possibly
preventing adequate knee flexion and speed during swing phase.
• Disadvantage :- • Advantages :-This unit can be
• less precise cadence control used both with single axis and
• Require more maintenance polycentric knees.
• This unit can produce heat when • Efficient use of air compression
actively worked for longer lower the energy consumption.
duration • Provide better swing control
than constant friction systems.
• Lighter and less expensive than
comparable hydraulic knee
Hydraulic knee unit
• Hydraulic units are more prescribed than pneumatic knee
joints because they allow ambulation at any speed from
very slow to very fast.
• The knee resistance automatically compensates to change
in walking speed. Hydraulic knee units uses oil (typically
silicon oil) for friction control.
• Silicon oil minimizes viscosity fluctuations with
temperature changes. Therefore, stiffness in cold weather
and looseness in hot weather are avoided.
• Hydraulic control achieves nearly normal knee action over
a wide cadence range.
• The design provides normal heel rise and extension in the
swing phase independent of walking speed.
INDICATIONS:
• Varying cadences.
• Persons who walk on uneven ground.
• Take small steps in there occupation.

Disadvantges:-
• Increased maintenance,
• Increased weight,
• Increased expense.
Microprocessor-controlled knees (MPKs)
• Use computer technology to enhance the function of basic mechanical knee designs, including single axis and pneumatic
and hydraulic functions.
• Some MPKs use a computer-regulated valve to adjust the swing phase resistance of a pneumatic cylinder.
• Another design uses the computer to control swing phase function and stance phase stability.
• More advanced systems use multiple sensors to send messages about changes in walking back to the microchip 50 times
per second.
This is how a MPKs functions.
References:-
• Ron Seymour
• Atlas of Limb Prosthetics: Surgical, Prosthetic, and Rehabilitation
Principles
• Transfemoral Amputation: Prosthetic Management
• C. Michael Schuch, C.P.O.