Abstract
Chapter 1 reviews briefly the historical development of lower limb amputations and their prosthetic fitting. Chapter 2 defines the stump/socket interface and examines in detail its various functions, relating these to some of the problems associated with the fitting of a prosthesis to an above knee amputation stump. It is stressed that the design of the amputation stump and the prosthetic socket must be complementary to each other if a successful result is to be achieved. The Author then divides the subject into two parts, the amputation stump and the prosthetic socket. Chapter 3 reviews various surgical techniques for performing an above knee amputation, and follows this with a critical assessment of the advantages and disadvantages of each technique, both as a surgical procedure and in relation to the subsequent performance of the resulting stump as an integral part of the stump/socket complex. Chapter 4 reviews the current designs of above knee prosthetic sockets. Chapter 5 introduces the concept of "Total Surface Bearing" as an alternative to present brim bearing and total contact fit sockets. The Author proposes, from a theoretical concept, the necessary disposition of the soft tissues of the stump within a total surface bearing socket to achieve a uniform pressure distribution, a self-retaining fit of the socket on the stump, and stability of the femoral shaft within the soft tissues. Chapter 6 gives criteria for a casting technique to introduce total surface bearing above knee sockets in the clinical situation. A method is suggested for casting the patient in the supine position using an elastic pressure sleeve and traction weights to apply predetermined loads to defined areas of the stump while a plaster cast is applied. Chapter 7 states the criteria for the selection of patients for the new socket. Chapter 8 describes the organisation of clinical trials, and presents the results obtained on patients fitted with the socket between 1971 and 1973. Chapter 9 proposes some simple theoretical models for the stump/ socket complex for comparison with experimental results. Chapter 10 describes the experimental procedures employed to examine the level and distribution of pressure across the stump/socket interface under axial compression load. Chapter 11 presents the data from the experimental work, and discusses it in relation to the objectives of the project. The results are given in a series of graphs. Chapter 12 sums up the work of the project and examines how far it has achieved its objectives. An indication is given of further work which still has to be undertaken. Appendix A describes the preparations for taking, the cast of the stamp, and lists the materials and apparatus required. Appendix B gives detailed instructions on how to take the cast and on the subsequent management of the negative and positive plaster casts. Appendix C describes the technique for making the plastic laminate socket. Appendix D describes the procedure for applying, fitting and checking the socket on the patient. Appendix E details the theory of the elastic pressure sleeve. Appendix F is the specification for the production of the elastic material from which the pressure sleeve is made. Appendix G consists of a general assembly drawing of the casting couch proposed by the Author and designed by the Research Department of the Royal College of Arts and by the Design Office of the Biomechanical Research and Development Unit, Roehampton.