Clinical Practice Guideline Developed for Prosthetic Knee Selection

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Phil Stevens, MEd, CPO, and Shane Wurdeman, PhD, MSPO, CP, have published a clinical practice guideline that was developed to present the evidence and provide clinical recommendations on prosthetic knee selection for people with unilateral amputations at the knee disarticulation or transfemoral level. The open-access article was published in the January issue of the Journal of Prosthetics and Orthotics.

The guideline was based upon the best available evidence, and recommendations were drawn from systematic review, meta-analysis, and additional published practice guidelines.

The results led to the following recommendations:

1.      Fluid knee benefits and indications: Knees with hydraulic or pneumatic swing resistance are indicated for active walkers, permitting increased walking comfort, speed, and symmetry.

2.      Microprocessor knee benefits: Compared with nonmicroprocessor knees:

a.                With respect to self-report indices and measures, microprocessor knees are indicated to reduce stumbles, falls, and associated frustrations as well as the cognitive demands of ambulation.

b.                With respect to self-report indices and measures, microprocessor knees are indicated to increase confidence while walking, self-reported mobility, satisfaction, well-being, and quality of life.

c.                With respect to physical performance indices and measures, microprocessor knees are indicated to increase self-selected walking speed, walking speed on uneven terrain, and metabolic efficiency during gait.

3.      Microprocessor knee equivalence: Given the comparable values observed with the use of microprocessor and nonmicroprocessor knees with regard to daily step counts, temporal and spatial gait symmetry, self-reported general health, and total costs of prosthetic rehabilitation, these parameters may not be primary indications in prosthetic knee joint selection.

4.      Microprocessor knees for limited community ambulators: Among limited community ambulators, microprocessor knees are indicated to enable increases in level ground walking speed and walking speed on uneven terrain while substantially reducing uncontrolled falls and increasing both measured and perceived balance.

The guidelines are meant to serve only as guides, as they may not apply to all patients and clinical situations, according to the authors.