Creating Your Custom Above-Knee Prosthesis

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An above-knee prosthesis (also called a transfemoral prosthesis) will typically consist of a custom-made socket, a knee, a pylon, a foot, and some means of suspending the prosthesis to the body.  Your prosthesis will be individualized by creating a custom socket specific to your limb and choosing the most appropriate componentry for your lifestyle and needs.

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Initial Prosthesis

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The shape and size of your limb will change a great deal during the first six months after an amputation. Your prosthetist will help you manage these initial changes by teaching you when to wear additional layers of socks over your limb to keep the socket from becoming too loose, or by adding padding to the socket itself to tighten its fit. If the socket gets too loose even with these changes, it may be necessary to fabricate a new socket.

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In many instances, the pylon of this initial prosthesis does not have a cosmetic covering, making it easier for the prosthetist to make changes to the socket or adjustments in the alignment.

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Gait training, or learning to walk with your prosthesis, will begin with this initial prosthesis. When the volume of your residual limb stops shrinking and you have reached a steady level of activity, it may be time to move to a definitive prosthesis.

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Definitive Prosthesis

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Using similar techniques, your initial prosthesis will be replaced with a more definitive device. While some people prefer the look of their prosthesis without a cosmetic cover, others may wish to seek a cosmetic cover at this time. Creating a definitive prosthesis and improving its fit may require several visits and can take a few weeks to complete, in order to help ensure you can use your prosthesis comfortably and successfully.

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Depending on daily use and your activity level, a prosthesis can last anywhere from two to five years. With children, prostheses need to be replaced more frequently. It is important to remember that a prosthesis is a mechanical device that sometimes needs repairs and adjustments. Sometimes, single components can be repaired or replaced rather than creating an entirely new prosthesis.

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Significant changes in weight can require adjustments to the socket or other parts of the prosthesis.

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Component Considerations

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There are distinct challenges that come with the absence of your anatomic knee and ankle joints. These include balance and stability issues as well as increased energy requirements. In many instances, these challenges may create the need for a more sophisticated prosthesis. Advanced prosthetic technology, like microprocessor-controlled knees, may be able to help.

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​Bilateral Above-Knee Limb Loss

The loss of both legs above the knee (also called bilateral above-knee amputation or BAKA) comes with its own unique set of challenges, but with hard work and dedication, walking again is a possibility. The common steps for rehabilitation are:

1. Begin physical therapy, daily stretching, conditioning and weight control to help strengthen and prepare your body for the next steps.

2. You may begin walking on short legs, also called shorties or stubbies, with special training feet. Starting here will help you improve your balance, learn to fall safely, and avoid injury from those falls.

3. Once you become comfortable on short legs, your prosthetist may gradually lengthen the legs to make you taller, allowing you to gain confidence at each stage.

4. Finally, you will transition to full-length legs with prosthetic knees and ankles/feet. However, most bilateral above-knee amputees (BAKAs) find that their short legs continue to be useful tools for some situations and activities.

Your recovery and rehabilitation will take time. Be patient with yourself and reach out for support when you need it. Peer support can be integral to the healing process and allows you to learn how others are overcoming obstacles and living their lives to the fullest.  

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LEARN MORE ABOUT THE PROSTHETIC PROCESS >