Why might you need a prosthetic?

There are many factors that inform people's decisions to have prosthetic limbs fitted, both from a medical and a personal perspective. Artificial limbs can be an essential aspect of the rehabilitation process after a critical injury, with significant benefits in terms of quality of life.

One primary medical reason for needing a prosthetic is amputation. Amputations can occur for several reasons, including trauma, infection, or complications related to chronic medical conditions; for instance, severe infections that are not treated with antibiotics might necessitate amputation to prevent the spread of infection or save the patient’s life. Additionally, individuals with diabetes or peripheral arterial disease may require lower limb amputation due to poor circulation that has been badly managed, which can lead to tissue death and gangrene.

Another medical reason for prosthetic use is congenital limb differences. Some individuals are born with missing or underdeveloped limbs, which can significantly affect their mobility and independence; for these individuals, prosthetics might be a preplanned aspect of their lifelong health support, as developed by their physiotherapists and occupational therapists.

Prosthetics can provide these individuals with the ability to perform daily tasks more efficiently, participate in physical activities, and lead a more fulfilling life. There are various reasons that patients might choose to have a prosthesis fitted:

• To regain a sense of normality and improve self-esteem after a life-altering injury.
• To help regain independence and perform essential day-to-day tasks; for example, a person who has lost an arm might use a prosthetic to hold objects, cook or drive, while someone who has an amputated leg may rely on a prosthetic to walk, run, or play sports.
• To address phantom limb pain, a condition that causes amputees to experience pain in a part of the limb that is no longer there. Wearing a prosthetic limb has often been shown to alleviate these feelings of phantom pain, because of their direct contact with the amputation site.
• To help address the psychological impact of limb loss, as prosthetics can restore a sense of wholeness and make it easier for individuals to engage in social activities and build support networks, as they can participate more fully in various aspects of life.

“Adjusting to life with a prosthesis can be difficult as you experience new sensations and make adaptations to your daily activities; however, you will be assigned a prosthetist to help you with the transition,” prosthetic wearer Jim explained. 

“As a generalisation, try to be patient with yourself while you problem-solve and develop new strategies to achieve your goals – because that’s what life is all about!”

How does a prosthesis work?

Prosthetic devices can vary significantly in design, complexity and appearance, depending on factors such as the location of the amputated limb, the user's specific needs and the desired level of functionality.

The primary goal of a prosthesis is to mimic the function of the amputated limb or body part as closely as possible. To achieve this, prostheses are designed to work in harmony with the user's residual limb and existing muscle strength; for example, in the case of a prosthetic leg, the artificial device should allow the user to walk or run with a natural gait.

Prosthetic devices can be passive, body-powered, or powered by external sources like batteries. Passive prosthetics primarily serve aesthetic purposes and provide minimal functional benefits, while body-powered prosthetics rely on the user's muscle strength and body movements to control the device. For example, a body-powered prosthetic arm uses a cable suspension system connected to a harness worn around the shoulder to open and close the artificial hand. In contrast, externally powered prosthetics - such as myoelectric devices - use sensors to detect muscle contractions in the residual limb, which then control the movement of the prosthesis.

In some cases, you may receive a temporary prosthesis in the weeks after your surgical procedure. This will help you to start your physical therapy as soon as possible, allowing you to build strength in your remaining limb and improve your overall physical condition, before getting a more permanent prosthesis fitted after a few months.

The most crucial component of a prosthesis is the socket, which is custom-moulded to fit the user's residual limb. The socket is designed to distribute pressure evenly and provide a comfortable, secure fit. It is usually made from lightweight materials like thermoplastics or carbon fibre.

A liner, made of materials such as silicone, polyurethane, or gel, is placed between the socket and the residual limb to provide cushioning, reduce friction, and protect the skin. The liner may also have a locking mechanism or a suction system to keep the prosthesis securely attached to the residual limb.

Jim said: “The residual limb, or ‘residuum’, on which the prosthesis is designed to fit, is sometimes called a ‘stump’. I am an arm amputee and I prefer to call the residuum my ‘wee arm’. My choice!”

The appearance of a prosthesis can also vary significantly based on the user's preferences and needs; some may prioritise functionality over aesthetics, while others may want a natural-looking prosthesis that matches their remaining limb. Functional components, such as joints and actuators, can be covered with a cosmetic shell made of materials like foam or silicone, which can be shaped and coloured to match the user's skin tone and natural limb shape. Alternatively, some users may choose to embrace the mechanical appearance of their prosthesis and opt for a more futuristic or artistic design.

“Your prosthesis will be designed with your life goals, comfort and, most of all, safety in mind. This is particularly the case with leg prostheses," Jim explained.

Why is it important to get the correct prosthesis fitted?

A well-fitting prosthesis is crucial for comfort, functionality, and overall user satisfaction. The process typically begins with a thorough evaluation by a prosthetist, who will assess your residual limb, muscle strength, range of motion, and specific needs.

Different types of prosthetic devices are available depending on the state of the limb and the nature of your surgery. For example, if you have had a leg amputation below your knee joint, the relevant prosthetic device will function and look different than what you would require from an upper limb prosthesis - this will all need to be discussed and considered with your physical therapists and care team to ensure you choose a prosthesis that will meet your needs.

If a prosthetic does not fit properly, it can lead to a range of complications, including discomfort, skin irritation, pressure sores, and even infection. Poorly fitting prosthetics may impede mobility, diminish functionality, and negatively impact the user's quality of life; over the longer term, the muscle strain and postural imbalances they cause might potentially lead to long-term musculoskeletal issues. A poorly-fitted artificial arm or leg can also make the symptoms of phantom limb pain feel worse.

Jim explains that, “If you’re a younger person, you’ll need a prosthesis that can grow with you and adapt as your body changes. You’ll also want something that can withstand many years of wear and work with you, rather than against you.”

If your prosthetic device does not fit properly or feels uncomfortable, this could be due to your body naturally changing or growing, weight loss or gain, or because your injury might not have fully healed. You should contact a medical professional for a consultation if your prosthesis is causing you discomfort, as they can help you adjust the fit and alignment of your artificial limb.

How do I choose a prosthetist?

Prosthetists will play a key part in your recovery process. They will work closely with your physiotherapist and occupational therapist, and are responsible for helping you find the right prosthetic for your needs.

For example, if you require a prosthetic leg, they will use their expertise in gait analysis and engineering solutions to consider your specific anatomy and physiology, and then provide prostheses tailored to replicate the structural or functional characteristics of your missing limb. Over time, they will help to modify and tailor the use of your leg prosthesis to make sure it is serving your needs in daily life, and that your functional abilities with your prosthetic limb are fully maximised.

“All prosthetists working in the UK must be qualified and accredited by the Health & Care Professions Council (HCPC). Prosthetists usually work in a multidisciplinary team, which includes amputee specialist physiotherapists, occupational therapists, counsellors, nurses and an orthopaedic or rehabilitation consultant,” Jim added.

To find the prosthetist who is right for you, you should consult with your existing rehabilitation team to identify a practitioner who has the skills, capabilities and qualifications to serve your needs. This should take into account the distance of the prosthetist’s office from your home, and any recommendations and endorsements they can demonstrate; remember, you are likely to have an extended relationship with your prosthetist as they help to support your recovery, so it is important to ensure you are working with a professional that you trust and are comfortable with.

To check the credentials of your prosthetist, visit the HCPC website.

Once a prosthetic device has been fitted, how long will it take to get used to it and back to normal?

After successful amputation surgery, it can take over six weeks for your limb to be healed enough to have a prosthetic limb fitted. The length of time varies depending on the rate at which your body heals from the surgical procedure, which can be frustrating, but it is always advised that you listen to your rehabilitation team and do not rush into the process, as you could risk damaging your amputated limb further.

Usually, it is estimated that it takes about a year to get used to functioning with a prosthetic device, and this can also vary depending on the location of the amputation surgery, as certain prosthetics may feel more unnatural than others, meaning a longer time to feel comfortable. You may have to use a wheelchair or crutches for a while after receiving your prosthesis, but, as you get used to it, you will have to rely on these less and less.

While your prosthesis may feel unusual at first, you will improve with time. When asked about his own experience, Jim stated that: “As a primary amputee, there is no doubt that it does take a while to get used to the new sensations associated with wearing and using a prosthesis.”

This adjustment time for a prosthetic leg or arm can vary from person to person, and you should not compare your experience with prosthetics to others. You may find that what works for others doesn’t suit you, and vice versa. 

“The sensory feedback and mechanical stability you get through the socket are especially important in enhancing control and balance, and part of the prosthetist’s skill lies in carefully shaping the socket to ensure a secure but comfortable fit. This is very much the craft side of the business, and often a number of adjustments are required to get things just right," Jim added.

“There is then the factor of change in yourself. The volume of your residual limb is likely to change over time and this translates directly into the socket fitting and feeling different. Early on, these volume changes can be quite marked and it’s not unusual for the patient to receive a couple of new sockets. One solution that prosthetists use is to fit the socket with variable thickness liners or socks so that these changes in limb size can be accommodated to an extent.”

Having a comfortable and functional prosthetic means that you can continue living life to the fullest, without the worry of your prosthetic slowing you down or getting in the way of daily tasks. Getting accustomed to the emotional impact of this change, and gradually building your self-confidence and general health back up after your injury, may also be a factor in the speed of your recovery.

How can I get used to a prosthesis?

After working with many new amputees, Jim learned that the most effective and comfortable way to get used to a prosthetic limb is to “start off by wearing the prosthesis for short periods of time - as short a period as 15 minutes for the first day or two, and then build up wear time gradually as directed by your healthcare team. This is particularly the case if you are prone to breakdown over the skin - for example, if you have poor sensation, brittle scar tissue, or a tissue viability problem related to circulation. This is to ensure you are certain that the prosthesis won’t cause you injury. 

“The next phase is to test the prosthesis in the function that it’s intended for. Particularly if you have a lower limb prosthesis, your prosthetist will spend a lot of time making sure that the alignment and positions of the foot, knee and hip are optimised for comfort and walking mechanics prior to delivery. 

“However, moving around in the real world throws up situations that might not be considered in a clinical setting, so be aware and take a little care in new environments to ensure that you remain comfortable, well-balanced and safe.”

How should I take care of my prosthetic?

A prosthetic is an expensive and highly sophisticated assistive device. Although they are designed to be robust in order to hold up to daily use, they nevertheless need to be looked after carefully to ensure they remain in optimal condition.

Jim explained: “Before the prosthesis is delivered, your prosthetist will show you how to carry out quick daily safety checks before you don your prosthesis. There’s always a lot to take in, so I recommend that recent amputees ask for printed instructions. If you identify a problem, you should report it as soon as you can, particularly if you feel that it compromises your safety.”

If your prosthesis does not feel comfortable when it arrives or you notice a fault with it, you should alert the provider or arrange an appointment with your consultant to go over the issues and quickly amend them.

“Over the longer term, your service is responsible for maintaining the device and so attending review appointments regularly is a good idea, especially when you are starting out as a primary amputee or when you have a new type of component or prosthesis fitted.”

How can I avoid damaging my prosthetic?

Damaging artificial limbs can be just as common as damaging functioning limbs, and can be just as difficult to repair. Jim says: “From a skin health point of view, the socket or liner that’s in contact with your skin needs to be cleaned regularly in order to prevent bacteria building up, which could then cause skin irritation or infection.”

“Some prosthesis designs use suspension liners with ratchet pins attached, or sleeves that help to maintain suction. These need to be checked regularly for damage in order to prevent your prosthesis from coming loose.”

How long does a prosthesis last?

The amount of time a prosthesis can last before needing to be replaced by a new one will vary depending on different factors, including how often you wear it and whether your body changes shape or size. Because of this, it can be difficult to assess, so Jim and other experts recommend regular contact with a medical professional:

“All the components in a prosthesis have recommended service intervals. Your prosthetic service will recommend you come in for a review in line with those service intervals. So often, it’s more a case of making sure that parts that are worn out are replaced when they need to be, or highlighting a problem to your prosthetist as soon as it arises. This will make the prosthesis as a whole last much longer for you than it otherwise would.”

By following this guidance and working closely with both your occupational therapist and physical therapist, you will be able to get the most out of your new prosthesis for as long as possible.

How much does a prosthesis cost?

As the devices are considered very advanced technology and are made of resistant materials, they can be expensive to source. Fortunately, those who require prostheses can have the option to receive funding for their device through not-for-profit organisations.

If you have had to undergo amputation surgery due to medical negligence, you could claim a large amount of compensation from the opponent that would help you to pay for the financial impact on your life and your prosthesis. If you think this applies to you, you should contact the expert medical negligence solicitors at JMW immediately to find out whether you have a case.