200 Section - A Unilateral “Stubbie” Transfemoral Prosthesis – An Innovative Approach to Achieve Patient-Centered Functional Goals in an Elderly Patient with New Unilateral Transfemoral Amputation: A Case Report.

A 78-year-old man presented with a new right transfemoral amputation due to venous thrombosis. He was a poor candidate for transfemoral prosthesis use due to barriers including heart failure, contralateral knee osteoarthritis, and ipsilateral hip flexion contracture. In this case report, we describe use of a unilateral “stubbie,” (a short transfemoral prosthesis without a knee) – a style usually used in the context of bilateral transfemoral amputations – as an innovative approach towards supporting the patient’s personal goal of ground-level recreational activities.

Case Description:

Although the patient was not a good candidate for standard transfemoral prosthesis use, his interdisciplinary team felt that a stubbie might allow him to work towards ground-level mobility goals. The length of the patient’s right residual limb with a stubbie was similar to the kneeling height of his left lower limb. His rehabilitation program worked towards activities at the “kneeling” level (kneeling on his left lower limb, standing on his right with the stubbie). With therapists, he worked to build prosthesis tolerance, hip and core strength, and upright balance. He developed skills transitioning between ground level, sitting, and “kneeling” with the unilateral stubbie. Ultimately, the patient achieved his goals of gardening and outdoor play with his grandchildren, demonstrating safe, controlled movement on uneven surfaces.

Discussions:

A full-length transfemoral prosthesis presents an innate challenge for the user due to the potential of the knee buckling (even with a manual locking knee). This makes a transfemoral prosthesis much more difficult to use compared to a transtibial prosthesis. A stubbie transfemoral prosthesis does not have a knee joint, and hence cannot buckle.

Conclusions:

Through the patient’s experience in working with a stubbie, he developed a deep appreciation for the effort required to utilize a transfemoral prosthesis, even when the prospect of the knee buckling is taken out of the picture.