Aug. 04, 2025
Advances in lower limb prosthetics, using novel and innovative materials, have gathered apace in recent years allowing people who have lost limbs to maintain, or even improve on, previous levels of mobility, activity and independence. Microprocessor technology, which is also developing at an even faster rate, is contributing to the creation of even more sophisticated products.
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These electronic knees feature sensors, a microprocessor, software, a resistance system and a battery. The microprocessor monitors each phase of the gait cycle using a series of sensors. The continuous monitoring allows the knee to make adjustments in resistance enabling the user to walk more efficiently at various speeds and improves safety when descending ramps and stairs. They have been shown to reduce falls and allow patients to walk more confidently and with less concentration. However mechanical knees are still widely prescribed as they do not require charging and can be easier to learn to use.
‘Polycentric knees’ have a centre of rotation based upon multiple linkages rather than being a simple hinge. Similar to the human knee, these knees have a variable centre of rotation during flexion of the knee. This may allow functional shortening of the limb during swing thus aiding toe clearance.
Hydraulic knees use a fluid similar to that in automotive breaking systems, and an array of valves, to change stance or swing resistance.
Matching people who have had a trans-femoral amputation with the prosthetic knee that helps them reach their full rehabilitation potential is essential. Making that match is challenging as there are so many devices on the market and the quantum rate of technological advance is driving new developments. With that in mind it is vital that clinical staff prescribing, fitting and training with these devices maintain an up to date knowledge of commonly prescribed prosthetic knees. The latest edition of the West of Scotland Mobility and Rehabilitation Centre (Westmarc) Knee Guide hopes to address all these issues.
The guide was re-written by myself and fellow specialist physiotherapist Nicola Porteous, prosthetists, Laura Brady, David Morrison and Alison Morton; and bioengineer, Bruce Carse. We are NHS clinicians who work together at Westmarc in Glasgow. We use the products described on a daily basis and have no commercial interest in their prescription or use. It is important to stress that we have not produced an evidence based guideline but it is informed by the expert opinion of clinical staff and guidance supplied by the manufacturers.
We also recognise that as advances prosthetic components and clinicians experience are evolving at a rapid pace, this document will require updating within the next 5 years. With that in mind we are also keen to receive ongoing feedback from professionals and patients and the guide includes full contact details.
The guide starts with a detailed glossary of terms and gives information on the various categories or ‘families’ of knee joints, from relatively straightforward mechanical prostheses to the complex microprocessor controlled devices.
We have defined and described each category including examples of specific knees that fit into each category. These examples have been chosen as they are the most common types of knee used in clinical practise in the UK but they do not constitute a definitive list due to the number of prosthetic knees available.
Many knees will have similar features within their ‘family’ and the guide explains any significant differences. For more in-depth or practical training the reader should contact the manufacturer or supplier of each knee joint.
This edition is the second and expanded edition of the ‘Physiotherapist’s Guide to Prosthetic Knees’ published by Scottish Physiotherapy Amputee Research Group (SPARG) in . Information on normal gait and prosthetic knees has been updated and more information on microprocessor technology has been included.
The hints and tips section is intended to facilitate problem solving when teaching patients to use a particular knee ensuring they gain maximum benefit from the different features and functions.
Also included in the guide are quick reference sheets designed to summarise important points from the body of the document. Each knee ‘family’ is represented with specific examples of knees within each category.
All the information supplied about each knee joint has been checked and approved by the appropriate manufacturer and is up to date at time of publishing. The authors are planning to include a review of the current evidence to support prescription guidance in the next edition.
We would like to express our thanks to John Colvin, Westmarc Clinical Services Manager and the wider prosthetic team in Westmarc without whose support we could not have completed this project.
Their contribution to many lively discussions and debates and their proof reading skills were invaluable. Also, fundamental to the accuracy of the guide was feedback from a group of expert advisors credited in the guide and the prosthetic companies themselves.
The West of Scotland Mobility and Rehabilitation Centre (Westmarc) Knee Guide for the Prosthetic Multidisciplinary Team is intended as a guide to assist the prosthetic multidisciplinary team. It was published electronically in May this year and is freely available from The Knowledge Network. The website also has links to manufacturer’s training videos and other related resources/organisations.
If you're living with limb loss, finding the right prosthesis can feel overwhelming. Choosing one isn't just about regaining mobility—it's about reclaiming your independence, comfort, and confidence. Still confused about the types, costs, and technology related to the different kinds of above-the-knee prostheses? Don’t fret; we will clear it up for you! Read on to find out more.
Several choices are available for above-knee prostheses, designed to suit diverse lifestyles and preferences. Choosing the right one depends on your needs, goals, and activity levels. Below, we will outline standard options and their primary features.
Mechanical knees are dependable and preferred for their simple, elegant design. A typical example is the single-axis knee, which hinges at a single point. It’s both lightweight and cost-effective, though it may feel less natural in motion. For additional balance, the weight-activated stance controls knee locks during weight-bearing, which makes it a popular choice for beginners seeking extra stability.
The polycentric knee features multiple pivot points, creating smooth, natural movement when sitting or bending. This option suits more active users, though it requires stronger muscles to operate effectively. For maximum support, the manual locking knee stays locked until intentionally released. While its walking mechanism lacks fluidity, it offers superior stability for users needing additional reassurance.
Computerized prostheses represent a significant leap forward in technology. These advanced knees use microprocessors to analyze real-time movements and respond accordingly. A computerized knee can adjust to changes in walking speed, step patterns, and terrain slope, delivering a more natural and efficient gait.
Many models feature built-in safety mechanisms, such as systems that instantly lock when needed to reduce the risk of tripping. While heavier and more expensive than mechanical versions, they simplify walking and improve daily functionality for active users. Some models are versatile enough to adapt to activities like cycling or running, making them a popular choice among highly mobile individuals.
Above-knee prostheses consist of four essential components. The socket, customized to fit the user’s residual limb, provides the crucial connection between the leg and the prosthesis. Comfort and control depend heavily on this part.
The knee joint, which influences the fluidity of movements, is located beneath the socket. Below the joint is the pylon, a lightweight tube often made of materials like titanium, designed to support seamless motion. Finally, the foot contributes to balance and stability, with variations tailored to specific lifestyles—whether for hiking, daily walking, or more specialized activities.
The socket fitting process is the foundation of a successful prosthesis fit. The prosthetist initially measures the residual limb to craft a custom socket. Modern prosthetists often rely on advanced scanning or molding techniques to ensure accuracy. The goal is a snug fit, essential for both comfort and mobility.
Once the measurements are complete, the prosthetist creates a clear, lightweight plastic test socket. This trial socket allows users to stand, walk, and sit, so fit and balance can be carefully evaluated. Adjustments follow until the user feels comfortable, after which a durable final socket is constructed from carbon fiber or silicone materials.
Socket fitting isn’t a one-time event— residual limbs often change shape over time, necessitating future refinements. Regular check-ins ensure comfort and help prevent potential issues.
Suspension systems keep the prosthesis securely attached to the limb. Without proper suspension, the prosthesis may shift during use, leading to discomfort and inefficiency. Standard suspension systems include suction, pin lock, and vacuum designs. Each has unique benefits, catering to different needs and preferences.
A suction system creates a close seal between the socket and limb, minimizing movement and providing a firm connection. Alternatively, pin lock systems incorporate a liner equipped with a locking pin that secures the prosthesis in place. Vacuum systems, widely regarded as the most advanced option, use pumps to remove air and maintain a dynamic, stable fit.
The right suspension system directly influences the alignment and stability of the prosthesis. Poor suspension can lead to a host of problems, including skin irritation, fatigue, and even posture issues. The best match depends on factors like your limb shape, activity level, and daily habits.
Alignment plays a critical role in how seamlessly the prosthesis works with your body. Improper alignment can disrupt balance, overstress joints, and make walking unnecessarily tricky. A well-aligned prosthesis promotes a smooth, efficient gait, reducing both pain and fatigue.
Prosthesis alignment is typically fine-tuned by the prosthetist early on, with ongoing adjustments as the user adapts to the device. These tweaks ensure better pressure distribution and a more natural walking experience. Ultimately, good alignment enhances mobility and supports an active, pain-free lifestyle.
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An above-knee prosthesis typically costs between $5,000 and $50,000. Lower-end models feature basic components, while more advanced prostheses with microprocessor-controlled knees or premium materials, like carbon fiber, are more expensive.
Pricing depends on several factors, including the materials, design complexity, and level of customization required. For example, a prosthesis with advanced features like electronic components or pneumatic mechanisms may cost significantly more than a simpler mechanical alternative.
Additionally, custom-fitted sockets, which are necessary for comfort and functionality, contribute to the total expense.
Budget-conscious individuals can explore refurbished prostheses offered by specialized providers. These are carefully restored and sold at reduced prices. Some organizations also provide financial assistance programs, ensuring that users from all backgrounds can access reliable prosthetic solutions.
New prosthetic designs excel at mimicking natural motion. Microprocessor-controlled knees analyze movement patterns and adjust instantly for smoother, balanced steps. Hydraulic and pneumatic systems further support lifelike mobility by managing joint movement during walking, sitting, or climbing.
For many users, prostheses offer independence and the ability to return to meaningful activities. Adaptive prostheses enable participation in sports, hobbies, and everyday tasks without discomfort. Custom components reduce strain on other body parts, leading to improved physical and emotional well-being.
Routine care ensures the prosthesis stays functional and comfortable over time. Cleaning reduces skin issues and wear, while regular professional adjustments address limb shape or alignment changes. A well-maintained prosthesis fosters reliability, which supports an active and fulfilling lifestyle.
Above-knee prostheses combine cutting-edge technology, tailored components, and attentive care to restore mobility. Whether you’re exploring suspension systems, advanced knee joints, or innovative materials, these devices offer personalized solutions to meet diverse needs. With proper use and support, above-knee prostheses provide renewed freedom and the ability to pursue life’s opportunities confidently.
There are several choices for above-knee prostheses designed to suit diverse lifestyles and preferences. Selecting the right one depends on your specific needs, goals, and activity levels. Below, I’ll outline common options and their primary features.
Mechanical knees are dependable and preferred for their straightforward design. A common example is the single-axis knee, which hinges at a single point. It’s both lightweight and cost-effective, though it may feel less natural in motion. For additional balance, the weight-activated stance controls knee locks during weight-bearing, which makes it a popular choice for beginners seeking extra stability.
The polycentric knee features multiple pivot points, creating smooth, natural movement when sitting or bending. This option suits more active users, though it requires stronger muscles to operate effectively. For maximum support, the manual locking knee stays locked until intentionally released. While its walking mechanism lacks fluidity, it offers superior stability for users needing additional reassurance.
Computerized prostheses represent a significant leap in technology. These advanced knees use microprocessors to analyze real-time movements and respond accordingly. A computerized knee can adjust to changes in walking speed, step patterns, and terrain slope, delivering a more natural and efficient gait.
Many models feature built-in safety mechanisms, such as systems that reduce the risk of tripping by locking instantly when needed. While heavier and more expensive than mechanical versions, they simplify walking and improve daily functionality for active users. Some models are versatile enough to adapt to activities like cycling or running, making them a popular choice among highly mobile individuals.
Above-knee prostheses consist of four essential components. The socket, customized to fit the user’s residual limb, provides the crucial connection between the leg and the prosthesis. Comfort and control depend heavily on this part.
The knee joint, which influences the fluidity of movements, is located beneath the socket. Below the joint is the pylon, a lightweight tube often made of materials like titanium, designed to support seamless motion. Finally, the foot contributes to balance and stability, with variations tailored to specific lifestyles—whether for hiking, daily walking, or more specialized activities.
To explore these components in greater detail, check out How Prosthetics Work .
The socket fitting process is the foundation of a successful prosthetic fit. The prosthetist first measures the residual limb to craft a custom socket. Modern prosthetists often rely on advanced scanning or molding techniques to ensure accuracy. The goal is a snug fit, essential for both comfort and mobility.
Once the measurements are complete, the prosthetist creates a test socket from clear, lightweight plastic. This trial socket allows users to stand, walk, and sit, so fit and balance can be carefully evaluated. Adjustments follow until the user feels comfortable, after which a durable final socket is constructed from carbon fiber or silicone materials.
Socket fitting isn’t a one-time event—residual limbs often change shape, necessitating future refinements. Regular check-ins ensure comfort and help prevent potential issues.
Suspension systems keep the prosthesis securely attached to the limb. Without proper suspension, the prosthesis may shift during use, leading to discomfort and inefficiency. Common suspension systems include suction, pin lock, and vacuum designs. Each has unique benefits, catering to different needs and preferences.
A suction system creates a close seal between the socket and limb, minimizing movement and providing a firm connection. Alternatively, pin lock systems incorporate a liner equipped with a locking pin that secures the prosthesis in place. Vacuum systems, widely regarded as the most advanced option, use pumps to remove air and maintain a dynamic, stable fit.
The correct suspension system directly influences the alignment and stability of the prosthesis. Poor suspension can lead to many problems, including skin irritation, fatigue, and even posture issues. The best match depends on your limb shape, activity level, and daily habits.
Alignment is critical in how seamlessly the prosthesis works with your body. Improper alignment can disrupt balance, overstress joints, and make walking unnecessarily difficult. A well-aligned prosthesis promotes a smooth, efficient gait, reducing pain and fatigue.
Prosthetic alignment is typically fine-tuned by the prosthetist early on, with ongoing adjustments as the user adapts to the device. These tweaks ensure better pressure distribution and a more natural walking experience. Ultimately, good alignment enhances mobility and supports an active, pain-free lifestyle.
An above-knee prosthesis typically ranges from $5,000 to $50,000. Models on the lower end feature basic components, while more advanced prostheses with microprocessor-controlled knees or premium materials, like carbon fiber, fall on the higher end of the spectrum.
Pricing depends on several factors, including the materials, design complexity, and level of customization required. For example, a prosthesis with advanced features like electronic components or pneumatic mechanisms may cost significantly more than a simpler mechanical alternative.
Additionally, custom-fitted sockets, necessary for comfort and functionality, contribute to the total expense.
Budget-conscious individuals can explore refurbished prostheses offered by specialized providers. These are carefully restored and sold at reduced prices. Some organizations also provide financial assistance programs, ensuring that users from all backgrounds can access reliable prosthetic solutions. For charities that help amputees with prostheses, go here.
New prosthetic designs excel at mimicking natural motion. Microprocessor-controlled knees analyze movement patterns and adjust instantly for smoother, balanced steps. Hydraulic and pneumatic systems further support lifelike mobility by managing joint movement during walking, sitting, or climbing.
For many users, prostheses offer independence and the ability to return to meaningful activities. Adaptive prostheses enable participation in sports, hobbies, and everyday tasks without discomfort. Custom components reduce strain on other body parts, improving physical and emotional well-being.
Routine care ensures the prosthesis stays functional and comfortable over time. Cleaning reduces skin issues and wear, while regular professional adjustments address limb shape or alignment changes. A well-maintained prosthesis fosters reliability, which supports an active and fulfilling lifestyle.
Above-knee prostheses combine cutting-edge technology, tailored components, and attentive care to restore mobility. Whether you’re exploring suspension systems, advanced knee joints, or innovative materials, these devices offer personalized solutions to meet diverse needs. With proper use and support, above knee prostheses provide renewed freedom and the ability to pursue life’s opportunities confidently.
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