Principles
Amputation levels
The closer the amputation level is to the body, the more difficult the rehabilitation. This means that, as a rule, people with below-knee amputations find rehabilitation easier and have better mobilisation prospects than those with disarticulation at the
Amputation at the level of the pelvis
Amputations at the level of the pelvis lead to a considerable limitation of functional performance. As a rule, the patient can only move about using forearm crutches and can walk only very short distances using a pelvic socket prosthesis. These patients can be expected to perform activities in sitting without having to walk far and protected from the weather. According to the German Severely Disabled Act, this constitutes an exceptional walking handicap [German = außergewöhnliche Gehbehinderung, or "aG"].
Above-knee amputation
Providing the surgical technique is suitable, it is today possible to provide patients with a prosthesis with a socket that usually surrounds the residual limb, even with short residual limbs. Short to medium walking distances are most certainly possible with these. The patients should avoid activities that involve lots of stair climbing and activities where they have to stand on ladders. The activity profile should normally favour sitting with the option of walking around occasionally, the patient can be expected to walk to work and protection from the weather is recommended. With regard to sitting, chairs that have been adapted for surgical destruction of a joint (arthrodesis chairs) are useful. Letter "G" in the German Severely Disabled Act.
Knee disarticulation
Knee disarticulation results in a fully weight-bearing residual limb that allows for satisfactory prosthetic care. When the prosthesis fits properly and the condition of the residual limb is normal, medium and even long walking distances are possible, walking to work can be expected. The activity profile should avoid moisture as far as possible (risk of chafing). Letter "G" in the German Severely Disabled Act.
Below-knee amputation
Below-knee amputations allow patients to use their own knee joints. With a suitable prosthesis, the patients can be expected to perform a moderately demanding physical job. The work can be carried out in all physical positions although work that often involves crouching or cramped conditions should be avoided. Normal work can also be carried out, where necessary, on uneven ground (gardening etc.) when using a prosthesis with a thigh corset. In Germany such patients are classified as “G” in the Severely Disabled Act.