Prosthetic Rehabilitation of a Female With Bilateral Transfemoral Amputation in Japan: A Case Report

Individuals with bilateral transfemoral (TF) amputation experience difficulties when walking with lower limb prostheses. Walking with prostheses is even more difficult when the cause of the amputation is nontraumatic, or the gender is female. We provided prosthetic rehabilitation to a woman who underwent bilateral TF amputation due to internal disease. A 42-year-old woman underwent bilateral TF amputation for ischemic necrosis of the lower extremities during septic shock treatment. Upon admission to our convalescent rehabilitation ward 3 months after surgery, the patient weighed 32 kg and was underweight. After admission, she underwent strength training of the trunk and hip muscles, hip joint range of motion exercises, and bottom shuffle exercises on the physical therapy table. The prosthetist created stubby prostheses for standing and standing-up exercises on the floor, as well as gait exercises. We gradually extended the length of her prostheses and subsequently switched her knee joints to Ottobock locking and polycentric knees and eventually to Kenevo, which are microprocessor-controlled prosthetic knees (MPK). During occupational sessions, she practiced household activities such as washing dishes, cleaning, and cooking while wearing her prostheses. Six months after admission, the patient was discharged and could walk outdoors alone with two canes without using a wheelchair. At discharge, the Kenevo modes were Mode C on the right and Mode B + on the left. The patient's weight recovered to 41 kg. The patient completed the 10-meter walk test at 0.50 m/s at a comfortable walking speed, the 6-minute walk test at 180 meters, and the timed up and go (TUG) test in 26 seconds. The motor Functional Independence Measure (FIM) score was improved from 60 on admission to 83 on discharge. Strengthening the hip and trunk muscles, improving endurance and balance, preventing hip contracture, and maintaining the hip range of motion are necessary for walking with bilateral TF prostheses. In the prosthetic rehabilitation of bilateral TF amputations, stubby prostheses, protocols for gradual extension of the prosthetic length, and Kenevo, a mode-changeable MPK, are helpful. MPK is essential for individuals with bilateral TF amputations to walk independently and use their prostheses daily. This report is a valuable reference for healthcare professionals involved with bilateral TF amputees in the future who need prosthetic rehabilitation.