Bilateral Transfemoral Amputations Research Articles

The importance of rehabilitation in patients with bilateral transfemoral amputation

Мета: двостороння трансфеморальна ампутація становить як реабілітаційну, так і соціальну проблему. Хоча це не поширений діагноз, його фізичний і психологічний вплив є значним. Наша мета полягає не тільки в покращенні локомоції пацієнта, але й у ресоціалізації пацієнта.Матеріали та методи: наше досьє складалося з пацієнтів з діагнозом двостороння трансфеморальна ампутація, які пройшли 8-тижневе комплексне реабілітаційне лікування з липня 2015 року по червень 2019 року. Дані були оцінені ретроспективно, а потім оброблені статистично.Результати: на основі наших спостережень ми можемо оцінити позитивний вплив комплексного відновного лікування. Відбулося покращення показника самозабезпечення в оцінці FIM. Висновки: у своїй роботі ми підтвердили позитивний ефект комплексного активного реабілітаційного лікування шляхом підвищення рівня самозабезпеченості у звичайній повсякденній діяльності. Своєчасна і комплексна реабілітація позитивно впливає не тільки на самодостатність, пересування, але й на соціальну реінтеграцію.Ключові слова: двостороння трансфеморальна ампутація, коефіцієнт функціональної самозабезпеченості, комплексне реабілітаційне лікування, соціалізація.

Enthesopathy, a Cause for Persistent Peristomal Pain after Treatment with an Osseointegrated Bone-Anchor: A Retrospective Case Series

ABSTRACT Introduction After limb loss, many patients undergo treatment with an osseointegrated implant. Unfortunately, some develop persistent peristomal pain after surgery. This can be sufficiently severe to reduce the speed of their rehabilitation or may halt the process altogether. The pain may be due to an enthesopathy of the residual muscles. We describe the phenomenon and outcomes of treatment in a series of patients who underwent treatment with an osseointegrated prosthetic limb, bone-anchor. Materials and Methods Over 36 months, we followed 14 patients with symptoms consistent with enthesopathy. Thirteen had undergone treatment with a transfemoral bone-anchor and one underwent treatment with a transhumeral bone-anchor. One patient had a bilateral transfemoral amputation. Analysis of the patients' ages, heights, weight at the time of surgery, length of residual femur, or preoperative dual-energy x-ray absorptiometry scans showed no correlation with the development of enthesopathy pain. Thirteen patients received steroid injections. Most received at least one injection of Adcortyl™ and bupivacaine. Patients were then encouraged to follow a program of physiotherapy to stretch out their enthesis, after injection. Results All patients experienced relief from their symptoms, but only two were rendered completely pain free. The remaining 11 patients gained sufficient control of their symptoms to allow them to continue daily use of their prosthesis with less difficulty or, where rehabilitation had been delayed or halted completely, to resume this process. Conclusion Enthesopathy seems to be a common phenomenon after bone-anchor surgery in individuals with transfemoral amputation. Steroid injections can help to relieve pain, allowing physiotherapy to be carried out. Patients undergoing treatment with a bone-anchor should be advised of the possibility of enthesopathy pain but can be reassured that there is a solution that works well in most cases. Clinical Relevance This article may be of benefit to clinicians who are struggling to manage patients with persistent peristomal pain after insertion of a bone-anchor. It may also encourage further research into measures for securing the soft tissues around the stoma for patients undergoing bone-anchor surgery.

Bilateral Transfemoral Amputation in a 45 Day Old Secondary Infant to Traditional Treatment in a Developing Country

Lower limb amputations are well known with various etiologies. In contrast, bilateral variability secondary to traditional treatment, especially in infants, has received little attention in the literature. The WHO estimates that 80% of rural populations living in developing countries rely on Traditional Medicine for their health needs. We report the observation of a bilateral transfemoral amputation in a 45-day-old infant initially treated by a traditherapeute for swelling of both thighs. The treatment consisted of bilateral restraint with traditional splints, which developed into ischaemic gangrene of both lower limbs during 28 days of restraint, which led to a consultation at the Gabriel Touré University Hospital in Bamako. Faced with this dreadful situation, an amputation was immediately carried out to save the life of the innocent infant. The traditional treatment, despite the damage it causes, is practised everywhere in Africa. The authors plead for information and sensitisation of the population on the danger of this practice. They recommend to the public authorities and to national and international institutions working for the well-being of children, the urgent need to put in place a regulation of these anarchic and co-pilot practices which are a great source of handicaps in our population and moreover among children.

Patient-reported benefits of bone-anchored transfemoral prostheses as assessed by MedTech20: A general outcome measure for medical products.

The medical community demands evidence for the benefits of medical devices such as bone-anchored prostheses (BAPs). MedTech20 is a novel instrument aiming to address general benefits of medical devices. To describe general patient-reported benefits of BAPs measured with MedTech20. This is a cross-sectional descriptive survey. Patients treated in Sweden who had used a BAP for >1 year were mailed the MedTech20 Questionnaire. Responses to each attribute were described, and the MedTech20 Index (0-1), in which a higher figure represents larger benefits from the product, was calculated. Index values were compared based on demographic variables (sex, unilateral or bilateral transfemoral amputation (TFA), and those having experienced any complication of implant parts or the prosthetic connection device). The response rate was 72%. The 62 participants (41 men and 21 women; mean age 57 years) had 11 ± 6.9 mean years of BAP experience. Single attributes stated as highly relevant and with high benefit for BAPs included perceived reliability, perceived safety, sense of control of the disability, facilitation of movement outside home, no discomfort at use, and ease of use. Attributes with less relevance included aid to remember tasks, reduction of barriers to a good sleep, and reduced sense of compromised integrity. The MedTech20 Index was 0.655 ± 0.188 and was not statistically significantly different based on any of the demographic variables. By using a general measure on attributes of medical devices, this study provides new insights strengthening the evidence regarding the benefits that BAPs provide for patients with TFA who had difficulties with socket-suspended prostheses.

Using Stubby Prosthesis after Bilateral Transfemoral Amputation: A Biomechanical Case Study

Background: After bilateral transfemoral amputation, people may experience limitations in everyday life due to limited mobility and prosthesis problems. Materials and method: The case study covered a 54-year-old man after bilateral traumatic amputation of his lower limbs. Transfemoral amputations were performed using the Caldwell method; disproportion in the length of stumps was 5 mm. The motion task was recorded using the SMART-E optoelectronic system (BTS Bioengineering, Milan, Italy) according to the standard Davis protocol (the Newington model). Biomechanical evaluation included the measurement of angle-time relationships, characterizing the range of motion (ROM) in lower limb joints and Ground Reaction Force (GRF). The analyzed tasks are walking with self selected speed, fast gait and walking in stubby prostheses. Results: Step width was the most similar to the gait of healthy persons walking with stubby prostheses (0.17 ± 0.01 m for healthy people, 29% higher for stubbies, 35% for prosthetic gait with self-selected gait speed and 41% for fast gait speed). Step width was the smallest when walking with stubbies. Conclusions: The reduction of body height allows to reduce the risk of fall. Higher metabolic cost of gait in people after amputation result from a greater need to maintain balance and posture, and to perform walking movement.

Efficacy of Stubbies in Initial Phase of Rehabilitation for A Woman with Bilateral Transfemoral Amputation-A Case Study

Background: Individuals with a Transfemoral Amputation (TFA) may encounter impediments in day to day life because of decreased mobility. The utilization of “Stubby” prostheses in bilateral transfemoral amputees has been pushed by several authors. The significant focal points of these prostheses are that they 1) Lower the Centre of Gravity, decreasing the rate and reality of falls and 2) eliminate prosthetic knee joint, providing better control and possible reducing the cardiovascular stress of ambulation 3) Cosmesis has been the significant hindrance. Case description and method: The stubby prosthesis was designed on basis of patient’s condition and complaint. Result: The prostheses provided optimal mediolateral stability, allowed easy balance, Prevented falling backward and push-off was initiated by rocker bottom. Conclusion: This Prosthesis is an economic and design with proper biomechanical implications.

Can high-functioning amputees with state-of-the-art prosthetics walk normally? A kinematic and dynamic study of 40 individuals.

Previous work has highlighted the highly functional post-rehabilitation level of military individuals who sustained traumatic amputation. Understanding how these individuals walk with their prosthesis could be key to setting a precedent for what is realistically possible in the rehabilitation of individuals with amputations. The aim of this paper is to answer how "normal" should the gait of an individual with an amputation(s) be and can we aspire to mimic able-bodied gait with the most advanced prosthetics in highly functioning individuals? This was a cross-sectional study comparing the gait of severely injured and highly functional UK trans-tibial (n=10), trans-femoral (n=10) and bilateral trans-femoral (n=10) military amputees after completion of their rehabilitation programme to that of able-bodied controls (n=10). Joint kinematics and kinetics of the pelvis, hip, knee and ankle were measured with 3-D gait analysis during 5min of walking on level ground at a self-selected speed. Peak angle, moment or range of motion of intact and prosthetic limbs were compared to control values. Joint kinematics of unilateral trans-tibial amputees was similar to that of controls. Individuals with a trans-femoral amputation walked with a more anterior tilted pelvis (P=0.006), with reduced range of pelvic obliquity (P=0.0023) and ankle plantarflexion (P<0.001) than controls. Across all amputee groups, hip joint moments and power were greater and knee and ankle joint moments were less than for controls. This is the first study to provide a comprehensive description of gait patterns of unilateral trans-tibial, trans-femoral and bilateral trans-femoral amputees as compared with healthy able-bodied individuals. The groups differed in joint kinematics and kinetics, but these can be expected in part because of limitations in prosthesis and socket designs. The results from this study could be considered benchmark data for healthcare professionals to compare gait patterns of other individuals with amputation who experienced similar injuries and rehabilitation services.

Rehabilitation Program Using Short Prostheses after Bilateral Transfemoral Amputation: A Case Report

ABSTRACT Introduction Individuals with bilateral lower-limb (LL) amputations require more energy when using bilateral prostheses compared with those who have unilateral LL amputations. A short prosthesis is often used to determine whether someone will be functional using a more advanced prosthesis long term. Patient Information This case report describes physical therapy interventions for a 72-year-old male subject in subacute rehabilitation after a bilateral transfemoral amputation secondary to peripheral artery disease (PAD). At initial examination, the patient was dependent for all transfers and unable to sit unsupported. Intervention The interventions were done in three phases. Phase 1 focused on trunk strengthening, postural control, sitting and standing balance, and standing tolerance using short prostheses on a tilt table. Phase 2 progressed to dynamic standing activities using a tilt table and LiteGait with the goal to increase standing tolerance. Phase 3 focused on transfers and gait with assistance from the LiteGait and a platform walker. Outcomes After 8 weeks of rehabilitation, the patient achieved all short-term goals (STGs) and made 75% progress toward meeting his long-term goals. His Functional Balance Grades Scale (FBGS) score increased from poor to fair, whereas his Functional Independence Measure (FIM) scores for transfers and ambulation increased from 3 to 4 and 0 to 1, respectively. Discussion There is limited information in the literature on progressing exercise programs in individuals with bilateral transfemoral amputation. Physical therapists may wish to consider the interventions described in this case report when designing programs for individuals with bilateral transfemoral amputation.

Efficacy of stubbies in initial phase of rehabilitation for a woman with bilateral transfemoral amputation - a case study

Efficacy of stubbies in initial phase of rehabilitation for a woman with bilateral transfemoral amputation - a case study

Developing a rigid frame wheelchair in Brazil

Purpose Describing the development process of a rigid frame wheelchair using user-centered and open innovation approaches, as envisaged by the WHO Wheelchair Guidelines. Methods Unstructured interviews and group discussions with conveniently sampled active wheelchair users oriented the initial brief, product design and selection. The initially approved prototype was subject to ISO 7176 tests, leading to further product adjustments. The long-term follow-up was inclusive of a new group of purposively selected active wheelchair users and measured user satisfaction and safety, as well as user mobility and wheelchair fitting. Data on user satisfaction, safety and effectiveness was produced using QUEST 2.0 and WHO Wheelchair Service Training Package’s forms and checklists in Portuguese. Results Iterative design and selection led to a prototype that was found appropriate by multiple stakeholders. ISO testing ensured its safety and durability. Follow-up trials included 40 active wheelchair users, who used the studied wheelchair for at least two months. They were 80% male, on average 36.3 years old, and had received their rigid frame wheelchair approximately 4.7 years after disability onset. 92.5% of them had SCI, 7.5% had bilateral transfemoral amputations. Users’ assessments showed satisfaction with products (4.4) and services (4.1). Users spent an average of 4.2 h/day sat in their wheelchairs. 7.5% and 20% of users reported pressure sores and falls, respectively. Conclusion A user-centered, open innovation approach led to the development of a good quality, affordable, and acceptable rigid frame wheelchair model that increased the range of manual wheelchairs available through the Brazilian public healthcare system. Implications for rehabilitation The feedback of rehabilitation professionals with respect to new products’ features is fundamental in order to understand how these devices will be adequately serviced and delivered to users. Engaging users of assistive products and rehabilitation professionals in developing new and innovative products facilitates the iteration and selection of the best project alternatives and saves considerable time and resources. Rehabilitation professionals are in the best position to work with user of assistive products and other stakeholders, such as the industry and research and development centres, to identify the impact of new assistive products in users' functionality, acknowledging their conditions and environments and exploring their potential. Working with users and other stakeholders from different backgrounds and areas of expertise makes the moto “Nothing about us, without us” real. Working towards improving functionality often requires developers to challenge the usual top-down development process in order to adopt a user-centered perspective.

バージャー病を呈した両側大腿切断者に対し，義足装着と膝継手に工夫を行い，義足歩行が自立した治療経験

バージャー病を呈した両側大腿切断者に対し，義足装着と膝継手に工夫を行い，義足歩行が自立した治療経験

Avaliação da porcentagem de gordura corporal em um indivíduo com amputação transfemoral bilateral por diferentes métodos

A amputação predispõe a um risco de alterações na composição corporal, condição que interfere no equilíbrio no uso da prótese, aumenta o cansaço físico e tem como consequência menor rendimento nas terapias físicas. Nesse sentido, é fundamental eleger o método mais apropriado para avaliar a composição corporal. Objetivo: Avaliar a porcentagem de gordura corporal em um indivíduo com amputação transfemoral por diferentes métodos. Método: Trata-se de um estudo de caso de caráter clínico retrospectivo com um participante do sexo masculino, idade 67 anos com amputação transfemoral bilateral por insuficiência vascular, atendido pelo Serviço de Nutrição do Instituto de Medicina Física e Reabilitação do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - IMREA HCFMUSP. Utilizou-se o somatório das dobras cutâneas, absorciometria de raio-X de dupla energia (DXA) e análise de impedância bioelétrica (IB). Resultados: Os dados antropométricos apontaram porcentagem de gordura corporal de 34,3%, a IB 33% e o DXA revelou 37%. Conclusão: Para este caso, sugere-se que na inviabilidade de avaliar a porcentagem de gordura corporal em indivíduos com amputação com o DXA, o somatório das dobras é o método elegível. Estudos futuros são imprescindíveis a fim de estabelecer o método adequado para avaliação da composição corporal de pessoas com amputações bilaterais de membros inferiores, tendo em vista que este resultado contribui para o melhor desfecho clínico de pacientes em processo de reabilitação.

FUNCTIONAL DIFFERENCES OF BILATERAL TRANSFEMORAL AMPUTEES USING FULL-LENGTH AND STUBBY-LENGTH PROSTHESES.

Many unilateral amputations are followed by a contralateral amputation within three years, sometimes presenting as bilateral transfemoral amputations. Bilateral transfemoral amputees that successfully use prostheses are an understudied patient population. This study establishes reference values for this population in users of short non-articulating (stubby) or full-length articulating prostheses. Anthropometric and demographic information was collected from participants. Additionally, participants completed a self-reported Prosthesis Evaluation Questionnaire-Mobility Subscale 12/5 (PEQ-MS) and performed multiple physical mobility tests, including walking tests and the multi-directional Four Square Step Test (FSST). Full-length users rated their abilities to complete the PEQ-MS tasks as less difficult than stubby users in eight of the 12 items. Gait analysis revealed a greater amount of time is spent in stance phase with a greater portion in double limb support for both user groups, and a greater percentage in stance phase for the subject-reported dominant limb. Stubby users' gait velocity had a significant reduction from that of their full-length peers; however, cadence was similar between groups. Both user groups completed the FSST at comparable times. These outcomes may be of benefit for identifying tasks bilateral transfemoral prosthetic users may find to be most difficult as well as for identifying normal ambulation patterns within this population. Future studies with a greater number of subjects would enable these results to be further generalized.

Spatiotemporal parameters in sprinters with unilateral and bilateral transfemoral amputations and functional impairments.

Although sprinters with unilateral (UTF) and bilateral transfemoral (BTF) amputations and functional impairments (FIs) without amputation were allocated into different classifications because of the recent revision of the International Paralympic Committee Athletics Rules and Regulations, it is unclear whether running mechanics differ among the three groups. The aim of this study was to investigate the differences in the spatiotemporal parameters of the three groups during 100-m sprint in official competitions. Using publicly available Internet broadcasts, we analyzed 11 elite-level sprinters with UTF amputation, 4 sprinters with BTF amputation, and 5 sprinters with FI without amputation. The best personal times for nearly all individuals were included. For each sprinter's race, the average speed, step frequency, and step length were calculated using the number of steps in conjunction with the official race time. Although there were no significant differences in the average speed among the UTF, BTF, and FI groups (7.95 ± 0.22, 7.90 ± 0.42, and 7.93 ± 0.14m/s, respectively, p = 0.87), those with BTF amputation showed significantly lower step frequency (UTF: 4.20 ± 0.20Hz, BTF: 3.71 ± 0.32Hz, FI: 4.20 ± 0.10Hz, p < 0.05) and longer step length (UTF: 1.90 ± 0.08m, BTF: 2.14 ± 0.02m, FI: 1.89 ± 0.06m, p < 0.05) than the other two groups. These results suggest that the step characteristics during sprinting are not the same among sprinters with UTF amputation, BTF amputations, or FI without amputations.

Differences in spatiotemporal parameters during 200-m sprint between bilateral and unilateral transfemoral amputees.

Although Paralympic T42 class Men's 200 m sprints are currently competed by athletes with bilateral and unilateral transfemoral amputations, there may be performance differences between the groups. This study aimed to compare the spatiotemporal parameters of a 200-m sprint between bilateral and unilateral transfemoral amputees wearing running-specific prostheses. We analyzed 29 races (nine sprinters) with bilateral or unilateral transfemoral amputations from publicly available Internet broadcasts. For each sprinter's race, the average speed, step frequency, and step length were calculated using the number of steps in conjunction with the official race time. Average speed of bilateral transfemoral amputees was 5.7% greater than in unilateral transfemoral amputees. Bilateral transfemoral amputees exhibited lower step frequency (-8.9%) but longer step length (16.3%) than unilateral transfemoral amputees. Therefore, even in the same Paralympic classification (T42), different spatiotemporal strategies exist between bilateral and unilateral transfemoral amputees wearing running-specific prostheses during 200-m sprints. Since different spatiotemporal strategies exist between bilateral and unilateral transfemoral amputees during 200-m sprints, our data supports recent revisions of classification rules (1st January, 2018), which each population was allocated into the different classification (T61 and T63, respectively).

Bone-anchored prostheses in patients with traumatic bilateral transfemoral amputations: rehabilitation description and outcome in 12 cases treated with the OPRA implant system

Purpose: To describe the rehabilitation experience and outcome of treatment with bone-anchored prostheses in individuals with bilateral transfemoral amputations (TFAs) treated in Sweden over a period of 25 years.Method: Hospital records were reviewed for all patients with traumatic bilateral TFAs treated until 2015. The use of prostheses, walking aids and wheelchairs was noted.Results: The cohort comprised 12 patients (nine men and three women with a mean age 35 years at treatment) and the median follow-up time was seven years (1–20). At baseline, 9/12 used prostheses and 3/12 did not. The main means of locomotion was in a wheelchair without wearing prostheses (n = 8/12) or in a wheelchair in combination with prosthetic walking supported by walking aids (n = 4/12). All prosthetic users had problems with sitting comfort. At follow-up, 11/12 patients used prostheses, while one did not. The means of locomotion was prosthetic walking in 3/12 cases, a combination of a wheelchair and prosthetic walking in 4/12, a wheelchair while wearing prostheses but not walking in 4/12 and a wheelchair without wearing prostheses in 1/12. Three patients walked unsupported by walking aids. Seven patients had no problem with prosthetic sitting comfort (n = 3 had small problems).Conclusions: Bone-anchored prostheses in patients with bilateral TFAs resulted in more prosthesis use during everyday locomotion, due hypothetically to improved comfort while wearing prostheses. The results further underline the importance of other assistive devices such as wheelchairs and walking aids used in combination with prostheses in this group of patients facing severe functional limitations.Implications for RehabilitationThis study provides an insight into the details of the rehabilitation and outcome in patients with traumatic bilateral transfemoral amputations treated with bone-anchored prostheses in Sweden.The treatment can lead to a large amount of prosthetic use, but most patients will also use a range of assistive devices including full-length prostheses, stubbies, walking aids and wheelchairs after treatment.The importance of sitting in comfort while wearing prostheses should not be underestimated in patients with bilateral transfemoral amputations.

Comprehensive Treatment Strategy for Chronic Low Back Pain in a Patient with Bilateral Transfemoral Amputations Integrating Changes in Prosthetic Socket Design

ABSTRACT Introduction Wounded service members with amputations undergo a complex rehabilitation regimen that can often become complicated by skin breakdown, heterotopic ossification (HO), and pain of the residual limb, contralateral limb, or low back. These complications can impact prosthetic socket fit, decreasing one's functional independence, and potentially negatively impact quality of life. The purpose of this report is to present a case involving the treatment of HO along with prosthetic socket modifications, with the intention to address low back pain (LBP), in a patient with bilateral transfemoral amputations. Materials and Methods The patient experienced traumatic bilateral amputations as a result of an improvised explosive device blast. He was initially fit with ischial containment sockets to provide stability and enhance early mobility. He became a community ambulator but was experiencing LBP and issues with HO. After extensive HO resection, a multidisciplinary discussion took place to determine the best way to diminish LBP by improving spinopelvic alignment while restoring function. It was decided to refit the patient with subischial containment sockets. Subjective questionnaires and three-dimensional gait analysis were used to quantify results. Results After HO resection and prosthetic socket modifications, the patient's complaints of LBP decreased, along with subjective improvements in the Oswestry Disability Index and Short Musculoskeletal Functional Assessment. During upright standing, anterior pelvic tilt decreased from 27.6° to 18.1°. During walking, excursion of the trunk relative to the pelvis decreased in all planes after changing prosthetic socket design to subischial and completing 6 months of rehabilitation: from 24.0° to 17.6° in the frontal plane, 12.4° to 7.8° in the sagittal plane, and 23.1° to 19.1° in the transverse plane. Conclusions A multidisciplinary team approach to the care of patients with bilateral transfemoral amputations can help to improve functional outcomes. For this patient with nonradicular, mechanical LBP, a subischial prosthetic socket design that minimized intrusion on the pelvis had a significant influence on static and dynamic sagittal spinopelvic alignment and overall outcomes. In the end, contributions by orthopedic and plastic surgeons, pain management strategies by a physical medicine and rehabilitation physician, rehabilitation by a physical therapist, and prosthetic modifications all played a role in reduction of this patient's LBP. Among the numerous interventions provided to this patient, including surgical revisions, prosthetic socket design, prosthetic alignment, and physical therapy, it is hypothesized that the change in prosthetic socket design from ischial containment to subischial had a significant, long-lasting impact on LBP and function.

両大腿切断スイマーのクロール泳ストロークの最適化

両大腿切断スイマーのクロール泳ストロークの最適化

Optimizing simulation of arm stroke in freestyle for swimmers with bilateral transfemoral amputation

Optimizing simulation of arm stroke in freestyle for swimmers with bilateral transfemoral amputation

Hip prosthesis in sitting posture for bilateral transfemoral amputee after burn injury

To overcome the challenges of rehabilitation of bilateral transfemoral amputees, we developed a novel "hip prosthesis in the sitting posture." Case Description and Methods: A 64-year-old male bilateral transfemoral amputee was transferred for rehabilitation 4 months following a burn injury. His wounds remained unhealed for 20 months; thus, he was unable to participate in standing training with the standard prosthetic sockets. Hip prosthesis in the sitting posture has very little friction between the sockets and residual limbs, which facilitated our patient to begin standing and walking exercises. Findings and Outcomes: The patient's refractory wounds healed 1 month after initiating exercises using hip prosthesis in the sitting posture, and he could begin rehabilitation with the standard prostheses. Hip prosthesis in the sitting posture enabled a bilateral transfemoral amputee with unhealed residual limbs to stand, walk, and begin balance training. Hip prosthesis in the sitting posture is an effective temporary prosthesis to prevent disuse until wounds are healed and to continue rehabilitation with standard prostheses. Clinical relevance Hip prosthesis in the sitting posture is useful for bilateral transfemoral amputees with unhealed residual limbs after burn injuries to prevent disuse and maintain motivation for walking.