Hip Disarticulation Few hip disarticulation amputees will become
functional walkers due to the high energy cost of prosthetic ambulation.
Posttrauma or tumor patients will occasionally use a prosthesis for limited
activity. These patients sit in their prostheses and must use their torsos
to achieve momentum to throw the limb forward and advance the limb.
Prosthetic fitting for growing children is challenging because
frequent adjustments are needed. Prosthetic fitting should be initiated to
closely coincide with normal skill development. In the upper limb, this
development begins at the time of sitting balance, usually 4 to 6 months of
age. Initially, a passive rubberized terminal device with blunt rounded
edges is used. Active cable control and a voluntary opening terminal device
are added when the child exhibits initiative in placing objects in the
terminal device, usually in the second or third year of life. Myoelectric
prostheses are not usually prescribed until the child has mastered
In the lower limb, prosthetic fitting usually coincides with crawling
and pulling to stand at 8 to 12 months of age. Knee control at the
transfemoral level cannot be expected until the child demonstrates
proficiency in walking with a locked knee. Children will have unusual gait
patterns, and formal gait training should be delayed until age 5 to 6
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