Fitting Timetable
The lower limb-deficient child should be fit with a prosthesis when they are ready to pull up to a standing position (48). This usually occurs between 9 and 10 months of age. The goals in fitting a prosthesis at this early age are to allow for normal two-legged standing, provide a means for reciprocating gait development, and provide a normal appearance.
The prosthesis should be simple in design, allow growth adjustment, suspend securely, and be lightweight. Historically, at an early age, the transfemoral prosthesis should not utilize a knee joint due to the complexity of operating a free knee, however, this philosophy is being reevaluated. Knee joints were usually added between 3 and 5 years of age, at times with a manual locking option (140). Knee units are can be added initially if an extension assist on the knee is utilized to help bring the knee into full extension prior to loading. Either an endoskeletal or an exoskeletal construction may be employed; each has advantages and disadvantages (138). Endoskeletal construction is good for growth consideration and is generally durable enough in most settings. The foam cover of the endoskeletal design requires more maintenance than an exoskeletal finish. The exoskeletal construction is robust and should be considered for those individuals who will test the limits of durability.The child who acquires an amputation will be treated much the same as the congenital limb-deficient child, with a few exceptions. A child who undergoes an amputation will likely require a preparatory prosthesis while postoperative swelling subsides. The preparatory limb will probably be worn for approximately three months. In the case of the child who is undergoing chemotherapy treatment, it is useful to use a volume-adjustable socket.