Acute Care

Early Mobility

Early mobility following lower limb amputation can be broken in to two phases:

  • Immediate post-operative mobility
  • Early prosthetic mobility

Immediate Post-Operative Mobility

Regaining mobility as soon as possible following surgery is crucial. This can start as soon as it is clinically judged safe to do so, from a patient safety perspective, and from a wound protection perspective. Mobility at this point can include practice of transfers, standing up, standing balance, and hopping with crutches / frames. The presence of a rigid dressing can assist with protecting the stump and reducing potential gravity-induced oedema while mobilising. The goals of mobility in this early phase are:

  • Maintain / improve strength
  • Maintain / improve cardiovacular fitness
  • Regain independence
  • Prevention of complications: contractures, pressure sores, deconditioning
  • Improve psychological well being
  • Prepare for transfer to Rehabilitation and/or discharge home

Early Prosthetic Mobility

Early prosthetic mobility is usually commenced as soon as the wound is judged sufficiently healed. There is also some evidence in the literature that early mobility can improve healing, possibly through the increased blood flow to the stump through exercise and muscular compression / relaxation within the socket.

Please see the Gait Analysis & Training Portal for tips on training early prosthetic mobility.

Early Prosthetic Mobility

Historically, devices used to achieve early prosthetic mobility were:

  • Immediate Post-Operative Prosthesis (IPOP). The are many variations described in the literature, and they can be made from plaster or synthetic materials. Some designs are as basic as a rigid dressing with pylon & foot attachments.
  • Pneumatic Post-Amputation Mobility Aid (PPAM). These consist of an inflatable air splint surrounded by a metal frame, with an adjustable pylon and foot extension. The splint cushioned the stump and also assisted in distributing weight around the residual limb.
  • Plaster of Paris Temporary Prosthesis. These consisted of plaster patella tendon bearing (PTB) or quadrilateral sockets manufactured following the principles of total contact and selective weight bearing, with standard modular components attached below the socket. Usually these were manufactured by Physiotherapists, in NSW.

Use of these devices is largely discontinued in Australia, although there may still be some centres where they are still used. However, documents related to the fabrication and use of these devices are listed here, for historical reasons. Other devices do exist, such as the Total Environment Control (TEC) system, also described in attached documents.

Interim Prostheses for Early Weight Bearing

An Interim Prosthesis is described as a Prosthetist-manufactured prosthesis, constructed using the same design principles as definitive prostheses. Sockets may be made of cheaper materials, as they are designed to be replaced as the stump shrinks and matures. Ideally the modular components prescribed are the same as those recommended for the definitive prosthesis, as they will be retained when the stump is judged to be ready for the definitive socket. Because of the cost of these devices, compared to those used historically, post-operative Physiotherapy to minimise oedema and shape the residual limb is even more crucial, as the sockets cannot be replaced as quickly as they were historically.

Interim Prosthesis Program (NSW)

In October 2010, the NSW Artificial Limb Service announced their program of prosthetist-manufactured interim prostheses, supplied through contracted Prosthetists to NSW public patients. Details of the program follow, with thanks to Marnie Jones for supplying the information. This information should only be regarded as correct up to the time the initial contract expires, or earlier if otherwise stated. For further information, contact Enable NSW (details below).

Provision of Interim Artificial Limb Prosthetics and Associated Services for EnableNSW (Metropolitan Area Health Services only). User Guide (Version 3).

Contract period: 1 November 2010 to 30 September 2011 (with 2 x 12 months extension options). Contract Officer Caroline Sanoyan.

Health Support Service have tendered and contracted designated service providers to deliver interim prosthetic care for NSW PLS entitled amputees for a period of 6 months post amputation. The contracts are for a period of 12 months commencing November 2010, but may be extended by a further period up to 24 months. This contract was reviewed in December 2011, and subsequently extended to June 2012.

The contract excludes services to private and compensable amputees. Service will be provided to trans-tibial, knee-disarticulation and trans-femoral amputees.

Tenderers must supply the service as a package of care which includes assessment, manufacturing and fitting of the interim prosthesis and the first socket replacement, labour and incidental material costs incurred with castings, fabrication and fitting of the prosthesis, any volume adjustments and / or alignment adjustments as well as travel to and from the client to provide this service if the client is an inpatient.


  1. Appliance and Limb Centre (International) Pty Ltd with Reed Prosthetics, Orthotics Pty Ltd, and Wright Orthopaedics Pty Ltd)
  2. Premier Prosthetics and Orthotics Pty Ltd

Hospitals/ Facilities Serviced:

  • Royal North Shore Hospital
  • Royal Ryde Rehab Centre
  • Hornsby Ku-ring-gai / Mona Vale Hospitals
  • Wyong Hospital
  • Gosford Hospital
  • Prince of Wales Hospital
  • St Vincent's Hospital
  • St George Hospital
  • Sutherland Hospital
  • Port Kembla/ Wollongong Hospitals
  • Shoalhaven / Berry Hospitals
  • Royal Prince Alfred Hospital
  • Concord Hospital
  • Camden Hospital
  • Braeside Hospital
  • Bankstown-Lidcombe Hospital
  • Blacktown Hospital
  • Westmead Hospital
  • Nepean Hospital

Warranty period of three months for the interim socket and a period of three months for the replacement socket


  • Inpatient: Travel to and from the hospital / facility areas are included in the package.
  • Outpatient: Patients may travel to the provider's premises or arrange fitting at the prescribing hospital's outpatient clinic.

Manufacturing time: from casting to fitting of the interim limb three working days, maximum five working days.

Response time: from prescription to casting two working days; for adjustments two working days.

Prescription forms are available from EnableNSW, Locked Bag 5270, Parramatta, NSW 2124, fax 87976543, phone 1800 362 253, or see