Which of the following describes the ideal resting position for a transfemoral amputation?

• A. Elevated residual limb with hip flexion
• B. Prone lying with hip in external rotation
• C. Supine with hip in neutral flexion and neutral abduction
• D. Ideal resting position: supine with hip in neutral flexion and neutral abduction

Answer: (D)

Preventing hip contractures by keeping the hip in a neutral position at rest is essential after a transfemoral amputation. When the residual limb rests with the hip in neutral flexion and neutral abduction, the muscles on the front and sides of the hip are not kept in a shortened or lengthened state that would promote contractures. This neutral alignment also helps the limb align with a future prosthesis and reduces discomfort that can come from abnormal stress on the joint.

Elevating the residual limb with the hip flexed tends to encourage a hip flexion contracture, making it harder to achieve a comfortable, functional prosthetic fit and increasing stiffness and pain. Prone lying with the hip externally rotated places the hip in a nonneutral position that can promote muscle imbalances and abnormal rotation, which isn’t ideal for a resting posture. The neutral supine position balances the hip and supports healing while keeping options open for prosthetic use.