Gait Characteristics of Transtibial Amputees on Level Ground in a Cohort of 53 Amputees - Comparison of Kinetics and Kinematics With Non-amputees.

STUDY DESIGN: Retrospective analysis. BACKGROUND: The gait characteristics of transtibial amputees (TTs) have been described many times. In general, the literature reported nearly consistent results for the kinematic and kinetic parameters of the prosthetic side. However, the literature revealed inconsistent findings on kinetic parameters for determining the risk of developing knee osteoarthritis, such as the peak knee adduction moment, knee flexion moment and vertical ground reaction forces. OBJECTIVES: The objective of our study was to describe the sagittal kinetic and kinematic gait characteristics of the ankle and residual knee joint of the prosthetic limb and the knee loading parameters of the sound side of unilateral TTs. This specific consideration may contribute to resolving the controversy of these parameters in the literature. METHODS: We analysed our database containing gait analyses from 53 unilateral TTs and compared data to a control group (CG), also taken from our database. The sagittal kinetic and kinematic gait characteristics of the ankle and residual knee joint of the prosthetic limb, and selected knee loading parameters of the sound side (the peak knee adduction moment, knee flexion moment and vertical ground reaction forces) were evaluated. Beside these parameters we reported typical spatiotemporal gait parameters as gait velocity, step length, step length asymmetry, stance phase duration and asymmetry of stance phase duration. RESULTS: The TTs walked slower and more asymmetrically than the CG. The kinematic pattern of the prosthetic ankle differed from that found in the CG. The largest difference was observed for the range of motion of the plantarflexion at push-off, which was significantly reduced for the prosthetic foot. The residual knee joint was generally affected with respect to decreased moments and reduced knee flexion during stance phase. The peaks of the vertical ground reaction forces and knee adduction moments showed no differences between the sound side of amputees and the CG. The peak knee flexion moment at midstance was significantly reduced for the sound side of amputees in comparison with the CG. CONCLUSION: The biomechanical data measured for the prosthetic side in a cohort of 53 unilateral TT amputees conformed with the literature. The parameters determining the risk of developing knee osteoarthritis investigated in our retrospective analysis were not increased on the sound side in comparison with non-amputees. We deem it reasonable to assume that an appropriate prosthesis will reduce the likelihood of overloading the knee on the sound side during normal walking.

[Changes in the Locomotor System as a Consequence of Amputation of a Lower Limb]. / Veränderungen am Bewegungsapparat als Folge von Amputationen an der unteren Extremität.

Background: It is often assumed that leg amputations result in a greater risk of degenerative changes to the locomotor system. This paper analysed the extent to which this assumption is supported by the scientific literature. In particular, the study analysed the level of risk of various degenerative diseases in amputees. Method: A systematic literature search was conducted in scientific databases on degenerative changes caused by amputations. All pertinent articles were qualitatively analysed; the available quantitative results were summarised and compared to data for the able bodied population. Results: The search yielded 40 publications that met the inclusion criteria. A quantitative summary of the studies showed that 56 % of amputees suffered from back pain, radiographic signs of arthritis were found in the sound knee of 35 % of patients, compared with clinical signs in 33 %. Clinical symptoms of hip osteoarthritis were seen in 15 % of amputees on the prosthetic side and in 20 % on the sound side. 87 % of patients exhibited reduced bone density in the hip on the prosthetic side and all amputees exhibited muscular atrophy in the residual limb. Conclusions: Thanks to the development of prosthetic components it is possible to adjust the length of the prosthesis to the length of the sound limb, so that there are no longer discrepancies in leg length. This means that flexion deformities of the spine of amputees have become rarer and are therefore no longer discussed in the current literature. The risks of back pain, knee osteoarthritis in the sound side, reduced bone density on the prosthetic side hip and muscular atrophy are still significantly greater than in the able bodied population. The prevalence of back pain and knee osteoarthritis increases in more proximal amputations. It may be possible to reduce these risks with novel prosthetic components and by optimising prosthetic fitting. On the one hand, an optimised prosthesis will be used more often. On the other hand, it will be exposed to greater loads and therefore the load to the locomotor system could be distributed more evenly between the two legs. Both aspects would result in a more physiological loading of the locomotor system. There was not enough published evidence to determine to what extent the sound side foot shows degenerative changes.