Designs and performance of three new microprocessor-controlled knee joints.

A crossover design study with a small group of subjects was used to evaluate the performance of three microprocessor-controlled exoprosthetic knee joints (MPKs): C-Leg 4, Plié 3 and Rheo Knee 3. Given that the mechanical designs and control algorithms of the joints determine the user outcome, the influence of these inherent differences on the functional characteristics was investigated in this study. The knee joints were evaluated during level-ground walking at different velocities in a motion analysis laboratory. Additionally, technical analyses using patents, technical documentations and X-ray computed tomography (CT) for each knee joint were performed. The technical analyses showed that only C-Leg 4 and Rheo Knee 3 allow microprocessor-controlled adaptation of the joint resistances for different gait velocities. Furthermore, Plié 3 is not able to provide stance extension damping. The biomechanical results showed that only if a knee joint adapts flexion and extension resistances by the microprocessor all known advantages of MPKs can become apparent. But not all users may benefit from the examined functions: e.g. a good accommodation to fast walking speeds or comfortable stance phase flexion. Hence, a detailed comparison of user demands and performance of the designated knee joint is mandatory to ensure a maximum in user outcome.

Designs and performance of microprocessor-controlled knee joints.

In this comparative study, three transfemoral amputee subjects were fitted with four different microprocessor-controlled exoprosthetic knee joints (MPK): C-Leg, Orion, Plié2.0, and Rel-K. In a motion analysis laboratory, objective gait measures were acquired during level walking at different velocities. Subsequent technical analyses, which involved X-ray computed tomography, identified the functional mechanisms of each device and enabled corroboration of the performance in the gait laboratory by the engineering design of the MPK. Gait measures showed that the mean increase of the maximum knee flexion angle at different walking velocities was closest in value to the unaffected contralateral knee (6.2°/m/s) with C-Leg (3.5°/m/s; Rel-K 17.0°/m/s, Orion 18.3°/m/s, and Plié2.0 28.1°/m/s). Technical analyses corroborated that only with Plié2.0 the flexion resistances were not regulated by microprocessor control at different walking velocities. The muscular effort for the initiation of the swing phase, measured by the minimum hip moment, was found to be lowest with C-Leg (-82.1±14.1 Nm; Rel-K -83.59±17.8 Nm, Orion -88.0±16.3 Nm, and Plié2.0 -91.6±16.5 Nm). Reaching the extension stop at the end of swing phase was reliably executed with both Plié2.0 and C-Leg. Abrupt terminal stance phase extension observed with Plié2.0 and Rel-K could be attributed to the absence of microprocessor control of extension resistance.