Absent loading response knee flexion: The impact on gait kinetics and centre of mass motion in individuals with unilateral transfemoral amputation, and the effect of microprocessor controlled knee provision

Abstract

BackgroundIndividuals with unilateral transfemoral amputation walk with increased levels of asymmetry, and this is associated with reduced gait efficiency, back pain and overuse of the intact limb. This study investigated the effect of walking with a unilateral absence of loading response knee flexion on the symmetry of anterior-posterior kinetics and centre of mass accelerations. MethodsA retrospective cohort study design was used, assessing three-dimensional gait data from individuals with unilateral transfemoral amputation (n = 56). The anterior-posterior gait variables analysed included; peak ground reaction forces, impulse, centre of mass acceleration, as well as rate of vertical ground reaction force increase in early stance. With respect to these variables, this study assessed the symmetry between intact and prosthetic limbs, compared intact limbs against a healthy unimpaired control group, and evaluated effect on symmetry of microprocessor controlled knee provision. FindingsSignificant between-limb asymmetries were found between intact and prosthetic limbs across all variables (p < 0.0001). Intact limbs showed excessive loading when compared with control group limbs after speed normalisation across all variables (p < 0.0001). No improvement in kinetic symmetry following microprocessor controlled knee provision was found. InterpretationThe gait asymmetries for individuals with transfemoral amputation identified in this study suggest that more should be done by developers to address the resultant overloading of the intact limb, as this is thought to have negative long-term effects. The provision of microprocessor controlled knees did not appear to improve the asymmetries faced by individuals with transfemoral amputation, and clinicians should be aware of this when managing patient expectations.