Changes in the Locomotor System as a Consequence of Amputation of a Lower Limb

Abstract

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.