Distance et vitesse de marche chez les amputés en transfémoral équipés d’une prothèse à appui distal

Abstract

IntroductionPreservation of femoral condyles in patients with knee disarticulation amputation (KDA) facilitates distal support inside the socket, compared to transfemoral amputation (TFA), and allows the direct transfer of weight-bearing loads toward residual limbs. HypothesisThe hypothesis was that the gait distance and speed of TFA patients after a surgical femoral implant that allowed the distal support of the residuum would improve. Material and methodsIn total, 23 TFA patients received a titanium implant that allowed the distal weight bearing of the residuum inside the socket. The post-intervention follow-up period lasted 14 months. Gait distance and speed were assessed with the 2-minute walk test (2MWT). ResultsThe amputation etiology was trauma in 11 patients (48%), peripheral vascular disease in nine (39%) and oncologic disease in three (13%). The mean 2MWT distance was 103.6±34.7m prior to femoral implant and 128±38.9m at 14 months, which implies an improvement of 24% (p<0.001). The mean gait speed was 0.86±0.29m/s prior to femoral implant and 1.06±0.32m/s at 14 months (p<0.001). DiscussionAfter implant placement, distance covered increased by 24%. This value is higher than those described by other groups, such as Rau (12.6%) and Darter (19.2%), who assessed improvement in distance covered with the 2MWT in a younger population and after completing different physiotherapy programs. Our results showed improved distance walked and gait speed as well as in the physical functioning score in TFA patients 14 months after receiving a femoral implant that permitted distal residuum loading. Type of studyAn experimental prospective study. Level of proofIII, case-control study.