Femur Abduction Associated with Transfemoral Amputation Alters the Profile of Lumbopelvic Mechanical Loads During Generalized End-Limb Loading.

Abstract

Pain in the lower back is frequent problem for most individuals with transfemoral amputation, which limits their overall mobility and quality of life. While the underlying root causes of back pain are multifactorial, a contributing factor is the mechanical loading environment within the lumbopelvic joint. Specifically, this study aims to explore the upstream effects amputation has on the mechanical loading environment of the lumbopelvic joint using a 3D musculoskeletal model of transfemoral amputation. A generic musculoskeletal model was altered to represent a transfemoral amputation. Muscle parameters were adjusted to represent a myodesis amputation surgery that preserved musculotendon tension in a neutral anatomical pose. The model contained a total of 28 degrees of freedom and 76 muscles spanning the lower-limb and torso. In forward dynamics simulations, generalized external forces were applied to the distal end of the residual limb at a series of directions. Axial, oblique and transverse 10 N end-limb loads were applied. In addition, simulations were performed for 0°, 4°, and 8° of femur abduction, which are clinically observed in individuals with transfemoral amputation. In these simulations, reaction forces and moments at the lumbopelvic joint were computed. In general, femur abduction had little effect on back loading for an axial applied end-limb force. These data showed that while the individual magnitudes of lumbopelvic force and moment reactions did not significantly deviate for differing levels of femur abduction, the pattern of how these forces changes in response to different end-limb force directions (applied circumferentially along the limb) was affected by femur abduction angle.Clinical Relevance- The changes in joint reaction forces in the lumbopelvic joint from an aligned position to an abducted position reinforce the importance of avoiding hip flexion-abduction contracture during amputation surgery. This suggests that surgical techniques such as myodesis, osseointegration, or medial thighplasty, which intend to maintain anatomical alignment may have beneficial upstream effects for the patients during locomotion. Given the prevalence of lower back pain in individuals with transfemoral amputation, teasing out the causes of lower back pain could bring relief to a population that struggles with community independence.