Hip Disarticulation Amputees Research Articles

Design and prototype validation of a laterally mounted powered hip joint prothesis.

Prosthetic technology has advanced with the development of powered prostheses to enhance joint function and movement in the absence of native anatomy. However, there are no powered solutions available for hip-level amputees, and most existing hip prostheses are mounted to the front of the prosthetic socket, thereby limiting range of motion. This research introduces a novel laterally mounted powered hip joint (LMPHJ) that augments user movement. The LMPHJ is mounted on the lateral side of the prosthetic socket, positioning the hip joint closer to the anatomical center of rotation while ensuring user safety and stability. The motor and electronics are located in the thigh area, maintaining a low profile while transmitting the required hip moment to the mechanical joint center of rotation. A prototype was designed and manufactured, and static testing was complete by modifying the loading conditions defined in the ISO 15032:2000 standard to failure test levels for a 100kg person, demonstrating the joint's ability to withstand everyday loading conditions. Functional testing was conducted using a prosthesis simulator that enabled able-bodied participants to successfully walk with the powered prosthesis on level ground. This validates the mechanical design for walking and indicates the LMPHJ is ready for evaluation in the next phase with hip disarticulation amputee participants.

A pelvic kinematic approach for calculating hip angles for active hip disarticulation prosthesis control

BackgroundControl system design for a microprocessor-controlled hip–knee–ankle–foot (HKAF) prosthesis is a challenge since hip disarticulation amputees lack the entire leg and, therefore, only have pelvis movement as user-guided input. This research proposes a method for determining hip joint angles from pelvis movement in a control system for the next generation of powered prostheses.MethodThree-dimensional pelvic motion and stance time of 10 transfemoral (TF) prosthetic users were used to identify important features and to develop an algorithm to calculate hip angles from pelvis movement based on correlation and linear regression results. The algorithm was then applied to a separate (independent) TF group to validate algorithm performance.ResultsThe proposed algorithm calculated viable hip angles during walking by utilizing pelvic rotation, pelvic tilt, and stance time. Small angular differences were found between the algorithm results and motion capture data. The greatest difference was for hip maximum extension angle (2.5 ± 2.0°).ConclusionsSince differences between algorithm output and motion data were within participant standard deviations, the developed algorithm could be used to determine the desired hip angle from pelvis movements. This study will aid the future development of gait control systems for new active HKAF prostheses.

Design of a Bio-Inspired Gait Phase Decoder Based on Temporal Convolution Network Architecture With Contralateral Surface Electromyography Toward Hip Prosthesis Control.

Inter-leg coordination is of great importance to guarantee the safety of the prostheses wearers, especially for the subjects at high amputation levels. The mainstream of current controllers for lower-limb prostheses is based on the next motion state estimation by the past motion signals at the prosthetic side, which lacks immediate responses and increases falling risks. A bio-inspired gait pattern generation architecture was proposed to provide a possible solution to the bilateral coordination issue. The artificial movement pattern generator (MPG) based on the temporal convolution network, fusing with the motion intention decoded from the surface electromyography (sEMG) measured at the impaired leg and the motion status from the kinematic modality of the prosthetic leg, can predict four sub gait phases. Experiment results suggested that the gait phase decoder exhibited a relatively high intra-subject consistency in the gait phase inference, adapted to various walking speeds with mean decoding accuracy ranging from 89.27 to 91.16% across subjects, and achieved an accuracy of 90.30% in estimating the gait phase of the prosthetic leg in the hip disarticulation amputee at the self-selected pace. With the proof of concept and the offline experiment results, the proposed architecture improves the walking coordination with prostheses for the amputees at hip level amputation.

Reciprocating gait prosthesis for the bilateral hip disarticulation amputee

Reciprocating gait prosthesis for the bilateral hip disarticulation amputee

Robotic hip-disarticulation prosthesis: evaluation of prosthetic gaits in a non-amputee individual

This is the first report regarding the application of a robotic prosthesis for hip-disarticulation amputees. Hip-disarticulation prostheses (HDPs) are used by amputees with either an amputation or anomaly at or close to the hip joint. Robotics can be beneficial in such cases, as these individuals have reduced levels of motor function compared to other amputees and have limited mobility. We developed a robotic HDP, and analysed the gaits of a non-amputee using the robotic and non-powered dummy HDPs. The results imply that a robotic HDP may induce proper gait and maintain the burdens of the prosthetic and non-prosthetic limbs symmetrically.

Effect of Ottobock 7E9 Hip Joint on the prosthetic walking ability of hip disarticulation amputees

Effect of Ottobock 7E9 Hip Joint on the prosthetic walking ability of hip disarticulation amputees

Energy consumption during prosthetic walking and physical fitness in older hip disarticulation amputees

The objective of this study is to investigate energy consumption during prosthetic walking and physical fitness in older hip disarticulation (HD) subjects and to examine the ambulatory outcome in a community setting. The subjects were seven unilateral HD amputees with an average age of 67.7 +/- 3.9 yr. Energy consumption was measured during prosthetic walking at each individual's comfortable walking speed (CWS) by means of a portable telemetric system. An incremental exercise test was performed to evaluate fitness. The average CWS for the subjects was 30.5 +/- 9.6 m/min. The average oxygen consumption rate at each CWS was 18.3 +/- 2.4 mL/kg/min, and the average oxygen cost was 0.639 +/- 0.165 mL/kg/m. The maximum oxygen uptake during exercise as a proportion of predicted maximum oxygen uptake (%VO2max) for the subjects was 57.2 +/- 11.1. Five subjects continued prosthetic walking on return to their communities. Two subjects abandoned prosthetic walking. The %VO2max for the five who continued prosthetic walking after discharge ranged from 55.8 to 72.0. The subjects who abandoned prosthetic walking had lower %VO2max of 43.3 and 44.2. Energy consumption during prosthetic walking at CWS seemed not to be excessive. Older HD amputees in good physical condition were able to successfully walk with a prosthesis in a community setting. A lower level of fitness appears to make community walking prohibitive.

Biomechanical Differences between Two Exoprosthetic Hip Joint Systems during Level Walking

Previous studies have shown low end-user acceptance of a hip disarticulation style prosthesis and that the limitations of such prostheses, including poor gait pattern, socket discomfort, weight of the prosthesis, loss of mobility, instability and high energy consumption are a contributing factor. This study was initiated to determine if a new style of prosthetic hip joint could help to overcome some of the limitations concerning the gait pattern. The present study analyzed the gait pattern of six hip disarticulation amputee subjects. The objective was to compare two different prosthetic hip joints, both from Otto Bock HealthCare: The new Helix(3D) and the 7E7, which is based on the Canadian model proposed by McLaurin (1954). Kinematics and kinetics were recorded by an optoelectronic camera system with six CCD cameras and two force plates. During weight acceptance, the Helix(3D) extends considerably slower and reaches full extension later than the 7E7. The increased range of pelvic tilt observed with hip disarticulation amputees is significantly reduced (by 5 ± 3 degrees) when using the Helix(3D) Hip Joint. In addition, this system showed increased stance phase knee joint flexion as well as increased maximum swing phase knee flexion angles compared to the 7E7. These motion analysis results show that the Helix(3D) Hip Joint can reduce gait abnormalities compared to the uniplanar design of the 7E7 hip joint.

Factors Affecting Prosthetic Rehabilitation Outcomes in Amputees of Age 60 Years and Over

This retrospective, observational study was designed to investigate factors affecting successful prosthetic ambulation in elderly amputees aged > or = 60 years. The study included 64 unilateral transfemoral or hip disarticulation amputees. Patients who were able to walk > or = 100 m with prosthesis were classified as successful and those who could walk < 100 m as failures. Age, comorbidities, cause of amputation, ability to stand on one leg, patient's motivation for walking and maximum oxygen uptake as a proportion of predicted maximum oxygen uptake (%VO(2max)) during an exercise load test were examined as indicators of physical fitness. Significant differences were noted between the two groups in the number of comorbidities, ability to stand on one leg, patient's motivation for walking and mean %VO(2max). A low number of comorbidities, the ability to stand on one leg, motivation for walking and adequate physical fitness allowing an exercise intensity of > or = 50% VO(2max) were considered to be predictive factors for successful prosthetic rehabilitation.

Energy Consumption During Prosthetic Walking and Wheelchair Locomotion by Elderly Hip Disarticulation Amputees

To investigate the differences in energy consumption by patients with hip disarticulation between prosthetic walking and wheelchair locomotion. : The subjects consisted of seven amputees, all older than 60, with unilateral hip disarticulation. Energy consumption when walking with prosthesis and when propelling a wheelchair, each at the respective comfortable movement speed, was measured by means of a portable telemetric system. The average comfortable movement speed for prosthetic walking was 30.5 m/min, which was much slower than the 63.1 m/min average for wheelchair locomotion (P < 0.01). The average oxygen cost value for prosthetic walking was 0.639 ml/kg/m, and the average for wheelchair locomotion was 0.175 ml/kg/m, indicating that oxygen cost was significantly higher for prosthetic walking than for wheelchair locomotion (P < 0.01). The results of this research clearly showed that the efficiency of prosthetic walking for elderly hip disarticulation amputees was very low. When the subject is judged not to be a candidate for practical prosthetic walking after a careful multidisciplinary evaluation, wheelchair locomotion may be an alternative to prosthetic walking as a realistic goal.

Functional outcome of hip disarticulation and hemipelvectomy: a cross-sectional national descriptive study in the Netherlands

Objective: To describe characteristics of hip disarticulation and hemipelvectomy amputees, to assess their level of activities, participation and experienced limitations in mobility and to describe the amputation-related problems. Design: A cross-sectional study. Setting: Patients were mainly recruited via orthopaedic workshops in the Netherlands. Subjects: Forty-six patients with an acquired unilateral hip disarticulation or hemipelvectomy at least one year post amputation. Main outcome measures: Sickness Impact Profile 68 (SIP 68) to assess the level of activity and participation and the questionnaire Rising and Sitting Down, Walking and Climbing Stairs to assess perceived limitations in mobility. Results: The 46 patients (31 with hip disarticulation and 15 with hemipelvectomy) had a mean age of 55.8 years (SD 12.1). In 78% of cases the reason for amputation was a tumour. Mean SIP 68 was low, 10.5 (SD 6.9). Hip disarticulation amputees had significantly poorer emotional stability than the hemipelvectomy amputees (P = 0.04). All amputees experienced considerable limitations in their mobility according to the Rising and Sitting Down, Walking and Climbing Stairs scores. Conclusions: Hip disarticulation and hemipelvectomy amputees have a relatively high level of activity and participation (SIP scores) but at the same time experience limitations in walking, rising and sitting down and climbing stairs.

Successful prosthetic fitting of a 73-year-old hip disarticulation amputee patient with cardiopulmonary disease

Patients with hip disarticulation (HD) require high energy expenditure for successful prosthetic ambulation. Thus, older patients are rarely fitted with an HD prosthesis. To our knowledge there are no reports of gait analysis following successful prosthetic fitting of an elderly HD amputee patient with systemic cardiopulmonary disease. We report the case of successful prosthetic ambulation in a 73-year-old man with HD secondary to histiosarcoma and a medical history significant for stable angina, chronic obstructive pulmonary disease, and diabetes mellitus. The patient underwent gait training with an endoskeletal prosthesis and achieved ambulation to 400 feet with bilateral forearm crutches. Vicon kinematic gait analysis revealed a cadence of 44steps/min (112steps/min normal), and double support time of 47% (26% normal). Oxygen rate during ambulation (Vo 2) was 11.0mL/kg/min at velocity of .35m/sec, compared with published figures for ambulation in those with HD of 10.73mL/kg/min at velocity of .93m/sec. At 1-year follow-up, the patient continued to walk into church with the prosthesis. We conclude that a trial fitting of an HD prosthesis should be considered on an individual basis in elderly amputee patients.

Poster 160 Successful prosthetic fitting of an elderly hip disarticulation amputee patient with cardiopulmonary disease: Manouchehr Refaeian, MD (The University of Texas Health Science at San Antonio, San Antonio, TX); Robert D. McAnelly, MD; Dennis G. O'Connell, PhD; Gregory D. Powell, MD; Nicolas E. Walsh, MD

Poster 160 Successful prosthetic fitting of an elderly hip disarticulation amputee patient with cardiopulmonary disease: Manouchehr Refaeian, MD (The University of Texas Health Science at San Antonio, San Antonio, TX); Robert D. McAnelly, MD; Dennis G. O'Connell, PhD; Gregory D. Powell, MD; Nicolas E. Walsh, MD

Clinical gait analysis of hip disarticulation amputees

To assess the efficacy of an off-loading wheelchair seat cushion in removing pressure from high-risk ischial tuberosities and the coccyx/sacrum in wheelchair sitting.Repeated-measures design.Private research laboratory.Manual wheelchair users with chronic spinal cord injuries (N=10).Three configurations of an off-loading wheelchair seat cushion compared with a flotation style (10-cm air inflation) wheelchair seat cushion.Outcome measures included peak pressure index (PPI), ischial tuberosity peak pressures, and the dispersion index or ratio of pressures under the ischial and sacral regions to the total of all pressures recorded.PPI and ischial tuberosities peak pressure ranged from a low of 39±18 and 68±46mmHg in the fully off-loaded cushion to a high of 97±30 and 106±34mmHg, respectively, for the flotation style cushion (2-way analysis of variance main effect across 4 conditions, P<.001). Dispersion index ranged from a low of 8%±3% in the fully off-loaded cushion to a high of 16%±3% in the flotation style cushion. Pairwise comparisons yielded significance in all cushion-pair analyses (P<.05 after multiple corrections).The force-removal approach of this orthotic off-loading cushion design effectively reduces a known extrinsic risk factor for pressure ulcers—interface pressure—in the high-risk ischial tuberosity and sacral/coccygeal regions of the buttocks.

Repeatability of kinetic and kinematic measurements in gait studies of the lower limb amputee.

During the last few years considerable attention has been given to the use of gait analysis as a tool for clinical use. The instrumentation for measurement of the kinetics and kinematics of human locomotion was originally designed for research use. Extension of its use into the clinical field calls for simplified methodology and clearly defined protocols with precise identification of the relevant parameters for the analysis. Force platforms, TV-computer and pylon transducer systems were used for collection of kinetic and kinematic data of five normal subjects, 10 below-knee, 10 above-knee and one hip disarticulation amputee. The repeatability tests showed significant differences in the measured parameters. These variations are attributed to the methodology of the analysis and the step to step variation of the subjects' gait. Differences in the degree of step to step variation between various amputee and normal subjects are quantified. In this presentation the capability of present day systems to perform repeatable gait measurements is discussed. A computational method for determination of representative measurements for the purposes of biomechanical evaluation and comparison as well as quantification of the degree of repeatability is described.

Technical note--auditory feedback of knee angle for amputees.

A new gait training device has been developed to provide auditory feedback of knee angle information to above-knee and hip disarticulation amputees. Traditionally, new amputees have relied on visual feedback of knee position during gait training (van Griethuysen, 1979). This auditory feedback system eliminates the need for visual feedback by providing a frequency encoded tone corresponding to knee angle.

Locomotion of the Hip Disarticulation Amputee

The Canadian type hip disarticulation prosthesis has been a significant improvement over the 'tilting table' design. In spite of its general use very little information on the patient/prosthesis performance exists. This paper describes an investigation carried out on three male patients. External load actions on the prosthetic and contralateral sides were measured simultaneously and synchronously with the configuration of the limb segments during level walking. Loading patterns at the ankle, knee and hip levels are presented and their significance discussed.

Temporary Prosthesis for the Hip-Disarticulation Amputee

Journal Article Temporary Prosthesis for the Hip-Disarticulation Amputee Get access Virginia Giaccone, MA, Virginia Giaccone, MA 1Ms. Giaccone is Assistant Chief, Physical Therapy, Elmhurst General Hospital, 79-01 Broadway, Elmhurst, NY 11373. Search for other works by this author on: Oxford Academic Google Scholar Dorothy Stack, BS Dorothy Stack, BS 2Mrs. Stack is Senior Physical Therapist, Elmhurst General Hospital, 79-01 Broadway, Elmhurst, NY. Search for other works by this author on: Oxford Academic Google Scholar Physical Therapy, Volume 57, Issue 12, December 1977, Pages 1394–1395, https://doi.org/10.1093/ptj/57.12.1394 Published: 01 December 1977