Hip Disarticulation Prosthesis Research Articles

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 and optimization of a new integrated hip and knee prosthesis structure.

Conventional hip disarticulation prostheses (HDPs) are passive devices with separate joint structures, limiting amputees' ability to control and resulting in abnormal gait patterns. This study introduces a new HDP integrating the hip and knee joints for amputees' natural gait. The new HDP restores the physiological rotation center of the hip with a remote center of motion (RCM) structure, and simulates the knee motion with a four-bar structure. Nonlinear programming was employed to optimize the hip-knee joint structure. A hybrid multi-objective drive structure with a series-parallel connection was also designed to ensure motion synergy between the hip and knee joints. Finally, a prototype of the prosthesis was tested using the HDP test system. The optimization results demonstrate that the new HDP accurately restores the rotation center of the femur in amputees, with the knee's instantaneous center of rotation (ICR) trajectory closely resembling that of the human knee (Pearson correlation coefficient is 0.999). The study shows that the new HDP achieves a motion reproduction accuracy of over 95% for the human hip joint at walking speeds above 1.5 km/h, 38% higher than conventional prosthesis. Similarly, at the same walking speed, the new HDP replicates the motion of the human knee at 82.89%, surpassing conventional prosthesis by 57.85%. The new HDP restores symmetry and replicates synergistic movement in amputees' lower limbs, exhibiting superior movement characteristics compared to conventional prostheses. This innovative HDP has the potential to enhance the quality of life for amputees.

A hip disarticulation prostheses test system to simulate gait for prostheses evaluation.

The limited number of hip prostheses users makes it less feasible to conduct amputee tests for prosthesis development in the clinic, which restricts the development efficiency of the intelligent prostheses. This study proposes a hip disarticulation prostheses test system (HDPTS) to supplement the amputee tests for hip disarticulation prosthesis (HDP) evaluation, which would potentially facilitate the prosthesis evaluation safety and development efficiency. The hip trajectory of an individual with normal gait was acquired and reproduced by calculating the corresponding movement joint angle of a manipulator. Then, an HDP was fit on an amputee and on the HDPTS respectively to obtain the hip and knee joint angles of the HDP during walking. Comparing the root mean square error (RMSE) of the expected and planned trajectory, the joint angles between the amputee test and HDPTS test, to verify the feasibility and accuracy of the HDPTS for prosthesis evaluation. The RMSE between the expected and planned trajectory value was less than 1.20mm (< 0.19%). The RMSE of the joint angles between the amputee test and HDPTS test were 2.18∘ (1.8%) and 3.13∘ (5.92%) for hip and knee joint respectively. The HDPTS was found accurate in hip trajectory reproduction and feasible in gait simulation for the prosthesis evaluation, which could potentially supplement the amputee test for prosthesis design thus improving prosthesis test safety and development efficiency.

Biomechanical gait analysis for a hip disarticulation prosthesis: power source for the swing phase of a hip disarticulation prosthetic limb.

[Purpose] This study aimed to clarify the power source for the swing phase of a hip disarticulation prosthetic limb using biomechanical gait analysis. [Participants and Methods] In this cross-sectional study, six participants who underwent hip disarticulation and seven healthy adults were recruited. Their gaits were assessed using the three-dimensional motion analysis and four force plates. [Results] From pre-swing to initial swing, the angle of the lumbar spine's angle changed by 9° from the flexion to extension positions. However, the power of the lumbar spine was <0.003 W/kg for the entire gait cycle. The peak value of joint moment and hip joint power on the unaffected side were 1 nm/kg and 0.7 W/kg, respectively. From pre-swing to initial swing, the prosthetic limb is pushed forward by extension of the hip joint on the intact side, while the spine returns to the flexion direction. [Conclusion] The hip extension force on the unaffected side was the main force responsible for swinging out the prosthesis, not the lumbar vertebrae's force.

Hip disarticulation and hemipelvectomy prostheses: A review of the literature.

Although the global population of people with a hip disarticulation (HD) or hemipelvectomy (HP) amputation is small, the degree of disability is high, affecting function and independence. A comprehensive literature review is needed to examine the evidence for prostheses in these amputation levels. A scoping literature review was conducted to examine related research documents from 1950 to September 2020, found using Scopus, Web of Science, PubMed, and Google Scholar databases. Studies evaluated (retrospectively or prospectively) HD or HP prostheses and were written in English. Study design and protocol, research instrument, sample size, and outcome measures were reviewed. In the past 70 years, 53 articles that evaluated HD or HP prostheses were published. Most research was conducted in the United States (24 articles) and Japan (nine articles). In 42 articles, authors prospectively evaluated the effects of prostheses in these amputation levels. On average, prospective studies had four (SD = 5) participants. Since 1950, only five prospective studies evaluated HD or HP prostheses with 10 or more participants. Moreover, sufficient information was often unavailable for research replication. More evidence is needed regarding the effects of HD or HP prosthetic components (i.e. hip, knee, ankle, socket type, and suspension system) on gait, patient satisfaction, prosthetic use, interface pressure, and energy expenditure. Articles mostly have small sample sizes that reduce confidence in the reliability of their findings and limit generalizability. Future investigations are needed with vigorous methodology and larger sample sizes to provide strong statistical conclusions.

Design and simulation of dynamic hip prosthesis based on remote motion center mechanism

The rotation center of traditional hip disarticulation prosthesis is often placed in the front and lower part of the socket, which is asymmetric with the rotation center of the healthy hip joint, resulting in poor symmetry between the prosthesis movement and the healthy lower limb movement. Besides, most of the prosthesis are passive joints, which need to rely on the amputee's compensatory hip lifting movement to realize the prosthesis movement, and the same walking movement needs to consume 2-3 times of energy compared with normal people. This paper presents a dynamic hip disarticulation prosthesis (HDPs) based on remote center of mechanism (RCM). Using the double parallelogram design method, taking the minimum size of the mechanism as the objective, the genetic algorithm was used to optimize the size, and the rotation center of the prosthesis was symmetrical with the rotation center of the healthy lower limb. By analyzing the relationship between the torque and angle of hip joint in the process of human walking, the control system mirrored the motion parameters of the lower on the healthy side, and used the parallel drive system to provide assistance for the prosthesis. Based on the established virtual prototype simulation platform of solid works and Adams, the motion simulation of hip disarticulation prosthesis was carried out and the change curve was obtained. Through quantitative comparison with healthy lower limb and traditional prosthesis, the scientificity of the design scheme was analyzed. The results show that the design can achieve the desired effect, and the design scheme is feasible.

A Gait Simulation and Evaluation System for Hip Disarticulation Prostheses

A little volume of lower extremity amputees needs hip disarticulation prostheses (HDPs). This situation makes it hard to invite hip amputees for prostheses test. The traditional evaluations for HDPs mostly refer to the questionnaires from the amputees and lack of quantitative criteria. In this article, we proposed a gait simulation and evaluation (GSE) system for HDPs testing. The GSE system contained a prosthetic thigh simulation robot that could reproduce the trajectory of human movement. We trained the simulation robot to walk with the tested HDPs using an adaptive neural network (ANN) control method. The ANN method was proposed to solve the unstable motion and large trajectory tracking error when the simulation robot was disturbed by the tested HDPs. The gait kinematic and kinetic data were collected to analyze the performance of the tested HDPs. The GSE system provided a stable test environment that opens up new possibilities for the HDPs test under controlled conditions. Note to Practitioners-Most of the prosthetic tests are based on amputees, especially hip disarticulation prostheses (HDPs). This work provides a gait simulation and evaluation system based on the quantified evaluation, which can repeatedly test the prostheses. The testing system improves the efficiency of the development of HDPs and decreases the security of the test with hip amputees. Furthermore, the system has backward compatibility for other lower limb prostheses (prosthetic knee and ankle).

Design and optimization of a hip disarticulation prosthesis using the remote center of motion mechanism.

Hip disarticulation prostheses (HDPs) are not routinely seen in clinical practice, and traditional hip prostheses rotate around an axis at the front side of the pelvic socket. This study proposes a mechanism to restore the rotation center to the acetabulum of the amputated side and uses comparative experiments with traditional HDP to verify the validity of the novel design. A double parallelogram design of HDP based on a remote center of motion (RCM) mechanism was presented in this paper. Optimization was achieved by a genetic algorithm with the maximal integral size and minimal driving force of the mechanism. The prototype was developed by final optimal results and tested by a hip disarticulated amputee. Testing results revealed that the RCM-HDP improved the range of motion of the hip prosthesis by 78%. The maximal flexion of the assorted prosthetic knee was closer to the sound side than a traditional HDP by 15%. The proposed RCM-HDP promoted the kinematic performance and symmetry of the hip prosthesis compared to the traditional design.

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.

Achievement of developmental walking by a hip disarticulation prosthesis in infancy

Achievement of developmental walking by a hip disarticulation prosthesis in infancy

Management of a Massive Stage IV Sacral Decubitus Ulcer With Anterior Flap Hip Disarticulation and Myocutaneous Gastrocnemius Fillet Flap In-Continuity

Severe sacral decubitus ulcers represent a common and often recalcitrant clinical problem in paralyzed or bedridden patients and require treatment strategies ranging from specialty beds and local wound care to aggressive debridement and local or free tissue flap coverage. This article presents the case of a young soldier who sustained severe injuries as a result of an improvised explosive device blast, including bilateral sciatic nerve injuries, sacrogluteal degloving, and severe left acetabular and femoral head fractures. The patient subsequently developed a recalcitrant stage IV sacral decubitus ulcer, left acetabular protrusio with minimal left lower extremity function, and ankylosis of the posterior right hip due to heterotopic ossification. A novel left anterior (quadriceps-based) hip disarticulation was performed with a double gastrocnemius myocutaneous fillet flap in-continuity. The procedure was successful in providing robust, partially sensate soft tissue coverage for the decubitus ulcer, permitting removal of the bridging posterior heterotopic ossification of the right hip, and removing the left hip for which reconstructive options were limited due to the absence of superior and inferior gluteal nerve function. The patient healed uneventfully and was subsequently able to resume unrestricted positioning for sitting and wheelchair mobilization and became a limited ambulator with a hip disarticulation prosthesis and contralateral ankle-foot orthosis.

動力股義足遊脚期制御器の開発と実験評価(機械力学,計測,自動制御)

動力股義足遊脚期制御器の開発と実験評価(機械力学,計測,自動制御)

1E4-3 股関節とひざ関節を駆動可能な股義足における遊脚期制御システムの開発(福祉介護のロボティクス・メカトロニクス,一般講演)

In this paper, a powered hip-disarticulation prosthesis, which can rotate the hip and knee joint with electric motors, is proposed. The prosthesis has a mechanical hip point axis positioning closer to an anatomical skeletal axis of hip joint on sagittal plane. About an evaluation of swing motion controller for the prosthesis, two kinds of maneuvering strategies are experimented by three hip-disarticulation prosthesis users. The first strategy is referring able-side leg swing motion and realizing the motion on the prosthesis, which is adequate for stable walking. And the second strategy is reading the angular speed of able-side standing leg and reflecting to the swing motion of the prosthesis instantly, which is adequate for transitional walking. These strategies are successfully functioned. Comparing subjects' pelvis pitching motion of the conventional hip-disarticulation prosthesis and our proposed prosthesis, it is shown that pelvis pitching is decreased more than 20% with our proposed.

ソケット側面に股継手回転軸を設けた股義足の機能評価

ソケット側面に股継手回転軸を設けた股義足の機能評価

Development of hip disarticulation prostheses using a simulator based on neuro-musculo-skeletal human walking model

Development of hip disarticulation prostheses using a simulator based on neuro-musculo-skeletal human walking model

3D2-05 股継手回転中心を解剖学的股関節中心に近付けた股義足の評価 : 正常歩行およびこれまでの股義足歩行との比較(OS 四肢機能およびその支援)

3D2-05 股継手回転中心を解剖学的股関節中心に近付けた股義足の評価 : 正常歩行およびこれまでの股義足歩行との比較(OS 四肢機能およびその支援)

1A2-14 股継手回転中心を解剖学的股関節中心に近付けた股義足の開発とその初期評価(講演,義足・装具)

1A2-14 股継手回転中心を解剖学的股関節中心に近付けた股義足の開発とその初期評価(講演,義足・装具)

Energy expenditure during walking in amputees after disarticulation of the hip

We have compared the energy expenditure during walking in three patients, aged between 51 and 55 years, with unilateral disarticulation of the hip when using the mechanical-controlled stance-phase control knee (Otto Bock 3R15) and the microprocessor-controlled pneumatic swing-phase control knee (Intelligent Prosthesis, IP). All had an endoskeletal hip disarticulation prosthesis with an Otto Bock 7E7 hip and a single-axis foot. The energy expenditure was measured when walking at speeds of 30, 50, and 70 m/min. Two patients showed a decreased uptake of oxygen (energy expenditure per unit time, ml/kg/min) of between 10.3% and 39.6% when using the IP compared with the Otto Bock 3R15 at the same speeds. One did not show any significant difference in the uptake of oxygen at 30 m/min, but at 50 and 70 m/min, a decrease in uptake of between 10.5% and 11.6% was found when using the IP. The use of the IP decreased the energy expenditure of walking in these patients.

股義足歩行シミュレーションによる股継手抵抗特性の最適化

This paper describes the optimization of hip joint characteristics of a hip disarticulation prosthesis. We attempted to optimize the characteristics for improved ability to walk using our passive walking model, which can walk by utilizing mechanical properties of rigid body segments and joint resistance.In order to understand how the hip disarticulation prosthesis gait is performed, we interviewed two hip disarticulation prosthesis users. The interviews showed that practical gait in daily life is different from the gait at a training stage. These two types of gaits were named “practical gait” and “training gait.” Users indicated that the training gait velocity was slower than that of the practical gait. Moreover, in the practical gait the heel contact on the prosthesis side was more natural in comparison with the training gait.Gait measurements showed that the lumbar angle pattern has rapid extension and lateral bending involving the swing prosthesis in training gait. Step length on the sound side is in agreement despite the different types of gait. In practical gait, step length on the sound side agrees with that on the prosthesis side. Gait velocity in practical gait compared with training gait was 28% faster with subject 1 and 7% faster with subject 2. Therefore, practical gait has an improved gait velocity by swinging the prosthesis, as step length on each side is the same. Motion of prosthesis is achieved not by sound lower extremities but by lumbar flexion, extension, and lateral bending. Furthermore, practical gait reduces lumbar motion as much as possible, and reduces muscle force around the lumbar area.We developed a passive swing model by applying the above characteristics. This model is composed of eight rigid segments: upper torso, pelvis, upper extremities, thigh, shank-foot. Each joint has passive resistance by ligament. The sound hip and lumbar joint have active moments by muscle, which were obtained from measurement. The objective function for practical gait is defined by the following parameters: (1) difference of each step length, (2) amplitude of active moments, (3) difference of cycles between gait patterns and active moments. As these parameters are minimized, postures of segments, translational velocity, angular velocities and cycle, and amplitude of active moment are recorded. In comparison of subjects, calculated motion patterns on the prosthesis side were well in agreement, so this model is available to estimate hip joint characteristics.When this model simulates a condition of the current hip elastic characteristic weakened by half, the gait velocity is 6% faster and amplitude of lumbar lateral bending moment is reduced 26%. For this reason, weakening current elastic characteristics around the hip joint can easily control the swing of the prosthesis. As a result, adjustment of the hip elastic characteristic can improve the walk capability.

Practical use of the hip disarticulation prosthesis in 3 patients of malignant tumor of the lower limb

Practical use of the hip disarticulation prosthesis in 3 patients of malignant tumor of the lower limb