Transfemoral Amputation Research Articles

Racial disparities in prosthesis abandonment and mobility outcomes after lower limb amputation from a dysvascular etiology in a veteran population.

Non-Hispanic Black (NHB) individuals have higher rates of amputation and increased risk of a transfemoral amputation due to dysvascular disease than non-Hispanic White (NHW) individuals. However, it is unclear if NHB individuals have differences in prosthesis use or functional outcomes following an amputation. To determine if there are racial disparities in prosthesis abandonment and mobility outcomes in veterans who have undergone their first major unilateral lower extremity amputation (LEA) due to diabetes and/or peripheral artery disease. National cohort study that identified individuals retrospectively through the Veterans Affairs (VA) Corporate Data Warehouse (CDW) from March 1, 2018, to November 30, 2020, then prospectively collected their self-reported prosthesis abandonment and mobility. Multiple logistic regression was used to control for potential confounders and identify potential effect modifiers. The VA CDW, participant mailings and phone calls. Three hundred fifty-seven individuals who underwent an incident transtibial or transfemoral amputation due to diabetes and/or peripheral arterial disease. Not applicable. (1) Self-reported prosthesis abandonment. (2) Level of mobility assessed using the Locomotor Capabilities Index. Rurally located NHB individuals without a major depressive disorder (MDD) had increased odds of abandoning their prosthesis (adjusted odds ratios [aOR] = 5.3; 95% confidence interval [CI]: [1.3-21.1]). This disparity was nearly three times as large for rurally located NHB individuals with MDD diagnosis, compared with other races from rural areas and with MDD (aOR = 15.8; 95% CI, 2.5-97.6). NHB individuals living in an urban area were significantly less likely to achieve advanced mobility, both with MDD (aOR=0.16; 95% CI: [0.04-7.0]) and without MDD (aOR = 0.26; 95% CI: [0.09-0.73]). This study demonstrated that health care disparities persist for NHB veterans following a dysvascular LEA, with increased prosthesis abandonment and worse mobility outcomes.

Robotic-Enhanced Prosthetic Liners for Vibration Therapy: Reducing Phantom Limb Pain in Transfemoral Amputees.

Phantom limb pain, a common challenge for amputees, lacks effective treatment options. Vibration therapy is a promising non-pharmacologic intervention for reducing pain intensity, but its efficacy in alleviating phantom limb pain requires further investigation. This study focused on developing prosthesis liners with integrated vibration motors to administer vibration therapy for phantom limb pain. The prototypes developed for this study addressed previous issues with wiring the electronic components. Two transfemoral amputees participated in a four-week at-home trial, during which they used the vibration liner and rated their initial and final pain intensity on a numeric rating scale each time they had phantom pain. Semi-structured interviews were conducted to gather feedback following the at-home trial. Both participants described relaxing and soothing sensations in their residual limb and phantom limb while using vibration therapy. One participant reported a relaxation of his phantom limb sensations, while both participants noted a decrease in the intensity of their phantom limb pain. Participants said the vibration liners were comfortable but suggested that the vibration could be stronger and that aligning the contacts could be easier. The results of this study highlight the potential effectiveness of using vibration therapy to reduce the intensity of phantom limb pain and suggest a vibration liner may be a feasible mode of administering the therapy. Future research should address optimizing the performance of the vibration liners to maximize their therapeutic benefits.

Validation of IMU against optical reference and development of open-source pipeline: proof of concept case report in a participant with transfemoral amputation fitted with a Percutaneous Osseointegrated Implant

BackgroundSystems that capture motion under laboratory conditions limit validity in real-world environments. Mobile motion capture solutions such as Inertial Measurement Units (IMUs) can progress our understanding of "real" human movement. IMU data must be validated in each application to interpret with clinical applicability; this is particularly true for diverse populations. Our IMU analysis method builds on the OpenSim IMU Inverse Kinematics toolkit integrating the Versatile Quaternion-based Filter and incorporates realistic constraints to the underlying biomechanical model. We validate our processing method against the reference standard optical motion capture in a case report with participants with transfemoral amputation fitted with a Percutaneous Osseointegrated Implant (POI) and without amputation walking over level ground. We hypothesis that by using this novel pipeline, we can validate IMU motion capture data, to a clinically acceptable degree.ResultsAverage RMSE (across all joints) between the two systems from the participant with a unilateral transfemoral amputation (TFA) on the amputated and the intact sides were 2.35° (IQR = 1.45°) and 3.59° (IQR = 2.00°) respectively. Equivalent results in the non-amputated participant were 2.26° (IQR = 1.08°). Joint level average RMSE between the two systems from the TFA ranged from 1.66° to 3.82° and from 1.21° to 5.46° in the non-amputated participant. In plane average RMSE between the two systems from the TFA ranged from 2.17° (coronal) to 3.91° (sagittal) and from 1.96° (transverse) to 2.32° (sagittal) in the non-amputated participant. Coefficients of Multiple Correlation (CMC) results between the two systems in the TFA ranged from 0.74 to > 0.99 and from 0.72 to > 0.99 in the non-amputated participant and resulted in ‘excellent’ similarity in each data set average, in every plane and at all joint levels. Normalized RMSE between the two systems from the TFA ranged from 3.40% (knee level) to 54.54% (pelvis level) and from 2.18% to 36.01% in the non-amputated participant.ConclusionsWe offer a modular processing pipeline that enables the addition of extra layers, facilitates changes to the underlying biomechanical model, and can accept raw IMU data from any vendor. We successfully validate the pipeline using data, for the first time, from a TFA participant using a POI and have proved our hypothesis.

FHIR-standardized data collection on the clinical rehabilitation pathway of trans-femoral amputation patients

Lower limb amputation is a medical intervention which causes motor disability and may compromise quality of life. Several factors determine patients’ health outcomes, including an appropriate prosthetic provision and an effective rehabilitation program, necessitating a thorough quantitative observation through different data sources. In this context, the role of interoperability becomes essential, facilitating the reuse of real-world data through the provision of structured and easily accessible databases. This study introduces a comprehensive 10-year dataset encompassing clinical features, mobility measurements, and prosthetic knees of 1006 trans-femoral amputees during 1962 hospital stays for rehabilitation. The dataset is made available in both comma-separated values (CSV) format and HL7 Fast Healthcare Interoperability Resources (FHIR)-based representation, ensuring broad utility and compatibility for researchers and healthcare practitioners. This initiative contributes to advancing community understanding of post-amputation rehabilitation and underscores the significance of interoperability in promoting seamless data sharing for meaningful insights into healthcare outcomes.

Identifying discriminant factors between phantom limb pain, residual limb pain, and both in people with lower limb amputations: a cross-sectional study.

Postamputation pain is a common condition in patients with lower limb amputation (LLA), which compromises amputees' rehabilitation, use of the prosthesis, and quality of life. The aim of our study was to investigate the prevalence of phantom limb pain (PLP), residual limb pain (RLP), or both types of pain among individuals with LLA, and to identify the factors associated with the presence of one type of pain versus the other. Patients who underwent amputation for traumatic or vascular reasons and who reported on RLP or PLP were analyzed and divided into three groups: PLP, RLP, or a group of subjects that presented both pains. We searched for factors that affect the occurrence of limb pain using univariate analyses, followed by multinomial logistic regression. Among the 282 participants with transtibial and transfemoral amputations, 192 participants (150 male and 42 female) presented PLP, RLP, or both types of pain, while 90 participants declared to perceive no pain. The estimated prevalence of any type of pain after transfemoral and transtibial amputation was therefore 68% (27% PLP, 10% RLP, and 31% both). Among the studied characteristics, only amputation level was associated with the type of pain ( P = 0.001). Multinomial logistic regression identified transfemoral amputation as the only statistically significant predictor for PLP (odds ratio = 2.8; P = 0.002). Hence, it was estimated that individuals with transfemoral amputation have nearly three times higher odds of experiencing PLP compared with those with transtibial amputation.

Importance of Bilateral Hip Assessments in Unilateral Lower-Limb Amputees: A Retrospective Review Involving Older Veterans.

Background/Objectives: This study aimed to evaluate bone mineral density (BMD) discordance and its implications in veterans with unilateral lower-limb amputation, emphasizing the need for comprehensive hip assessments. Methods: Data were collected from 84 male veterans, and BMD was measured using dual-energy X-ray absorptiometry (DXA) at the lumbar spine, intact hip, and amputated hip. Results: The T-scores for the lumbar spine, intact hip, and amputated hip were -0.27 ± 1.69, -0.25 ± 1.20, and -1.07 ± 1.33, respectively. Osteoporosis and osteopenia were present in 19% and 34.6% of patients, respectively. Osteopenia and osteoporosis were most prevalent in the hips on the amputated side (32.1% and 13.1%, respectively), followed by the lumbar spines (22.6% and 8.3%) and the hips on the intact side (17.9% and 2.4%). BMD discordance between the lumbar spine and hip was found in 47.6% of participants, while discordance between both hips was observed in 39.3%. Transfemoral amputees had significantly lower BMD at the amputated hip compared to transtibial amputees (-2.38 ± 1.72 vs. -0.87 ± 1.16, p < 0.001). Conclusions: Veterans with unilateral lower-limb amputation exhibit a high prevalence of osteoporosis and significant BMD discordance, particularly between both hips. These findings underscore the necessity for bilateral hip assessments to ensure the accurate diagnosis and effective management of osteoporosis in this population.

The immediate effect of thoracolumbar fascia taping on biomechanical properties, low back pain and balance in individuals with transfemoral amputation.

In individuals with transfemoral amputation (TFA), adaptations caused by prosthesis use may adversely affect contractile/noncontractile structures. To investigate the immediate effect of the thoracolumbar fascia (TLF) kinesiology taping (KT) on the tone and stiffness of the fascia, low back pain (LBP) and standing balance in individuals with TFA. Syrian male participants with TFA were enrolled in the prospective, single-blind, randomised controlled trial. Participants were divided into two groups: Experimental (EG with KT, n= 15) and Control (CG with sham KT, n= 14). A 6-minute walk test (6MWT) was performed, after which KT was applied. Measurements were taken at baseline, immediately after the 6MWT and 30minutes after KT. Although pain decreased below baseline in both groups at 30minutes post intervention (p< 0.001), the rate of pain reduction was significantly higher in the EG (p= 0.016). Anterior-posterior sway with eyes open improved significantly 30minutes after KT application only in the EG (p= 0.010). In the eyes closed condition, anterior-posterior and medio-lateral sway decreased significantly compared to baseline 30minutes after taping in the EG (p= 0.010-0.032). KT can be used as an effective method to support standing balance and reduce LBP in individuals with TFA.

EFFECTS OF SHORT-TERM PRACTICE OF FAST DEEP BREATHING EXERCISE ON PARASYMPATHETIC FUNCTIONS IN TRANS-FEMORAL AND TRANS-TIBIAL-AMPUTATION PATIENTS

Background of the Study: After lower limb amputation, the functioning parasympathetic system is compromised so the regular practice of breathing techniques improves cardiorespiratory functions. To determine the effects of short-term fast-breathing exercises on parasympathetic functions in amputees. Methodology: The study was conducted at the Armed Forces Institute of Rehabilitation Medicine Rawalpindi, on 61 stable transfemoral and transtibial amputation patients within the duration of six months (January to June 2017), performed fast deep breathing exercises Parasympathetic functions were observed through different variables. Data was analyzed using IBM® SPSS® v 21. Results: Breathing exercises showed significant effects on HR with a p-value of (0.000), the Valsalva ratio had a p-value of (0.000), and oxygen saturation was improved in both control and experimental groups with p-values of (0.000) and (0.000). Valsalva’s BP systolic and diastolic p values were (0.001) (0.012), breathing exercise BP systolic and diastolic values were (0.16) and (0.000), and orthostatic testing BP systolic and diastolic p values were (0.134) and (0.389). Post Borg scale readings showed a significant decrease in exertion level Conclusion: The study concludes that short-term fast deep breathing exercise improves cardiovagal functioning.

COMPARATIVE ASSESSMENT OF FUNCTIONAL ABILITY AND QUALITY OF LIFE IN LOWER LIMB AMPUTEES WITH PROSTHETICS IN CHILDREN, ADOLESCENTS AND ADULTS

Background of the Study: Physical activity and exercise part of maintaining good health. Its benefits are associated with improved life quality in the physical, psychological, and social sectors. Physical exercise is therefore essential to the recovery of amputees. A person’s quality of life might suffer when a limb is amputated. The quality of life for amputees in order to improve health, though, is little understood. The primary objective of this study was to look into the quality of life and physical activity of male adults and adolescents who had lower limb prosthesis. Methodology: Lower-limb amputees participated in the cross-sectional, descriptive study. investigation.72 Adolescents (5-17 years) and male adults (18-40 years) with unilateral transtibial and transfemoral amputees participated. The World Health Organization Quality of Life scale (WHOQOL) self-administration questionnaire was used to evaluate quality of life. Whereas, to check lower extremity conditions in the participants, The Lower Extremity functionality Scale was used. Results: Low Extremity Functions had significant positive relationship with overall Quality of Life with mean 32.45±9.44 and the strength of the correlation was .24*. Moreover, components of Quality-of-Life Environmental Health and Physical Health shows significant positive relationship with Lower Extremity Functions. Physical Health and Social Relationship showed non-significant correlation with lower Extremity Function. Conclusion: It was concluded that the age group differences were not significant with the Quality of Life, Physical health, Psychological health, social relationship and environmental health. However, the results showed that the quality of life and the lower extremity functional scale had a positive relationship. If the QOL of the individual increases that LEFS also increases. The social relationships and the psychological health do not correlate with the lower extremity functions but, the physical health and the environmental health has a significant impact on it.

Evaluating the Prognostic Accuracy of AMPREDICT in Predicting 1-Year Mortality Following Major Lower Limb Amputation

Accurately predicting postoperative outcomes is fundamental to informed clinical decision making, and alignment of patient, and family expectations. The AMPREDICT Decision Support Tool is a predictive tool designed to assess the probability of mortality one year after major and minor amputations. We aimed to evaluate the prognostic accuracy of AMPREDICT in our Veteran patient population. Retrospective review of lower extremity amputations completed at the West Los Angeles Veterans Affairs hospital from 2000 to 2020. Staged open amputations, and previous minor amputations were excluded. Using the AMPREDICT tool, the probability of mortality one-year post-surgery for single stage transfemoral and transtibial amputations was calculated, then compared with observed patient outcomes. Observed to predicted mortality was compared through boxplots, at one year after surgery, confidence intervals were calculated, and group means were compared using Students T-test. Receiver operator curves were constructed to assess discriminatory capacity of the tool. Significance was set at p < 0.05. 423 patients underwent 650 lower extremity amputations during our study period. 267 patients underwent single stage transfemoral or transtibial amputations comprising our study cohort. The average age at amputation was 66 years with an average age of death at 71 years. AMPREDICT tool's prognostic capability varied across the two amputations studied. For single staged transfemoral amputations, prediction aligned closely with observed outcomes, as indicated by a significant p-value of 0.0002 (C.I. 12.73 - 36.37). For single stage transtibial amputations, the predictions were also significant, p-value 0.0017 (C.I. 5.25 - 21.20), though had a wider prediction range. Our study confirms the reliability of the AMPREDICT tool in predicting one-year mortality for patients undergoing major lower limb amputations. The predictive accuracy was found to be statistically significant for both single staged transfemoral and transtibial amputations. These findings suggest that AMPREDICT may be a valuable tool in the clinical setting for patients undergoing major lower limb amputation.

Trombose e amputação na COVID-19 aguda: um relato de caso

During the outbreak of COVID-19, it has been discovered that the infection was associated to increased risk of venous or arterial thromboembolic events and many other dysfunctions in various systems of human body. In relation to thrombosis, in molecular/cellular levels numerous signaling pathways due to dysregulated RAAS may contribute to the observed coagulopathy in COVID-19. On the other hand, excessive innate immune response to SARS-CoV2 for which there is no prior acquired immunity mediates various pathways that may lead to thrombosis. Case report: This case report analyzes those hematologic disfunctions in a patient affected for a post COVID-19 conditions associated to a long-term hospitalization resulting in a bunch of sequels. We emphasized the transfemoral amputation was due to proximal arterial thrombosis and the functional loss related to it. We aborted the whole rehabilitation plan and its implementation since the beginning of the process of dehospitalization. We describe the role of each professional of the multi-professional team, the pharmacologic and non-pharmacologic treatment, the assistive technologies applied, the other sequels related to post COVID-19 conditions and long-term hospitalization and their functional gains. We used the Functional Independence Measure (MIF) to do the follow up of the case, 84 to 96. As results of the therapeutic program, the patient could achieve a high grade of modified independence for activities of daily living (ADLS) and Instrumental activities of daily living. Conclusion: Thrombosis and amputations are complications in COVID-19 patients. The absence of a multidisciplinary program of rehabilitation will cause to the patient an increasing risk of development of psychologic affections and great impact of their social life.

Mortality after major lower extremity amputation and association with index level: a cohort study based on 11,205 first-time amputations from nationwide Danish databases.

Mortality after major lower extremity amputations is high and may depend on amputation level. We aimed to examine the mortality risk in the first year after major lower extremity amputation divided into transtibial and transfemoral amputations. This observational cohort study used data from the Danish Nationwide Health registers. 11,205 first-time major lower extremity amputations were included from January 1, 2010, to December 31, 2021, comprising 3,921 transtibial amputations and 7,284 transfemoral amputations. The 30-day mortality after transtibial amputation was overall 11%, 95% confidence interval (CI) 10-12 (440/3,921) during the study period, but declined from 10%, CI 7-13 (37/381) in 2010 to 7%, CI 4-11 (15/220) in 2021. The 1-year mortality was 29% overall, CI 28-30 (1,140 /3,921), with a decline from 31%, CI 21-36 (117/381) to 20%, CI 15-26 (45/220) during the study period. For initial transfemoral amputation, the 30-day mortality was overall 23%, CI 22-23 (1,673/7,284) and declined from 27%, CI 23-31 (138/509) to 22%, CI 19-25 (148/683) during the study period. The 1-year mortality was 48% overall, CI 46-49 (3,466/7,284) and declined from 55%, CI 50-59 (279/509) to 46%, CI 42-50 (315/638). The mortality after major lower extremity amputation declined in the 12-year study period; however, the 1-year mortality remained high after both transtibial and transfemoral amputations (20% and 46% in 2021). Hence, major lower extremity amputation patients constitute one of the most fragile orthopedic patient groups, emphasizing an increased need for attention in the pre-, peri-, and postoperative setting.

Bone mineral density in osseointegration implant surgery: A review of current studies (Review).

Osseointegration implant (OI) surgery is the latest rehabilitation technology for amputees, where a bone-anchored implant obviates the limitations of traditional socket prostheses. The bone mineral density (BMD) in the periprosthetic and other anatomical regions can be used to assess bone remodelling following OI surgery. Currently, limited studies have used BMD measurements in reporting post-operative OI outcomes and the association between the maintenance of BMD and implant efficacy has remained elusive. This review captured and analysed all studies that have reported the BMD as an objective outcome measure in patients with trans-femoral or trans-tibial OI. The PubMed, Medline, Scopus and Web of Science databases were searched using the terms 'amputation', 'osseointegration' and 'bone mineral density'. A total of 6 studies involving human participants were included for analysis. All studies used dual X-ray absorptiometry and/or X-rays for measuring BMD. Rehabilitation of trans-femoral or trans-tibial amputation using OI may help restore healthy BMD by enabling physiological bone loading. However, there is a low correlation between the BMD around the OI and the success of OI surgery or the risk of periprosthetic fractures. This review summarises the current evidence on BMD assessment in OI for lower limb amputee rehabilitation. Despite the great variability in the results, the available evidence suggests that OI may help restore BMD following surgery. The limited evidence calls for further investigation, as well as the development of a standard BMD measurement protocol.

A Rare Case of Primary Sarcoma Arising Within Free Muscle Transfer

AbstractSoft tissue sarcomas are one of the rarest forms of cancer. We describe a unique case of a 35-year-old patient who sustained an open lower limb fracture requiring an intramedullary nail and free latissimus dorsi (LD) muscle flap reconstruction. He had a complex postoperative course including osteomyelitis, a refracture, and chronic pain. Eleven years following the injury, he presented with pain and localized swelling around the flap. Histological analysis confirmed a rhabdomyosarcoma within the LD muscle and he underwent a transfemoral amputation. He is now in remission and walks on a prosthesis pain-free.

Dynamic gait stability and stability symmetry for people with transfemoral amputation: A case-series of 19 individuals with bone-anchored limbs

For some individuals with severe socket-related problems, prosthesis osseointegration directly connects a prosthesis to the residual limb creating a bone-anchored limb (BAL). We compared dynamic gait stability and between-limb stability symmetry, as measured by the Margin of Stability (MoS) and the Normalized Symmetry Index (NSI), for people with unilateral transfemoral amputation before and one-year after BAL implantation. The MoS provides a mechanical construct to assess dynamic gait stability and infer center of mass and limb control by relating the center of mass and velocity to the base of support. Before and one-year after BAL implantation, 19 participants walked overground at self-selected speeds. We quantified dynamic gait stability anteriorly and laterally at foot strike and at the minimum lateral MoS value. After implantation, we observed decreased lateral MoS at foot strike for the amputated (MoS mean(SD) %height; pre: 6.6(2.3), post: 5.9(1.3), d = 0.45) and intact limb (pre: 6.2(1.2), post: 5.8(1.0), d = 0.38) and increased between-limb MoS symmetry at foot strike (NSI mean(SD) %; anterior–pre: 10.3(7.3), post: 8.4(3.6), d = 0.23; lateral–pre: 18.8(12.4), post: 12.4(4.9), d = 0.47) and at minimum lateral stability (pre: 28.1(18.1), post: 19.2(6.8), d = 0.50). Center of mass control using a BAL resulted in dynamic gait stability more similar between limbs and may have reduced the adoption of functional asymmetries. We suggest that improved between-limb MoS symmetry after BAL implantation is likely due to subtle changes in individual limb MoS values at self-selected walking speeds resulting in an overall positive impact on fall risk through improved center of mass and prosthetic limb control.

Comparing the lower limb joint biomechanics of the Power Knee, C-Leg and Rheo Knee during ramp and stair ambulation

One of the most significant developments in prosthetic knee technology has been the introduction of the Microprocessor-Controlled Prosthetic Knee (MPK). However, there is a lack of consensus over how different types of MPKs affect performance in different ambulation modes. In this study, we investigated the biomechanical differences in ramp and stair maneuvers when an individual with transfemoral amputation wears three commercial MPKs: the Össur Power Knee, the Össur Rheo Knee and the Ottobock C-Leg 4. The primary outcome variable for this study was the lower limb biological joint work, inclusive of the intact leg and prosthetic side hip. We hypothesized that (1) the Power Knee would result in lower biological work during ascent activities than the C-Leg and Rheo, both passive MPKs, and (2) the C-Leg and Rheo would result in lower biological work during descent activities than the Power Knee. During ramp ascent, the C-Leg was associated with lower biological joint work (p < 0.05) than the Power Knee. However, this relationship did not hold during stair ascent, where the Power Knee showed advantages for stair ascent with net reductions in biological joint work of 14.1% and 23.3% compared to the Rheo and C-leg, respectively. There were no significant differences in biological joint work between the knees during ramp and stair descent, indicating that choice of MPK may not be as important for descent activities. Our results demonstrate that differences are present between different types of MPKs during ascent activities which could prove useful in the prescription of these devices.

Asymmetry of peak plantar pressure in transfemoral amputees during indoor and outdoor walking

This study investigates the differences in peak plantar pressure between the amputated and intact limbs of transfemoral amputees when walking outdoors. Ten non-amputees (aged 24.4 ± 2.0 years, 176.9 ± 2.5 cm, 72.3 ± 7.9 kg) and six transfemoral amputees (48.5 ± 6.3 years, 173.8 ± 4.2 cm, 82.0 ± 11.9 kg) participated in the study. Over approximately 1.6 km, the participants encountered various obstacles, including stairs, uneven surfaces, hills, and level ground, both indoors and outdoors. Throughout the walking session, the peak plantar pressure in both feet was monitored using wearable insole sensors. For all terrains, the percentage asymmetry was determined. Significant changes in peak plantar pressure asymmetry were found between the intact and amputated limbs, particularly when walking on level ground indoors, uneven terrains, descending stairs, and on steep slopes outdoors (all p < 0.05). These findings highlight the greater peak plantar pressure asymmetry in transfemoral amputees when walking outside. In addition, this study revealed that not all terrains contribute uniformly to this asymmetry.

Gait asymmetrical evaluation of lower limb amputees using wearable inertial sensors

This study presents an analysis and evaluation of gait asymmetry (GA) based on the temporal gait parameters identified using a portable gait event detection system, placed on the lateral side of the shank of both lower extremities of the participants. Assessment of GA was carried out with seven control subjects (CS), one transfemoral amputee (TFA) and one transtibial amputee (TTA) while walking at different speeds on overground (OG) and treadmill (TM). Gait cycle duration (GCD), stance phase duration (SPD), swing phase duration (SwPD), and the sub-phases of the gait cycle (GC) such as Loading-Response (LR), Foot-Flat (FF), and Push-Off (PO), Swing-1 (SW-1) and Swing-2 (SW-2) were evaluated. The results revealed that GCD showed less asymmetry as compared to other temporal parameters in both groups. A significant difference (p < 0.05) was observed between the groups for SPD and SwPD with lower limb amputees (LLA) having a longer stance and shorter swing phase for their intact side compared to their amputated side, resulting, large GA for TFA compared to CS and TTA. The findings could potentially contribute towards a better understanding of gait characteristics in LLA and provide a guide in the design and control of lower limb prosthetics/orthotics.

Anesthetic management of a high-risk patient with complex medical conditions: A case report of multimodal analgesia and regional nerve blocks in urgent transfemoral amputation

This case article presents the anesthetic management of a patient with complex medical conditions and surgical requirements. The patient had secondary hyperparathyroidism due to chronic renal failure, resulting in hypocalcemia. The patient required a transfemoral amputation due to progressive bacterial infection and global foot gangrene. The urgency of the operation prevented preoperative preparation and necessitated careful consideration of the patient's cardiovascular and respiratory challenges. Due to the patient's facial deformity and limited neck mobility, general anesthesia was not feasible. Instead, a multimodal analgesia approach was adopted, utilizing regional nerve blocks targeting various nerves involved in lower limb innervation. This approach, combined with sedation, provided effective surgical anesthesia.

Cumulative loading increases and loading asymmetries persist during walking for people with a transfemoral bone-anchored limb

BackgroundA bone-anchored limb (BAL) is an alternative to a traditional socket-type prosthesis for people with transfemoral amputation. Early laboratory-based evidence suggests improvement in joint and limb loading mechanics during walking with a BAL compared to socket prosthesis use. However, changes in cumulative joint and limb loading measures, which may be predictive of degenerative joint disease progression, remain unknown. Research questionDo cumulative total limb and hip joint loading during walking change using a BAL for people with unilateral transfemoral amputation, compared to prior socket prosthesis use? MethodsA case-series cohort of eight participants with prior unilateral transfemoral amputation who underwent BAL hardware implantation surgery were retrospectively analyzed (4 M/4 F; BMI: 27.7 ± 3.1 kg/m2; age: 50.4 ± 10.2 years). Daily step count and whole-body motion capture data were collected before (using socket prosthesis) and one-year after BAL hardware implantation. Cumulative total limb and hip joint loading and between-limb loading symmetry metrics were calculated during overground walking at both time points and compared using Cohen’s d effect sizes. ResultsOne year after BAL hardware implantation, participants demonstrated bilateral increases in cumulative total limb loading (amputated: d = -0.65; intact: d = -0.72) and frontal-plane hip moment (amputated: d = -1.29; intact: d = -1.68). Total limb loading and hip joint loading in all planes remained asymmetric over time, with relative overloading of the intact limb in all variables of interest at the one-year point. SignificanceDespite increases in cumulative total limb and hip joint loading, between-limb loading asymmetries persist. Habitual loading asymmetry has been implicated in contributing to negative long-term joint health and onset or progression of degenerative joint diseases. Improved understanding of methods to address habitual loading asymmetries is needed to optimize rehabilitation and long-term joint health as people with transfemoral amputation increase physical activity when using a BAL.