Gait characteristics of transtibial amputees on level ground in a cohort of 53 amputees - Comparison of kinetics and kinematics with non-amputees

Abstract

STUDY DESIGN: Retrospective analysis BACKGROUND: The gait characteristics of transtibial amputees (TTs) have been described many times. In general, the literature reported nearly consistent results for the kinematic and kinetic parameters of the prosthetic side. However, the literature revealed inconsistent findings on kinetic parameters for determining the risk of developing knee osteoarthritis, such as the peak knee adduction moment, knee flexion moment and vertical ground reaction forces. OBJECTIVES: The objective of our study was to describe the sagittal kinetic and kinematic gait characteristics of the ankle and residual knee joint of the prosthetic limb and the knee loading parameters of the sound side of unilateral TTs. This specific consideration may contribute to resolving the controversy of these parameters in the literature. METHODS: We analysed our database containing gait analyses from 53 unilateral TTs and compared data to a control group (CG), also taken from our database. The sagittal kinetic and kinematic gait characteristics of the ankle and residual knee joint of the prosthetic limb, and selected knee loading parameters of the sound side (the peak knee adduction moment, knee flexion moment and vertical ground reaction forces) were evaluated. Beside these parameters we reported typical spatiotemporal gait parameters as gait velocity, step length, step length asymmetry, stance phase duration and asymmetry of stance phase duration. RESULTS: The TTs walked slower and more asymmetrically than the CG. The kinematic pattern of the prosthetic ankle differed from that found in the CG. The largest difference was observed for the range of motion of the plantarflexion at push-off, which was significantly reduced for the prosthetic foot. The residual knee joint was generally affected with respect to decreased moments and reduced knee flexion during stance phase. The peaks of the vertical ground reaction forces and knee adduction moments showed no differences between the sound side of amputees and the CG. The peak knee flexion moment at midstance was significantly reduced for the sound side of amputees in comparison with the CG. CONCLUSION: The biomechanical data measured for the prosthetic side in a cohort of 53 unilateral TT amputees conformed with the literature. The parameters determining the risk of developing knee osteoarthritis investigated in our retrospective analysis were not increased on the sound side in comparison with non-amputees. We deem it reasonable to assume that an appropriate prosthesis will reduce the likelihood of overloading the knee on the sound side during normal walking. LAYMAN’S ABSTRACT: The gait characteristics of a transtibial amputee (TT) with a prosthesis significantly deviate from normal gait patterns as shown in the literature. In general, the kinematic and kinetic parameters of the prosthetic side are described nearly consistently. However, literature revealed inconsistent results with respect to the sound side, specifically the parameters determining the risk of developing knee osteoarthritis. To resolve this controversy in the literature, an analysis of a large cohort seems necessary. Therefore, we analysed gait characteristics of TTs from our gait lab database and compared them to able-bodied individuals (CG). The results showed that the TTs walked slower and more asymmetrically than the CG. The movement pattern of the prosthetic ankle differed from that found in the CG. The residual knee joint was is affected with respect to decreased moments and reduced knee flexion during stance phase. The peaks of the vertical ground reaction forces and knee adduction moments showed no differences between the sound side of amputees and the CG. The peak knee flexion moment was significantly reduced for the sound side of amputees in comparison with the CG. The biomechanical data measured for the prosthetic side concurred with findings of other studies. The controversially discussed parameters determining the risk of developing knee osteoarthritis were not increased on the sound side in comparison with non-amputees. We deem it reasonable to assume that an appropriate prosthesis will reduce the likelihood of overloading the knee on the sound side during normal walking. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32955/25788 How to Cite: Pröbsting E, Bellmann M, Schmalz T, Hahn A. Gait characteristics of transtibial amputees on level ground in a cohort of 53 amputees - comparison of kinetics and kinematics with non-amputees. Canadian Prosthetics & Orthotics Journal. 2019;Volume2, Issue2, No.1. https://doi.org/10.33137/cpoj.v2i2.32955. CORRESPONDING AUTHOR:Dipl.-Ing (FH) Eva Pröbsting, Clinical Research & Services / Biomechanics, Ottobock SE & Co. KGaA, Hermann-Rein-Straße 2a, 37075 Göttingen, Germany.ORCID: https://orcid.org/0000-0002-6349-2992E-MAIL: Eva.Proebsting@ottobock.de