Are Gait Parameters for Through-knee Amputees Different From Matched Transfemoral Amputees?

Abstract

Background Through-knee amputation is a common amputation level after battlefield injuries during the medical evacuation process. However, there are limited data comparing through-knee amputation with transfemoral amputation as a definitive amputation level in terms of gait parameters. Questions/purposes (1) Does through-knee amputation result in improved gait velocity when compared with matched transfemoral amputees? (2) Do through-knee amputees have a faster gait cadence than matched transfemoral amputees? (3) Do through-knee amputees have a different stride length or stride width than matched transfemoral amputees? (4) Does through-knee amputation result in decreased work of ambulation when compared with matched transfemoral amputees? Methods Between January 2008 and December 2012, six male active-duty military patients who had undergone unilateral through-knee amputations as a result of trauma underwent gait studies at our institution. Of those, four of six underwent gait analysis after being able to walk for at least 3 months without assistive devices, and this group was studied here. Most through-knee amputees who were not included had elective revisions of their amputations from through-knee to a transfemoral amputation before completing 3-month gait data. Each of the amputees studied was matched to a transfemoral amputee based on height, body mass index, and contralateral amputation level resulting in a case-control study of active-duty Each author certifies that neither he or she, nor any member of his or her immediate family, has funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use. Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

Knee Disarticulation Versus Transfemoral Amputation: The Prosthetist's Perspective

“…In addition, the added length of the residual limb restricts the type of prosthetic components used, possibly resulting in inferior knee and/or feet components that can lead to patient and prosthetist dissatisfaction. 6 Contemporary socket designs for KD versus TFA have notable differences. Weight-bearing in the KD socket is shared among the distal end with global circumferential loading of the soft tissue of the residual limb.…”

“…They concluded that because outcomes were very similar, an amputation at the most distal level possible should be performed to maximize the residual limb's lever arm. In a similar study, Schuett et al 6 looked at active military service members with combat-related KD and matched them to similarly sized service members with a TFA and found no difference in gait velocity, cadence, stride length, or work of ambulation. Although there seemed to be no functional difference between amputation levels, 2 (33%) of the 6 patients with KD identified in the study underwent revision to TFA for difficulties related to knee axis asymmetry, highlighting the potential issues with the KD amputation level.…”

“…[1][2][3][4][5] With advancements in prosthetic components, the limitations of both levels of amputations have greatly improved with recent studies, demonstrating no appreciable difference in patient-reported outcomes or walking speeds between patients with KD and TFA. 3,6 As prosthetists work closely with amputees striving to maximize functional independence and prosthesis use, they are intimately familiar with the struggles involved with both levels of amputations. The purpose of this study was to survey a broad group of prosthetists on their experience with amputees with KD and TFA to determine their preference of amputation level, opinions on patient preference, and common problematic issues to guide decision-making for patients and surgeons faced with the decision of a high-level lowerextremity amputation.…”

“…With advancements in prosthetic components, the limitations of both levels of amputations have greatly improved with recent studies, demonstrating no appreciable difference in patient-reported outcomes or walking speeds between patients with KD and TFA. 3,6…”

Through-knee versus above-knee amputation for vascular and non-vascular major lower limb amputations

“…The ability to mobilise with a prosthesis has a direct impact on a person's QoL (Agrawal 2017; Davie-Smith 2017). People with through-knee amputation theoretically have gait biomechanical benefits, though some of these are potentially mitigated by the shorter lower leg segment, limited prosthetic knee joint options, and lack of prosthetist experience (Schuett 2018;Smith 2004). Recent global vascular guidelines for the management of chronic limbthreatening ischaemia set a research priority to determine whether the primary healing rates, postoperative mobility and prosthetic use, and quality of life data justify through-knee amputation rather than above-knee amputation (Conte 2019).…”